SHAPU: Forty years on Mystery Persists.

In 1975, our team encountered several cases of severe inflammatory eye disease presenting as a white pupil in a red eye with rapid loss of vision. The eyes became soft within a few days with shallow anterior chamber which we called "Malignant Hypotension" in view of the latter's sinister significance. Unilaterally, little or no pain, predominantly affecting children and difficulty in dilating the pupil and keeping it dilated were some of the other important features. Posterior segment was not visible due to massive exudation in vitreous. Microbiological investigations of aqueous humor did not retrieve any bacterial or fungal organisms. All eyes became pthisical in few weeks despite treatment with topical and subconjunctival antibiotics and steroids. Similar cases appeared again after two years in 1977 with identical presentation and outcome. Both out breaks began during September and lasted until about January- the next year.

Changing trends in the etiologic diagnosis of uveitis.

Just as different fads that seize the imagination of the general public are often carried to excess, so diagnostic or therapeutic fads may take over in the practice of medicine. Analysis of 33 surveys of the causes of uveitis reported by ophthalmologists over the course of 120 years shows how some diagnoses such as syphilis and tuberculosis fell from favor because tests ruled out these diseases, whereas others such as toxoplasmosis became popular because of the finding of the organism in a few cases by a famous ophthalmic pathologist. Yet others (pars planitis, sarcoidosis) were not even causes of disease, but rather merely descriptive, or the ocular component of a systemic disease whose etiology and pathogenesis remain unknown. We will examine the waxing and waning of these diagnostic categories and the impressive confidence of some clinicians in their own diagnostic acumen as they made diagnoses often unsupported by objective evidence.