Inflammatory glaucoma by dr. Nermin
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  • 1. Inflammatory glaucoma
  • 2. • Inflammatory glaucoma, also known as uveitic glaucoma, is a condition in which ocular inflammation causes a persistent or recurrent IOP elevation resulting in anatomical and physiological changes
  • 3. Diagnostic dilemmas: 1-IOP fluctuation :very sever in inflammatory glaucoma 2-cillary body shut down:occuring in acute exacerbation 3-steriod induced glaucoma 4-deficalty to assess fundus and pirmetry 5-iris vessels confuse with NVG
  • 4. • Pathogenesis Intraocular pressure is regulated by a balance between aqueous humor production and its outflow. During episodes of intraocular inflammation, IOP is typically reduced because of aqueous humor hyposecretion from ciliary body inflammation and increased uveoscleral outflow. Over time, multiple mechanisms can increase the resistance to aqueous outflow during episodes of uveitis, thereby leading to elevated IOP.
  • 5. Classification: 1-open angle 2-closed angle 3-Posner-Schlossman syndrom
  • 6. 1-open angle: A- acute:either d.t. -trabeculitis -trabecular obestraction
  • 7. B-chronic: -d.t. trabecular scarring or sclerosis 2ny to trabeculitis -defecult to diagnose
  • 8. 2-closed angle: A- with seclusio pupillae B-with PAS:mainly in granulomatous inflamation
  • 9. c/p: 1-open angle : A-aute: -IOP -open angle -sign of uveitis -+/- keratitis
  • 10. B-chorinic: -IOP -open angle -no active inflammation -sign of pervious episiod -disc ,field changes
  • 11. 2-closed angle: A- with seclusio pupillae: -IOP -seclusio pupillae -iris bombe -shallow AC -appositional angle closure -sign of previous epesiod
  • 12. B-with synechial closure: -IOP -shallow AC - angle closure -sign of previous epesiod
  • 13. • D.D: -Steriod induced -pig.glaucoma -neovascular -PEX
  • 14. TTT: • Medical: The following drug is CI: 1-miotics 2-PG analogue 3-biremonidine 4-metipranolol
  • 15. • So, the 1st line of ttt is B-blocker Then we may use : -CIA (systemic or topical) -Alpha agonist
  • 16. • TTT of uvitis : • Steriod • Cycloplegic • Cyclosporin • Cytotoxic drugs
  • 17. Laser PI: • Should be large &multiple • Intensive topical steriod
  • 18. Surgical ttt: A-pre-op precutions: 1-control uveitis for 3 m 2-topical steriod 3-systemic steriod
  • 19. Intra –op precautions: 1-aviod combined cat –trab. Surgery 2- use MMC 3-tight scleral suture to aviod hypotony Post op.: • Steriod tapered ccording to inflammation
  • 20. 2-GDD: If trab with MMC failed Has good result valves with Small surface area are preferred 2 step surgery to avoid hypotony
  • 21. 3-cyclodestruction : May cause: -increase inf. -sever hypotony
  • 22. Posner-Schlossman: • unilateral recurrent episodes of mild cyclitis and heterochromia. • Its pathogenesis still remains unknown, with suggested possible associations including an immunogenetic factor involving HLA-Bw54, viral infections (HSV and CMV)
  • 23. Symp.: • Blurring of vision • Haloes • No pain • No redness
  • 24. Sign: • The IOP is in the range of 40 – 70 mmHg during an acute attack • Minimal flare • Few cells • Few KPs • No PAS&PS • No shallow AC • Open angle
  • 25. D.D: • Prodromal stage of ACG-----other eye shallow AC • Disc form kiratitis------decrease corneal sensation Ttt: • Steriod Aquas subresent
  • 26. Fuch's Heterochromic Iridocyclitis • Def.:chronic non-granulomatous ant. Uveitis • age: middle • Sex: F • Unilat.
  • 27. Symp: • Decrease VA • Floaters • heterochoromia
  • 28. Sign: • White eye • Cornea:KPs • Iris: -atrophy -irir nodule -heterochoromia -no PS • Angle:neovasculrization • Vit.:vitrites • Fundus : • systemic
  • 29. Ttt: • Posterior subtenon steriod • vitrectomy
  • 30. HSV ant. Uveitis: • Granuloatous ant. Uveitis • IOP • Sectoral iris atrophy • Spontanous hyphema • Corneal sign Ttt: • Steriod • Oral aciclovire
  • 31. Juvenile idiopathic arthritis: • Inf.arthritis lasting at least for 6wks befor the age of 16 • Classification: -pauciarticular -polyarticular -systemic onset
  • 32. • Ant. • Unilat • Chronic • Non-granulomatous Symp.: • Asymptomatic • VA • Floaters
  • 33. Sign: • White eye • Band keratopathy • KPs • Flare &cells • PS • CAT • Glaucoma • Vitritis Ttt: • Screening • Topical steriod
  • 34. Thank you