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Uveitis

Uveitis. Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU. Def. : - Inflammation of the uveal tract. Classifications : The 4 most useful classifications are :- (1) Anatomical :. Anterior Uveitis. Intermediate uveitis. Posterior uveitis. Diffuse uveitis. Iritis.

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Uveitis

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  1. Uveitis Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU

  2. Def. : - Inflammation of the uveal tract. • Classifications: The 4 most useful classifications are :- (1) Anatomical : Anterior Uveitis Intermediate uveitis Posterior uveitis Diffuse uveitis Iritis Iridocyclitis

  3. Cont. (2) Clinical : (3) Etiological : (4) Pathological : Acute Chronic Exogenous Endogenous Granulomatous Non-Granulomatous

  4. Irido-cyclitis • Def. : - Inflammation of the iris & ciliary body. • Etiology : A- Primary: Syndromes of Unknown etiology Infection: Allergy Constitutional Exogenous Bacterial Behcet’s Endogenous Non-bacterial Vogt-Koyanagi-Harada

  5. N.B. • Behcet syndrom: - Oral ulcerations. - Genital ulcerations. - Uveitis. • Vogt-Koyanagi-Harada syndrom: - Alopecia. - Poliosis. - Vetiligo. - Uveitis

  6. B- Secondary : Cornea Sclera Lens Retina I.O. tumors I.O.F.B R.D. Keratitis Scleritis Subluxation Or Dislocation

  7. Pathology: 3 phases: 1)Vascular Phase: - Dilatation & congestion of the blood vessels to bring more leucocytes. 2) Exudative Phase: - Exudation of inflamm. Fluids from dilated vessels. * The result of this exudation: a- Iris & ciliary body:-Edema of iris & C.B. - Loss of iris pattern - Pressure on the nerves - Spasm of ciliary muscles

  8. b- Outside iris & C.B. : - Aquous flare. - Collection of exudates in: Angle, pupil, between iris & lens and behind lens. 3) Cellular Phase: - Keratic Precipitate (KPs): active & passive. - Lenticular Precipitates (LPs): - Vitrous opacities, Vitritis

  9. Clinical Picture:usually recurrent. • Symptoms: 1) Pain: Dull aching. Why??? -Nerves: Stretch & irritation of nerve ending. - Muscles: Spam of intrinsic muscles & C.M. - Glaucoma: Secondary.

  10. Cont. Reflex irritation of the 5th N. endings 2) Photophobia: 3) Lacrimation: 4) Blepharospasm: 5) Diminution of vision: Why??? -Corneal edema. - Aquous flare. - Pupillary memb. - Vitritis - Toxic maculopathy. - Hazziness of the lens.

  11. Painful red eye with blurring of vision 1- Pain. 2- Photophobia 3- Lacrimation 4- Blepharospasm 5- Diminution of vision 6- Redness of the eye

  12. Cont. • Signs: 1) Lid: Edema. 2) Conjunctiva: Conj. & ciliary injections. 3) Cornea: Edema & KPs. 4) Iris: Muddy. 5) Ciliarry body: Tender. 6) Anterior chamber:- Aquous flare. - Hypopon. - Hyphaema.

  13. External examination Conjunctival injection

  14. 7) Pupil:- Constricted. - Irregular. - Sluggish reaction. 8) Lens:- Iris pigment on the capsule (LPs). 9) Intra ocular pressure: raised, 2ry glaucoma. 10) Vitrous:Vitritis. 11) Macula:Toxic maculopathy.

  15. Complications: 1) Cornea: Deep keratitis. 2) Iris:- Post Synaechia. - Atrophy “late” 3) Angle: P.A.S. 4) Lens: Cataract. 5) Cyclitic memb. 6) Secondary glaucoma. 7) Retinitis, optic neuritis & toxic maculopathy. 8) Endophthalmitis or Panophthalmitisin sever cases

  16. Differential Diagnosis:

  17. Investigations: Clinically Radiologically Laboratory

  18. Treatment (1) Local: a) Atropine:- Internal eye rest. - Relaxation of the C.M. - Breaking fresh synaechia & dec. formation. b) Cortisone:- Anti-inflammatory. - Anti-Allergic. - Fibrinolytic. c) Hot Fomentation. d) Dark Glasses.

  19. (2) General: a) Systemic cortisone:in sever cases. b) Systemic broad spectrum A.B.s. c) Analgesics & anti-inflammatory drugs. - In sever resistant cases - d) Cytotoxic drugs. e) Immunosuppressive drugs. (3) Causal TTT: (4) TTT of complications:

  20. Posterior Uveitis- Choroiditis - • Def. : - Inflammation of the choroid. • Classification: Suppurative Non-suppurative Endophthalmitis Exudative Granulomatous Panophthalmitis

  21. Cont. • Treatment: • Endophthalmitis: a- Early cases:Anti-biotics, atropine & corticosteroids. b- Late cases: Evisceration. 2) Panophthalmitis: - Evisceration.

  22. Sympathetic Ophthalmitis • Def. : - Bilateral inflamm. Of the uveal tract. • Etiology:Unclear. a) Allergic theory: b) Infective theory: c) Mixed theory:

  23. Cont. • Clinical picture: - Signs & symptoms of iridocyclitis + trauma in the exciting eye. • Complications: As iridocyclitis. • Treatment: 1) Prophylactic: 2) Curative:

  24. Thank You

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