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Uveitis
Uveitis
Uveitis
Introduction
Uveitis : inflammation of uveal tract (iris, ciliay
body & choroid)
It is classified anatomically to
1. Ant.uveitis (iritis)
inflammation of iris accompanied by increased vascular permeability which
allow both protein & WBCs to extravasate into the aqueous.
2 types : granulomatous (Sarcoidosis,Syphilis, Vogt-Koyanagi-Harada
disease Sympathetic ophthalmi Multiple sclerosis Lyme disease
Tuberculosis.) nongranulomatous.
circulating White cells could be seen in the aqueous humor of Ant.
Chamber using a slit lamp.
Protein which leaked from BV is picked out by its
light scattering properties appear as “flare” in the beam of slit lamp.
Anterior Uveitis with hypopyon in a patient with IBD
2. Intermediate uveitis
Inflammation of ciliary body (cyclitis),of the
pars plana (pars planitis) and of the vitreous
(vitritis)
3. Posterior uveitis
Inflammation of posterior uvea May also
involve the choroid(choroiditis) or
retina(retinitis)
Panuveitis :its when inflammatory
changes involve the anterior
chamber,vitreous,retina and/or choroid.
Epidemiology
o Photophobia
o Blurring of vision Redness of the eye
HISTORY
o Respiratory symptoms (S.O.B , cough , nature of
sputum)……..TB, Sarcoidosis.
o Skin problems acompained by uveitis
erythema nodosum (arms +chin) >>>> Sarcoid & Bechet
oral & genital ulcers >> Bechet
o Joint disease
AS……….20% ant.uveitis
juvenule chronic arthrits
Reiter syndrome………..40% ant.uveitis
o Bowel dis : IBD
Signs
visual acuity may reduced
ciliary injection:mostly around limbus
Anterior uveitis:
Keratitic precipitates
inflam. Cells maybe visible as clumps on
endothelial of cornea (mostly Inferior)
On slit lamp exam.
flare & hypopyon in severe inflam.
Hypopyon highly suggestive for HLAB27 related & less
commonly with infectious iritis.
Dilated vessels on iris
Posterior synechia……….iris adhere to lens
Elevated IOP(inc aqeous protein or due to
occlusion of drainage angle by PAS)
Intermediate and posterior uveitis
Cells in the vitreous
Retinal or choroidal foci of inflammation
Macular edema
Grading of flare(flare refers to liberated protein from the
inflamed iris or ciliary body which gives the aqueous a
particulate, or smoky, appearance.)
Completely
0 absent
+1 Barely present
+2 moderate
+3 marked
+4 Intense (fibrin)
Syphilis accounts for less than 1 percent of patients with uveitis in most
large series. It may present in a variety of forms, including posterior
uveitis, such as a chorioretinitis or retinal vasculitis
CMV retinitis(cottage cheese
lesion)
Toxoplasmosis
Infections
Tuberculosis is an uncommon cause of uveitis in North American
referral centers. It should be considered in the differential diagnosis
when the uveitis worsens despite glucocorticoid therapy.
Additional factors that raise suspicion for this diagnosis are active
tuberculosis elsewhere in the body, cachexia, homelessness, a
granulomatous appearance for the ocular inflammation, or
immunosuppression. In some geographic areas such as Saudi
Arabia, tuberculosis is considered a common cause of uveitis.
20-40 %
Male >female
Juvenile idiopathic arthritis (JIA) may be associated with uveitis, particularly in the subset
of patients with pauciarticular disease and a positive antinuclear antibody. The onset of
uveitis is more common in younger children and, in the majority of patients, can be
asymptomatic . (white eye but wuth signs of uveitis present )
The uveitis associated with JIA is usually bilateral, insidious in onset, chronic in duration,
and anterior. The eye disease is commonly associated with complications such as band
keratopathy, posterior synechiae , cataract formation, and glaucoma. The uveitis
sometimes lasts for decades, long after the joint disease has disappeared.
Behcet
Male,young,bilateral , hypopyon
Immune-mediated systemic
disorders
Inflamed vitreous
70% catarct
cycloplegia
Long acting cycloplegic agents (cyclopentolate ,
hematropine )used to relief pain& photophobia by
medriasis .
Corticosteroids
1. Topical , is the mainstays of therapy used
aggressively esp. in initial phases of therapy
,
if no response in 7-10 days we use :
2. subconjunctival injection (celestone) , used
if pt poorly complies to topical type or iritis not
respond to topical ttt alone
3. oral corticosteroid maybe necessary in
severe cases of iritis and post uveitis
Topical aqueous suppressant
in case of elevated IOP