Parinaud oculoglandular syndrome
Cat scratch disease; Oculoglandular syndrome
Parinaud oculoglandular syndrome is an eye problem that is similar to conjunctivitis ("pink eye"). It most often affects only one eye. It occurs with swollen lymph nodes and an illness with a fever.
Note: Parinaud syndrome (also called upgaze paresis) is a different disorder in which you have trouble looking upward. The latter can be caused by a brain tumor, and requires an immediate evaluation by your health care provider.
Lymph nodes play an important part in the body's defense against infection. Swelling might occur even if the infection is trivial or not apparent. Swelling of lymph nodes generally results from localized or systemic infection, abscess formation, or malignancy.
Causes
Parinaud oculoglandular syndrome (POS) is caused by an infection with bacteria, a virus, fungus, or parasite.
The most common causes are cat scratch disease and tularemia (rabbit fever). The bacteria that cause either condition can infect the eye. The bacteria can directly enter the eye (on a finger or other object), or air droplets that carry the bacteria can land on the eye.
Other infectious diseases may spread the same way, or through the bloodstream to the eye.
Symptoms
Symptoms include:
- Red, irritated, and painful eye (looks like "pink eye")
- Fever
- General ill feeling
- Increased tearing (possible)
- Swelling of nearby lymph glands (often in front of the ear)
Exams and Tests
An exam shows:
- Fever and other signs of illness
- Red, tender, inflamed eye
- Tender lymph nodes may be present in front of the ear
- There may be growths (conjunctival nodules) on the inside of the eyelid or the white of the eye
Blood tests will be done to check for infection. The white blood cell count may be high or low, depending on the cause of the infection.
A blood test to check antibody levels is the main method used to diagnose many of the infections that cause POS. Other tests may include:
- Biopsy of the lymph node
- Laboratory culture of eye fluids, lymph node tissue, or blood
Treatment
Depending on the cause of the infection, antibiotics may be helpful. Surgery may be needed in rare cases to clean away the infected tissues.
Outlook (Prognosis)
The outlook depends on the cause of the infection. In general, if the diagnosis is made early and treatment starts right away, the outcome of POS can be very good.
Possible Complications
Serious complications are rare.
The conjunctival nodules can sometimes form sores (ulcers) during the healing process. The infection can spread to nearby tissues or into the bloodstream.
When to Contact a Medical Professional
You should contact your provider if you develop a red, irritated, painful eye.
Prevention
Frequent hand washing can reduce the likelihood of getting POS. Avoid being scratched by a cat, even a healthy cat. You can avoid tularemia by not having contact with wild rabbits, squirrels, or ticks.
References
Gruzensky WD. Parinaud oculoglandular syndrome. In: Mannis MJ, Holland EJ, eds. Cornea. 5th ed. Philadelphia, PA: Elsevier; 2022:chap 41.
Pecora N, Milner DA. New technologies for the diagnosis of infection, In: Kradin RL, ed. Diagnostic Pathology of Infectious Disease. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 6.
Rubenstein JB, Spektor T. Conjunctivitis: infectious and noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.6.
Salmon JF. Conjunctiva. In: Salmon JF, ed. Kanski's Clinical Ophthalmology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 6.
Version Info
Last reviewed on: 8/22/2022
Reviewed by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
