Seasonal Hyperacute Panuveitis in Nepal: A Review over 40 Years of Surveillance

ABSTRACT

Purpose: This review aims to provide a detailed update in Seasonal hypercute panuveitis (SHAPU) which is a blinding disease of unknown etiology reported only from Nepal, occurring every odd year since 1975 predominantly in children.

Methods: Data sources were literature reviewed using PubMed, Medline, and ISI Databases (since 1975 to late 2017). Search items included SHAPU, seasonal endophthalmitis, hypopyon uveitis, caterpillar induced uveitis alone or in combination with white moth, panuveitis, and review.

Results: Epidemics of SHAPU occur between August to December usually in odd years. Two thirds of the children present with unilateral blind eye which eventually becomes soft with shallowing of anterior chamber called as Malignant Hypotension. Hypopyon, fibrinous exudates in anterior chamber, difficult to dilate pupil and inability to visualize the retina because of massive exudation into vitreous producing a “White pupil in a Red eye” with little or no pain is its characteristic features. Contact with moths has been suspected. Because of presence of microbial agents in few cases, an infectious etiology has not been ruled out.

Conclusions: Although SHAPU has been reported only from Nepal, lack of its report from ecologically similar terrain along Hindukush Mountains and possible association with moths remain intriguing.

Keywords:

• Children
• endophthalmitis
• hypopyon
• moths
• Nepal
• panuveitis
• vitrectomy

ACKNOWLEDGMENTS

We acknowledge several ophthalmologists of Nepal who shared their personal experience to complete this review. We would also like to acknowledge continuous support of Prof Ananda K. Sharma and Dr Sagun Narayan Joshi of B. P. Koirala Lions Centre for Ophthalmic Studies. We would also like to extend our sincere gratitude to Dr Anadi Khatri (KC), Dr Ranjit Sah and Dr Sushila Khadka for their unconditional help. We are grateful to Mr Suresh Sharma for the technical support and clinical images.

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.