We read the case report on Vogt Koyanagi Harada Syndrome (VKHS) published recently(1). The Criteria for VKHS as stated by American uveitis society in 1978 include the following(2).
 

1. No history of previous ocular trauma or surgery.

2. Three of the following:

a. Bilateral chronic iridocyclitis.

b. Posterior uveitis as manifested by exudative retinal detachment, disc hyperemia, subretinal macular edema and sunset glow.

c. Neurological signs of tinnitus, neck stiffness, cranial or CNS finding, or CSF pleocytosis.

d. Cutaneous findings, i.e., alopecia, poliosis or vitiligo.

The reported case had neurological and cutaneous manifestations similar to VKHS but ocular involvement, which is essential for the diagnosis of VKHS according to above criteria, is only presumptive. In the absence of an objective ophthalmic examination it is difficult to say whether the patient had iridocyclitis or something else. History of pain, redness and watering may be due to a variety of reasons including phlyctenular conjunctivitis, scleritis and sclero-keratitis. These conditions (also uveitis) have a well known association with tuberculosis and some of them may be self limiting. Iridocyclitis in VKHS is typically chronic, recurrent and is likely to leave behind some stigmata in the form of pigment dispersal in the anterior segment, synechia formation, pigmentary fundus derangement and sometime choroidal neovascular membrane formation. Early and long term systemic corticosteroids and/or other immunosuppressive drugs are needed to control inflammation. It is recommended that the patients should be weaned cautiously from steroids to prevent recurrences(3). Since the eye examination was normal two years after the initial presentation, without any specific treatment, diagnosis of iridocyclitis is at best presumptive. Since the reported patient had tuberculosis, the neurological and ocular symptoms may be due to tuberculosis.
 

Manju Salaria,
Senior Lecturer,
Department of Pediatrics,
Government Medical College,
Chandigarh 160047, India.
S.S. Pandav,
Assistant Professor,
Department of Ophthalmology,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160012, India.
 

1. Malik S, Gupta AK, Joshi SM; Purohit SN, Khopkar US. Vogt Koyangi Harada syndrome. Indian Pediatr 1997; 34: 1124- 1126.

2. Masi RJ. Syndromes of possible infectious origin. In: Infections of the Eye, 1st edn. Eds. Tabbara KF, Hyndiuk RA. Boston, Little Brown and Co, 1986; pp 587-600.

3. Rubsamen PE, Gass DM. Vogt Koyangi Harada syndrome-Clinical course, therapy and long term visual outcome. Arch Ophthalmol1991; 109: 682-687.