1 / 32

RED EYE- UVEITIS

Brig Mazhar Ishaq Advisor in Ophthalmology, Comdt Armed Forces Institute Of Ophthalmology, Rwp. RED EYE- UVEITIS. ANATOMICAL CLASSIFICATION. ANTERIOR UVEITIS IRITIS IRIDOCYCLITIS INTERMEDIATE UVEITIS POSTERIOR UVEITIS PANUVEITIS. POSTERIOR UVEITIS.

turner
Download Presentation

RED EYE- UVEITIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Brig Mazhar Ishaq Advisor in Ophthalmology, Comdt Armed Forces Institute Of Ophthalmology, Rwp RED EYE- UVEITIS

  2. ANATOMICAL CLASSIFICATION • ANTERIOR UVEITIS • IRITIS • IRIDOCYCLITIS • INTERMEDIATEUVEITIS • POSTERIOR UVEITIS • PANUVEITIS

  3. POSTERIOR UVEITIS Involves the fundus posterior to the vitreous base - Retinitis - Choroiditis - Vasculitis

  4. SARCOIDOSIS • Presentation - Acute - Insidious • Ocular features - AAU - CAU - Intermediate - Candlewax drippings’ - Multifocal choroiditis - Retinal granulomas

  5. TUBERCULOSIS Anterior segment involvement Tuberculousuveitis - Anterior uveitis, - Choroiditis - Periphlebitis

  6. TOXOPLASMOSIS • Presentation - Unilateral sudden onset of floaters • Signs - Spill-over’ anterior uveitis- Satellite lesion- Multiple foci are uncommon - Severe vitritis (‘headlight in the fog’)

  7. TOXOPLASMOSIS

  8. BEHCET SYNDROME • Recurrent oro-genital ulceration • Ocular features • AAU - cold abscess • Retinitis • Retinal vasculitis • Vitritis,

  9. BEHCET SYNDROME

  10. FUNGAL UVIETIS

  11. INVESTIGATIONS Indications • Recurrent granulomatous anterior uveitis • Bilateral disease • Systemic manifestations with out a specific diagnosis • Confirmation of suspective ocular picture such as HLA-A29 testing in birdshortchorioretinopathy

  12. NOT NECESSARY • Single attack of mild unilateral acute anterior uveitis • A specific uveitis entity • When a systemic diagnosis compatible with the uveitis is already apparent

  13. INVESTIGATIONS • Obtain a history, attempting to define the etiology. • Complete ocular examination, including an IOP check and a dilated fundus examination.

  14. SKIN TESTS • Tuberculin skin test (montoux & Heaf) • Intradermal inj of purified protein • Positive Induration of 5-14 mm with in 48 hours Negative • Excludes TB • May occure in advanced disease

  15. PATHERGY TEST • Increased dermal sensitivity to needle trauma • Behcet syndrome • Rarely positive in absence of systemic activity • Pustule formation

  16. SEROLOGY SYPHILIS • Non-treponemal tests RPR or VDRL • Primary infection • Monitor disease activity • Response to therapy

  17. Immunofluorescent antibody test • Haemagglutination test

  18. Enzyme-linked Immunosorbent Assay (ELISA) • Antibodies in aqueous (more specific) • Other conditions (cat-scratch fever & toxocariasis Antinuclear Antibody (ANA) • In children with JIA who are at high risk of developing ant uveitis

  19. ENZYME ASSAY • Angiotensin converting enzyme (ACE) • Nonspecific test • Granulomatous disease like - Sarcoidosis (elevated in 80% & in acute) - TB - Leprosy • Lysozyme • Good sensitivity but less speceficity for sarcoidosis

  20. HLA TISSUE TYPING HLA type Associated disease B27 Spondyloarthropathies A29 Birdshot chorioretinopathy B51 Behcet syndrome HLA-B7 & POHS & APMPPE HLA-DR2

  21. IMAGING • Fluorescein angiography (FA) • Retinal vasculitis • CMO • Indocyanine angiography (ICG) • Better for choroidal disease

  22. Ultrasonography (US) • It is useful in opaque media especially in excluding a RD or intraocular mass • Optical coherence tomography(OCT) • Detecting CMO • Identify vitreoretinal traction as a mechanism of CMO

  23. BIOPSY Histopathology still remains the gold-standard • conjunctiva And Lacrimal gland - Sarcoidosis • Aqueous samples - For (polymerase chain reaction) PCR - Viral retinitis (occasionally) • Vitreous biopsy - Infectious endophthalmitis

  24. RADIOLOGY • Chest X-rays - To exclude TB and Sarcoidosis • Sacro-illiac joint X-Rays - Diagnosis of spondyloarthropathy • CT & MRI - Sarcoidosis - Multiple sclerosis - Primary intraocular lymphoma

  25. TREATMENT • AIM • Prevent vision threatening complications • Relieve patients discomfort • Treat the underlying cause • FOUR GROUP OF DRUGS • Mydriatics • Steroids • Cyclosporine • Cytotoxic agents

  26. TREATMENT • Mydriatics • To give comfort • To prevent formation of posterior synechia • To break down synechia • Drugs (atropine, homatropine, scopolamine, tropicamide)

  27. TREATMENT • Steroids (mainstay of treatment) • Topical administration • Complications (glaucoma, posterior sub capsular cataract, corneal complications, systemic side effects) • Periocular injections • Severe acute anterior uveitis • Adjuvant to topical/systemic • Poor compliance • Pre op

  28. TREATMENT • Systemic therapy • Preparations • Prednisolone 5mg • Indications • Rules • Start with large dose then reduce • Initial dose 1-1.5 mg/kg BW • Before breakfast • Taper off • Less than 2 weeks abrupt stop

  29. TREATMENT • Side effects • Short term • Long term

  30. TREATMENT • Cyclosporin • Steroid sparing agent • Complications are hypertension and nephrotoxicity • Cytotoxic drugs • Potentially blinding bilateral reversible uveitis • Intolerable side effects from systemic steroids therapy.

  31. THANK YOU

More Related