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ANTERIOR UVEITIS      Dr.Gayatree Mohanty      KIMS, BBSR,Orissa
DEFINITIONInflammation of the uveal tract from the iris upto the plars plicata of ciliary body
CLASSIFICATIONIritisIridocyclitisCyclitis
CLINICAL FEATURESAcute:   Symptoms more severeChronic: Signs more severe than signs
SYMPTOMS   Pain: Acute          Severe          Radiates along V1 nerve distribution          Worst at night   Redness:...
SIGNS   Lid Edema
CILIARY CONGESTION
3. CORNEAL SIGNS: Corneal  edema d/t toxic endothelitis &  increased IOP Keratitis precipitates:    Cellular deposits on...
KERATITIC PRECIPITATE
AC SIGNS: AQUEOUS CELLSAND FLARE
ANTERIOR CHAMBER SIGNS:AQUEOUS CELLSEarly signOn oblique illum.:3mm long 1mm wide slit with max light and magnificationsGr...
ANTERIOR CHAMBER SIGNS:AQUEOUS FLARED/t leakage of protein into the AC from the leaky  vesselsOn oblique illum.: a point o...
HYPOPYON: STERILE PUS IN AC
AC SIGNSHyphema:   Blood in ACIrregular AC depth d/t synechiaDeposits of debris in AC angleAnterior synechia
EXUDATES IN AC ANGLE
IRIS SIGNSLoss  of normal patternMuddy in color in active stage & hyper/ hypopigmentedIris nodules: Aggregations of lym...
KOEPPE’S NODULE; BUSSACCA’SNODULE
POSTERIOR SYNECHIAE: ADHESION OFPOST.   SURF. OF IRIS TO ANT. SURF OF LENS
POSTERIOR SYNECHIAE:SegmentalAnnularTotal
SLUGGISH PUPILLARY REACTION& MIOSIS
IRREGULAR PUPIL: FESTOONEDPUPIL
FIBRINOUS EXUDATE : OCCULSIOPUPIL
ECTROPION PUPILLAE
LENS SIGNSPigment   dispersion on lens surfaceFibrin exudates on lens surfaceComplicated cataract: Polychromatic lustur...
COMPLICATED CATARACT
Spillover anterior vitreous inflammation
Complications and   Sequelae
COMPLICATED CATARACT
SECONDARY GLAUCOMAEarly glaucoma:In active phase of diseaseDue to exudates & inflammatory cells in AC angle blocking th...
EXUDATES IN AC ANGLE
Late  Glaucoma (Post Inflammatory Glaucoma):D/t pupillary block (Seclusio Pupil/Occlusio pupil)Causes Iris Bombe then o...
CYCLITIC MEMBRANE:retrolental, fibrovascular membrane which stretches across the back of the lens
CHOROIDITIS
RETINAL SIGNS:Cystoid Macular DegenerationMacular DegenerationSerous Retinal DetachmentSecondary Peripapilitis Retinae
RETINAL SIGNS: CYSTOIDMACULAR EDEMA
SEROUS RETINALDETACHMENT
PERIPHLEBITIS:
PAPILLITIS
BAND KERATOPATHY
PHTHISIS BULBIShunken         Disorganized eyeballD/t chronic uveitis caused ciliary shock & reduced aqueous production…...
DIFFERENTIAL DIAGNOSIS1. Causes   painful red   eye2. Granulomatous & Non   granulomatous Uveitis3. Etiological D/d
CAUSES OF RED EYE                 Acute             Acute              Acute                 Conjunct ivitis   Iridocyclit...
CAUSES OF RED EYE (CONTD)             Acute             Acute             Acute             Conjunct ivitis   Iridocycliti...
CAUSES OF RED EYE (CONTD)               Acute             Acute            Acute               Conjunct ivitis   Iridocycl...
GRANULOMATOUS & NON-GRANULOMATOUS UVIETIS                        Granulomatous      Non- GranulomatousOnset               ...
GARANULOMATOUS & NON- GRANULOMATOUS UVIETIS              Granulomatous         Non- GranulomatousIris nodule   Koeppe’s & ...
WORK UP Hematological Examination TLC/DC: Gross idea of inflammatory response of body ESR: r/o Chronic infection Blood...
WORK UP Urine Examination: For WBC, Pus cells, RBS Culture : r/o Urinary tract infection Stool Examination For Cysts ...
TREATMENT:Non-   specific treatmentLocal therapySystemic therapySpecific TreatmentT/t of Complications
NON-SPECIFIC TREATMENT:LOCAL THERAPYCycloplegicsCorticosteroidsBroad   spectrum antibiotics
1.CYCLOPLEGICSShort acting cycloplegics:Tropicamide 1% e/d (3hrs)Cyclopentolate 1% e/d(24hrs)Long acting cycloplegics...
MODE OF ACTIONS OF CYCLOPLEGICSRelieves  pain: Relieves spasm of iris sphincter & ciliary m.Prevents posterior synechiae...
2.CORTICOSTEROID: TOREDUCE INFLAMMATIONCommonly used steroids:Long acting: Dexamethasone Betamethasone Hydrocortisone ...
ROUTE OF ADMINISTRATION:Topical: Eye drops or eye ointments       6times a dayAnterior subtenon injection       For seve...
BROAD SPECTRUM ANTIBIOTIC   Doesn’t have much role in anterior uveitis
SYSTEMIC THERAPYCorticosteroidsNon-Steroidal     Anti- inflammatory Drugs(NSAIDS)Immunosupressives
CORTICOSTEROIDSIndication:   Intractable anterior uveitisPrednisolone: 1mg/kgbdwt & taper gradually according to respons...
NON- STEROIDAL ANTI-INFLAMMATORY DRUGS:Used   when steroid are contraindicated or not tolerated.Phenylbutazone & oxyphen...
IMMUNOSUPPRESSIVESIn corticosteroid resistant or intolerant casesIn specific inflammations:Behcet’s syndromeSympatheti...
SPECIFIC TREATMENTTuberculosis:   ATTParenteral Penicillin:SyphilisHSV: Acyclovir
TREATMENT OFCOMPLICATION: Inflammatory Glaucoma:Timolol 0.5% BD & T.Acetazolamide 250mg BDContraindicated are Latanoprost...
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Anterior uveitis

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Anterior uveitis

  1. 1. ANTERIOR UVEITIS Dr.Gayatree Mohanty KIMS, BBSR,Orissa
  2. 2. DEFINITIONInflammation of the uveal tract from the iris upto the plars plicata of ciliary body
  3. 3. CLASSIFICATIONIritisIridocyclitisCyclitis
  4. 4. CLINICAL FEATURESAcute: Symptoms more severeChronic: Signs more severe than signs
  5. 5. SYMPTOMS Pain: Acute Severe Radiates along V1 nerve distribution Worst at night Redness: Photophobia Lacrimation Diminution of vision a.Turbid aqueous e. Sec. glaucoma b.Vitreous exudates f.Ciliary spasm c.Exudates in pupillary area g.Complic. Cat d.CME
  6. 6. SIGNS Lid Edema
  7. 7. CILIARY CONGESTION
  8. 8. 3. CORNEAL SIGNS: Corneal edema d/t toxic endothelitis & increased IOP Keratitis precipitates: Cellular deposits on the corneal endothelium. Distributed in a base down triangular area inferiorly (Arlt’s triangle) Small, medium, large (mutton fat) Posterior corneal opacities
  9. 9. KERATITIC PRECIPITATE
  10. 10. AC SIGNS: AQUEOUS CELLSAND FLARE
  11. 11. ANTERIOR CHAMBER SIGNS:AQUEOUS CELLSEarly signOn oblique illum.:3mm long 1mm wide slit with max light and magnificationsGrading:0 :0 cell+_ : 1-5 cell1+ : 6-10 cells2+: 11-20 cells3+ : 21-50 cells4+ : >50
  12. 12. ANTERIOR CHAMBER SIGNS:AQUEOUS FLARED/t leakage of protein into the AC from the leaky vesselsOn oblique illum.: a point of beam projected on the iris planeProtein particles seen floating the beam of light: Tyndall phenomenonMarked in NGUGrading:0 : No flare1+ : Just detectable2+: Moderate flare with clear detail view of iris3+ : Marked flare with iris details not clear4+ : Intense flare with no view of iris details
  13. 13. HYPOPYON: STERILE PUS IN AC
  14. 14. AC SIGNSHyphema: Blood in ACIrregular AC depth d/t synechiaDeposits of debris in AC angleAnterior synechia
  15. 15. EXUDATES IN AC ANGLE
  16. 16. IRIS SIGNSLoss of normal patternMuddy in color in active stage & hyper/ hypopigmentedIris nodules: Aggregations of lymphyocytes and epitheloid cells.
  17. 17. KOEPPE’S NODULE; BUSSACCA’SNODULE
  18. 18. POSTERIOR SYNECHIAE: ADHESION OFPOST. SURF. OF IRIS TO ANT. SURF OF LENS
  19. 19. POSTERIOR SYNECHIAE:SegmentalAnnularTotal
  20. 20. SLUGGISH PUPILLARY REACTION& MIOSIS
  21. 21. IRREGULAR PUPIL: FESTOONEDPUPIL
  22. 22. FIBRINOUS EXUDATE : OCCULSIOPUPIL
  23. 23. ECTROPION PUPILLAE
  24. 24. LENS SIGNSPigment dispersion on lens surfaceFibrin exudates on lens surfaceComplicated cataract: Polychromatic lusture Bread crumb appearance
  25. 25. COMPLICATED CATARACT
  26. 26. Spillover anterior vitreous inflammation
  27. 27. Complications and Sequelae
  28. 28. COMPLICATED CATARACT
  29. 29. SECONDARY GLAUCOMAEarly glaucoma:In active phase of diseaseDue to exudates & inflammatory cells in AC angle blocking the TMDecreased aqueous flow leading to increased IOP (Hypertensive Glaucoma)
  30. 30. EXUDATES IN AC ANGLE
  31. 31. Late Glaucoma (Post Inflammatory Glaucoma):D/t pupillary block (Seclusio Pupil/Occlusio pupil)Causes Iris Bombe then occlusion TMDecreased aqueous outflow
  32. 32. CYCLITIC MEMBRANE:retrolental, fibrovascular membrane which stretches across the back of the lens
  33. 33. CHOROIDITIS
  34. 34. RETINAL SIGNS:Cystoid Macular DegenerationMacular DegenerationSerous Retinal DetachmentSecondary Peripapilitis Retinae
  35. 35. RETINAL SIGNS: CYSTOIDMACULAR EDEMA
  36. 36. SEROUS RETINALDETACHMENT
  37. 37. PERIPHLEBITIS:
  38. 38. PAPILLITIS
  39. 39. BAND KERATOPATHY
  40. 40. PHTHISIS BULBIShunken Disorganized eyeballD/t chronic uveitis caused ciliary shock & reduced aqueous production….then hypotony….shrunken disorganized globe
  41. 41. DIFFERENTIAL DIAGNOSIS1. Causes painful red eye2. Granulomatous & Non granulomatous Uveitis3. Etiological D/d
  42. 42. CAUSES OF RED EYE Acute Acute Acute Conjunct ivitis Iridocyclitis Congestive GlaucomaOnset Gradual Usually gradual SuddenPain Mild discomfort Moderate Severe V 1 n. distribn. Whole V n. distrib.Discharge Mucopurulent Watery WateryColored haloes +/- -- +++Vision Unaltered Impaired Severely impairedCongestion Conjunctival Ciliary Ciliary
  43. 43. CAUSES OF RED EYE (CONTD) Acute Acute Acute Conjunct ivitis Iridocyclitis Congestive GlaucomaTenderness Absent Marked MarkedPupil Normal Small,irregular Dilated, Reacting Sluggish vertically oval & reacting fixedMedia Clear Hazy d/t Hazy d/t corneal KP,flare & edema pupillary exudateAnterior Deep Deep/ may be Very shallowchamber irregularIris Normal Muddy Edematous
  44. 44. CAUSES OF RED EYE (CONTD) Acute Acute Acute Conjunct ivitis Iridocyclitis Congestive GlaucomaIOP Normal Normal usually Markedly raisedConstitutional Absent Little Prostration &symptom Assoc. vomiting
  45. 45. GRANULOMATOUS & NON-GRANULOMATOUS UVIETIS Granulomatous Non- GranulomatousOnset Insiduous AcutePain Minimal MarkedPhotophobia Slight MarkedCiliary Congestion Minimal MarkedKeratitic Precipitate Large Mutton Fat Fine
  46. 46. GARANULOMATOUS & NON- GRANULOMATOUS UVIETIS Granulomatous Non- GranulomatousIris nodule Koeppe’s & Bussaca’s Absent nodulesPosterior Thick & broad based Thin & tenousSynechiaeFundus Nodular lesion Diffuse lesions
  47. 47. WORK UP Hematological Examination TLC/DC: Gross idea of inflammatory response of body ESR: r/o Chronic infection Blood sugar: r/o DM Blood Uric Acid: r/o Gout Seological Test: Syphilis, toxoplasmosis & histoplasmosis Test for: AntiAntinuclear Antibodies CRP Rh factor Anti-streptolysin O LE cells
  48. 48. WORK UP Urine Examination: For WBC, Pus cells, RBS Culture : r/o Urinary tract infection Stool Examination For Cysts & ova to r/o parasitic infestations. Radiological Investigation CXR,Paranasal sinus, Sacroiliac joints,Lumbar spine. Skin Tests: Tuberculin test, Kveims test & Toxoplasmin test.
  49. 49. TREATMENT:Non- specific treatmentLocal therapySystemic therapySpecific TreatmentT/t of Complications
  50. 50. NON-SPECIFIC TREATMENT:LOCAL THERAPYCycloplegicsCorticosteroidsBroad spectrum antibiotics
  51. 51. 1.CYCLOPLEGICSShort acting cycloplegics:Tropicamide 1% e/d (3hrs)Cyclopentolate 1% e/d(24hrs)Long acting cycloplegicsHomatropine 2% e/d(4days)Atropine sulphate 1% e/d (7- 14days)
  52. 52. MODE OF ACTIONS OF CYCLOPLEGICSRelieves pain: Relieves spasm of iris sphincter & ciliary m.Prevents posterior synechiae formationBreaks posterior synechiaeReduces hyperemia & vascular permeability which reduces exudation
  53. 53. 2.CORTICOSTEROID: TOREDUCE INFLAMMATIONCommonly used steroids:Long acting: Dexamethasone Betamethasone Hydrocortisone Prednisolone TriamcinoloneShort acting: Fluoromethalone Loteprednol Fluocinolone
  54. 54. ROUTE OF ADMINISTRATION:Topical: Eye drops or eye ointments 6times a dayAnterior subtenon injection For severe cases
  55. 55. BROAD SPECTRUM ANTIBIOTIC Doesn’t have much role in anterior uveitis
  56. 56. SYSTEMIC THERAPYCorticosteroidsNon-Steroidal Anti- inflammatory Drugs(NSAIDS)Immunosupressives
  57. 57. CORTICOSTEROIDSIndication: Intractable anterior uveitisPrednisolone: 1mg/kgbdwt & taper gradually according to responseSide effects: Glaucoma & Cataract
  58. 58. NON- STEROIDAL ANTI-INFLAMMATORY DRUGS:Used when steroid are contraindicated or not tolerated.Phenylbutazone & oxyphenylbutazone
  59. 59. IMMUNOSUPPRESSIVESIn corticosteroid resistant or intolerant casesIn specific inflammations:Behcet’s syndromeSympathetic ophthalmitisVKHPars planitis
  60. 60. SPECIFIC TREATMENTTuberculosis: ATTParenteral Penicillin:SyphilisHSV: Acyclovir
  61. 61. TREATMENT OFCOMPLICATION: Inflammatory Glaucoma:Timolol 0.5% BD & T.Acetazolamide 250mg BDContraindicated are Latanoprost & Pilocarpine. Post-inflammatory Glaucoma(d/t ring synechiea):Laser iridotomy Complicated Cataract:Cataract sx. After 3mths of quiet period. Retinal Detachment:Anterior vitrectomy Phthisis bulbiEnucleation

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