UVEITIS2ertdgdrsopthalmology2923452.pptx

Opthalmology

1. UVEITIS MUTETHIA DOMINIC HSM201-0013/2019 SITEKI ARNOLD TM226-3512/2015

2. Brief Anatomy of uveal tract.. The uveal tract consists of iris, ciliary body and choroid. Continuos so disease of one part may spread to the other It’s the vascular layer of the eye Iris is a coloured , free, circular diaphragm with a central aperture(Pupil) Regulates the amt of light reaching retina The ciliary body has ciliary muscles,ciliary processes 2 parts- ant 1/3 pars plicata , post 2/3 pars plana Involved in accommodation and secretion of aqueous humour Choroid is a dark, brown highly vascular layer btn sclera and retina and provide nutrition to outer layers of retina Blood supply from post and ant ciliary arteries

3. UVEITIS..classification Inflammation of the uveal tissue only Associated inflammation of adjacent structures( retina,sclera,cornea ) Based on anatomical location, onset and pathology 1. Anatomical location Anterior uveitis- divided as Iritis- affects the iris Iridocyclitis-iris and pars plicata Cyclitis- pars plicata of ciliary body predominantly Intermediate uveitis- inflam of pars plana, peripheral retina and choroid.(pars planitis ) Posterior uveitis- inflam of choroid(choroiditis)..ass retina(chorioretinitis) Panuveitis - inflam . of whole uveal tract. 2. clinical classification Acute uveitis- sudden onset<3wks Chronic uveitis-insidious onset>3wks Recurrent uveitis- keeps recurring periodically 3. Pathological classification Granulomatous uveitis- infective in nature,inflam is insidious onset, chronic in nature with minimal C/F Non- granulomatous uveitis- due to allergic/immune related rxn . Acute onset and short duration

4. UVEITIS..

5. Anterior Uveitis Inflam ..of the iris and the ciliary body Iritis- affects the iris Iridocyclitis-iris and pars plicata Cyclitis- pars plicata of ciliary body predominantly Occurs in 2 clinical forms Infective(granulomatous)- direct organism infection( TB,syphilis ). inflam .. Is insidious, chronic in nature. Dense nodular infiltration of tissues by lymphocytes, plasma cells. Xtised by keratic precipitates(lymphocytes deposits). Allergic(exudative/non-granulomatous)- acute onset, short duration.diffuse , no focal lesion in iris. Has fine keratic precipitates.

6. Anterior UVEITIS..ETIOLOGY Mostly not due to direct infection Usually due to allergy/hypersensitivity to an infectious agent Exogenous infection- perforating wound/corneal ulcer. Causes acute purulent iridocyclitis Secondary infection- inflam .. Spreads from cornea,sclera,retina Endogenous infection- hematogenous spread..can be Bacterial- septicemia from streph , staph.. TB, Syphillis,gonorrhea Viral- mumps,measles,herpes Protozoa- toxoplasma,cysticercosis Fungal- histoplamosis Allergic inflammation- occur in a sensitized ocular tissue which comes in contact with the same organism Hypersensitivity rxn - hypersensitivity rxn to autologous tissue(autoimmune) ass with RA, SLE

7. Clinical presentation.. Acute onset iridocyclitis 1. symptoms Redness- due to circumciliary congestion Pain- worse at night..severe neuralgic pain referred to forehead, scalp, cheek, nose, teeth ..iris has rich sensory innervation by V1 Lacrimation and photophobia may be present Impaired vision- hazy plasmoid aqueous

8. SIGNS Eyelid-lid edema Ciliary congestion due to dilatation of vessels Cornea-edema, keratitic precipitates(cellular deposits on the corneal endothelium), corneal opacities Anterior Chamber Flare-caused by leakage of proteins into the anterior chamber. Hypopyon -sterile pus in the anterior chamber Hyphema -Blood in the anterior chamber V. Iris-iris nodules, synechiae(adhesion of iris to adjacent structures) VI. Pupil-sluggish reaction to light, miosis, festooned pupil (irregular pupil after patchy dilatation) VII. Lens-fibrin exudates, cataracts

9. Signs..

10. Complications Cataracts Glaucoma Retina- macula edema, retinal detachment Chorodoitis Phthisis bulbi- ciliary body disorganizes and atrophies, decreased aqueos humour , eye is soft and shrinks DDx - red eye causes- scleritis, conjunctivitis..

11. Management Investigations Depend on suspected underlying condition Hematological- CBC,ESR TB- gene Xpert , CXR Syphillis -VDRL Viral- viral Ab testing Fungal serology Ova and cyst- R/O parasitic causes Autoimmune- RF, ANA Ab RX of Ant Uveitis Aims of RX of uveitis are Prevent vision-threatening complications Relieve pts discomfort,pain Rx underlying cause of uveitis

12. Treatment.. Rx involves non-specific(local, systemic therapy) and specific rx to the underlying condition and rx of complications 5 main principles Rest to the eye is given by dilating the pupil with atropine Heat application to improve blood circulation,relieve pain Control acute phase of inflam .. with corticosteroids Analgesics, anti-inflammatory to relieve pain,discomfort Broad- spectrum Abx that cross the blood-aqueous barrier if infectious

13. Treatment.. Non-specific Local treatment Hot compresses-reduce pain, prevent stasis, improve BF Atropine 1% eye drops/ointment- mydriatic and cycloplegic( paralyse ciliary muscle, cyclopentolate 1% Dark glasses/eye shades to avoid glare, discomfort,lacrimation in sunlight Systemic treatment Corticosteroids- prednisolone,betamethasone Analgesics , anti-inflammatory Antibiotics Specific rx - if cause identified..TB Rx of complications- Glaucoma-