Polyarteritis nodosa, with an unusual ocular presentation.

POLYARTERITIS nodosa (periarteritis nodosa), first described by Kussmaul and Maier (1866), is a relatively rare disease, but considerable attention has been paid to it in recent years. Duke-Elder (1962), describing the condition, wrote: "this is a disseminated disease of obscure cause characterized by necrosing obliterative lesions of small arteries and arterioles which appear nodular owing to the formation of aneurysms or granulomatous proliferation". Harvey (1963) described the lesions as segmental in their distribution and involving arteries throughout most of the body so that the resulting clinical picture was one of polymorphic manifestations which might seem unrelated. In its typical form, polyarteritis nodosa is a well-defined entity, but is not always typical (Anderson, 1961). This case of polyarteritis nodosa with an unusual ocular presentation is reported in full detail because it demonstrates the difficulty in diagnosis of the underlying condition with such a presentation. Harbert and McPherson (1947) described a similar case, but the lacrimal gland was not involved. Cogan (1955) reviewed and reported cases of corneoscleritis or scleritis associated with polyarteritis nodosa, and Moore and Sevel (1966) have recently reviewed cases associated with either polyarteritis nodosa or Wegener's granulomatosis, in none of which the lacrimal gland appeared to be affected. Dacryoadenopathy does not appear to have been reported as a presenting symptom in polyarteritis nodosa.