Sympathetic Opthalmitis.pptx uveitis ppt

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1. Case presentation

2. A 53-year-old male presented to the OPD with complaints of redness, watering, and diminution of vision in the right eye for the past two days. It was non-progressive and had an acute onset.It was was not associated with photophobia, floaters. The patient experienced associated redness and watering. No history of foreign body sensation No history of mucopurulent discharge.

3. No H/O any shortness of breath No H/O any joint pains. No H/O of any oral ulcer. No H/O of any pain abdomen. No H/O of any hearing defects. No H/O TB/ TB contact

4. Past History -The patient had a history of penetrating trauma 2 years ago, which led to a corneal laceration and an iron intraocular foreign body in the left eye. The patient then presented to Eye OPD with complaints of floaters RE,3 months after the corneal tear repair with IOFB Removal at RP Centre, AIIMS. Sys temic History - No significant systemic history noted.

5. General physical examination BP - 124/86 mm Hg RBS - 89 mg/dl PR - 74 per minute Pallor - Absent Icterus - Absent Cyanosis - Absent Clubbing- Absent Lymphadenopathy- Absent Edema - Absent

6. RE LE UCVA 6/24 Hand movement, PL +, PR inaccurate in inferonasal quadrant. BCVA 6/9 Hand movement Refraction +1.00 DS Plane Near Vision +2.00 DS - N6 + + + + — — + +

7. RE LE Adnexa WNL WNL Conjunctiva Ciliary congestion Pseudopterygium Cornea Keratic precipitates present Suture marks present nasally with superficial and deep vascularisation Pupil Pharmacologically dilated Round and regular Cannot be appreciated Anterior chamber 2+ cells Shallow with few fragments of cataractous lens Iris Normal in colour and pattern. No iris nodules seen Normal in colour and pattern. No iris nodules seen Lens NS 2

8. RE LE Fundus Media clear. 0.3 CDR, healthy neuroretinal rim FR present, macula on Sclerosed vessel present superotemporally. No choroiditis - IOP by NCT 16mm Hg 5 mm Hg

9. Clinical diagnosis- RE - Acute Anterior uveitis ?sympathetic ophthalmitis with IMSC LE - Atrophic bulbi s/p penetrating trauma repair. Differential diagnosis- Infectious - Tubercular uveitis - Syphilis Non infectious - Sarcoidosis HLA B27 systemic disorders Behcet disease. Masquerade - Lymphoma

10. Investigations Bscan LE - moderate to high amplitude spikes S/o retinal detachment . CBC with ES R- Hb - 13.2 g/dl ; TLC - 6800 KFT - WNL S.ANA - < 1.1 U S.ACE - 24 nmol/ml/min RA factor - negative Chest X ray - Normal VDRL - negative Mantoux test - negative

11. Treatment Given E.d Moxi Prednisolone 1 hrly E.d Homide BD E.d Timolol BD T. Wysolone 5 mg OD maintenance dose T. Pantop 40 mg

12. Discussion Sympathetic Ophthalmitis : Bilateral granulomatous panuveitis following penetrating trauma. -Onset: Symptoms typically appear between 2 weeks and 3 months after the initial injury. Incidence - 0.1% after intraocular surgery and 0.2% - 0.5% following penetrating trauma Presentation in Trauma-Induced Cases - Causative History-: Previous trauma to the eye. -Exciting Eye-- Frequently red and irritable. Sympathizing Eye - Symptoms: Irritation, blurred vision, photophobia, loss of accommodation.

13. Clinical Findings: - Anterior Uveitis- May be mild or severe, often granulomatous. - Fundus Examination - Multifocal choroidal infiltrates in the mid-periphery. - Sub-RPE infiltrates corresponding to Dalen-Fuchs nodules. - Possible exudative retinal detachment, vasculitis, and optic disc swelling. Prognosis: - Depends on the severity and location of the disease and response to treatment. - With aggressive therapy, 75% of sympathizing eyes retain a visual acuity of better than 6/60.

14. Investigations : - OCT May show choroidal thickening. - B-Scan Ultrasonography: Useful in detecting choroidal thickening. - FA (Fluorescein Angiography): Shows multiple foci of leakage at the level of RPE with subretinal pooling. Treatment : - Enucleation: Of the severely injured eye within the first week following injury. - Steroids: - High-dose oral prednisolone for several months, tapered according to response. - Intravenous methylprednisolone may be used in some cases. - Supplementary topical steroids and cycloplegics for anterior uveitis. - Immunosuppressants: - Azathioprine, cyclosporine, and methotrexate for resistant cases or as steroid-sparing agents.

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