Masquerade Syndromes

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This presentation gives an overview about Masquerae Syndromes which mimic Uveitis.

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Masquerade Syndromes

  1. 1. DR. ANKIT PUNJABI P.G., DEPT OF OPHTHALMOLOGY, K.I.M.S. HOSPITAL, BANGALORE EMAIL: DRANKITALWAYS@GMAIL.COM
  2. 2. <ul><li>DEFINITION </li></ul><ul><li>These include a gp. Of diseases which mimic Ant. Or Post. Uveitis in their C/F but </li></ul><ul><li>are having entirely diff. Aetiopathogenesis </li></ul><ul><li>being usually neoplastic or occasionally ischaemic </li></ul>
  3. 3. <ul><li>EXAMPLES </li></ul><ul><li>Intraocular lymphoma </li></ul><ul><li>Retinoblastoma </li></ul><ul><li>Uveal melanoma </li></ul><ul><li>Leukaemias </li></ul><ul><li>Juvenile xanthogranuloma </li></ul>
  4. 4. <ul><li>INTRAOCULAR LYMPHOMA </li></ul><ul><li>INTRODUCTION </li></ul><ul><li>NHL involving eye is a rare cond. Which mimics ch. Uveitis or post. Uveitis </li></ul><ul><li>Ocular lymphomas occur in both primary & </li></ul><ul><li>secondary forms </li></ul>
  5. 5. <ul><li>CLASSIFICATION </li></ul><ul><li>Primary intraocular lymphoma </li></ul><ul><li>B-cell lymphoma of retina & choroid </li></ul><ul><li>Intraocular manifestation of syst. Lymphoma </li></ul><ul><li>Sec. Lymphoma of uvea </li></ul><ul><li>Extranodular lymphoma of uvea </li></ul>
  6. 6. <ul><li>PRIMARY INTRAOCULAR LYMPHOMA </li></ul><ul><li>Pts. > 50 yrs. Of age </li></ul><ul><li>Ocular manifestations – </li></ul><ul><li>B/l , but asymmetrical </li></ul><ul><li>Blurred vision, Floaters </li></ul><ul><li>Cells, Flare in AC </li></ul><ul><li>Cells in vitreous </li></ul>
  7. 7. <ul><li>PRIMARY INTRAOCULAR LYMPHOMA </li></ul><ul><li>Extensive infiltration of retina & optic nv. Head </li></ul><ul><li>Mound like elevations of retina </li></ul><ul><li>GUN syndrome </li></ul>
  8. 8. <ul><li>PRIMARY INTRAOCULAR LYMPHOMA </li></ul>Sub retinal infiltrates
  9. 9. <ul><li>DIAGNOSIS </li></ul><ul><li>CNS imaging </li></ul><ul><li>Lumbar Tap </li></ul><ul><li>M/E of CSF, Vitreous, Biopsy of brain, retina </li></ul>
  10. 10. <ul><li>PATHOLOGY </li></ul><ul><li>Thickening of detatched retina ( Pizza-Pie </li></ul><ul><li>appearance ) </li></ul><ul><li>Subretinal pigment elevation </li></ul><ul><li>Vitreous infiltration </li></ul>
  11. 11. <ul><li>TREATMENT </li></ul><ul><li>Steroids </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Radiotherapy </li></ul>
  12. 12. <ul><li>SYSTEMIC LYMPHOMA </li></ul><ul><li>U/l </li></ul><ul><li>Men more affected </li></ul><ul><li>Choroidal mass, Exophthalmos </li></ul><ul><li>Uvea involved with various proliferative cell types </li></ul><ul><li>Some times ocular lesions precede systemic </li></ul>
  13. 13. <ul><li>RETINOBLASTOMA </li></ul><ul><li>MC primary intraocular malignancy </li></ul><ul><li>1: 20,000 live births </li></ul><ul><li>Malignant transformation of primitive retinal cells before final differentiation </li></ul><ul><li>Presentation- </li></ul><ul><li>Leucocoria, Strabismus,Glaucoma, IRIS INV- </li></ul><ul><li>ASION ,Orbital inflammation </li></ul>
  14. 14. <ul><li>RETINOBLASTOMA </li></ul>Leucocoria Iris invasion byTm cells
  15. 15. <ul><li>RETINOBLASTOMA </li></ul>Pseudohypopyon
  16. 16. <ul><li>RETINOBLASTOMA </li></ul>Endophytic Tm. Exophytic Tm.
  17. 17. <ul><li>RETINOBLASTOMA </li></ul><ul><li>Signs </li></ul><ul><li>Placoid white lesion, Endophytic Tm., Exophytic Tm. </li></ul><ul><li>Investigations </li></ul><ul><li>USG, CT, MRI, Bonemarrow aspiration, lumbar puncture </li></ul>
  18. 18. <ul><li>RETINOBLASTOMA </li></ul><ul><li>Treatment </li></ul><ul><li>Small Tm –TPT </li></ul><ul><li>Medium size Tm- Brachytherapy,Chemotherapy </li></ul><ul><li>External beam radoitherapy </li></ul><ul><li>Large Tm – Chemotherapy, Enucleation </li></ul>
  19. 19. <ul><li>CILIARY BODY MELANOMA </li></ul><ul><li>10% of uveal melanomas </li></ul><ul><li>C/F </li></ul><ul><li>6 th decade </li></ul><ul><li>Dilated episcleral vessels in same quadrants (Sentinel vessels ) </li></ul><ul><li>Astigmatism, Subluxation, Cataract </li></ul><ul><li>RD </li></ul>
  20. 20. Sentinel Vessels <ul><li>CILIARY BODY MELANOMA </li></ul>
  21. 21. <ul><li>CILIARY BODY MELANOMA </li></ul>
  22. 22. <ul><li>CILIARY BODY MELANOMA </li></ul><ul><li>C/F </li></ul><ul><li>Ant. Uveitis </li></ul><ul><li>Investigations – </li></ul><ul><li>Tripple mirror contact lens, Transillumination, Ultrasonic biomicroscopy, Biopsy </li></ul>
  23. 23. <ul><li>CILIARY BODY MELANOMA </li></ul><ul><li>TREATMENT </li></ul><ul><li>Enucleation </li></ul><ul><li>Iridocyclectomy </li></ul><ul><li>Radiotherapy </li></ul>
  24. 24. <ul><li>LEUKAEMIAS </li></ul><ul><li>INTRODUCTION </li></ul><ul><li>Gp. Of neoplastic disorders ch. By abnormal proliferation of WBC. </li></ul><ul><li>Three types </li></ul><ul><li>ALL- Children are affected </li></ul><ul><li>AML- Worse prognosis,Adults more affected </li></ul><ul><li>Chronic leukaemias – Elderly affected </li></ul>
  25. 25. <ul><li>LEUKAEMIAS </li></ul><ul><li>OCULAR FEATURES </li></ul><ul><li>SCH </li></ul><ul><li>Iritis & Hypopyon </li></ul><ul><li>Diffuse & Nodular iris thickening </li></ul><ul><li>Hyphaema </li></ul><ul><li>Orbital involvement </li></ul><ul><li>Optic neuropathy </li></ul>
  26. 26. <ul><li>LEUKAEMIAS </li></ul><ul><li>Retinopathy </li></ul><ul><li>Venous tortuosity & dilatation </li></ul><ul><li>Flame shaped H’ge & ROTH SPOTS </li></ul><ul><li>Cotton wool spots </li></ul><ul><li>Peripheral retinal neovascularisation </li></ul><ul><li>LEOPARD SPOT RETINA </li></ul>
  27. 27. <ul><li>LEUKAEMIAS </li></ul>Leopard Spot Retina
  28. 28. <ul><li>JUVENILE XANTHOGRANULOMA </li></ul><ul><li>Vascular Tm. Affecting skin & eye </li></ul><ul><li>Important cause spontaneous hyphaema & </li></ul><ul><li>seconary glaucoma </li></ul>
  29. 29. <ul><li>Thank You </li></ul>

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