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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.

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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.

Related Information

Swollen lymph nodes
Tularemia

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.

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Review Date: 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.

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