Seasonal hyperacute panuveitis: an update

Seasonal hyperacute panuveitis (SHAPU), a mysterious disease of Nepal, has increased the burden of childhood blindness ever since it was described in 1975. Although moths are suspected as the cause, this source is not yet proven. The management of this disease is still not well outlined. This article reviews recent developments in the understanding of SHAPU pathogenesis, clinical features, cause, and preventive measures as well as curative management.

Smaller summer outbreaks occur every even year together with larger autumn outbreaks every odd year. Vitreous fluid from some cases grew bacteria on culture. Viruses were isolated in one case. Tiny hair follicles have been identified in ocular structures. Several cases had decreased corneal sensation and few cases had iris atrophy. Early vitrectomy is beneficial. Intravitreal vancomycin, amikacin, and dexamethasone injection have given good results. Unlike previous reports, the use of repeated subconjunctival dexamethasone injection was also claimed to reverse the eye disease. However, treatment helped to save the vision in one eye or both only if cases presented early enough (within 7 days) for treatment.

Recent findings have shown a correlation between SHAPU and moths (probably Gazalina); therefore, more research on this moth is urged. Various new findings also hint towards the involvement of microbes; thus, further advanced studies are required to confirm this involvement.