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Inflammatory
glaucoma
• Inflammatory glaucoma, also
known as uveitic glaucoma, is a
condition in which ocular
inflammation causes a
persistent o...
Diagnostic dilemmas:
1-IOP fluctuation :very sever in
inflammatory glaucoma
2-cillary body shut down:occuring
in acute exa...
• Pathogenesis
Intraocular pressure is regulated by a
balance between aqueous humor
production and its outflow. During
epi...
Classification:
1-open angle
2-closed angle
3-Posner-Schlossman syndrom
1-open angle:
A- acute:either d.t.
-trabeculitis
-trabecular obestraction
B-chronic:
-d.t. trabecular scarring or
sclerosis 2ny to trabeculitis
-defecult to diagnose
2-closed angle:
A- with seclusio pupillae
B-with PAS:mainly in
granulomatous inflamation
c/p:
1-open angle :
A-aute:
-IOP
-open angle
-sign of uveitis
-+/- keratitis
B-chorinic:
-IOP
-open angle
-no active inflammation
-sign of pervious episiod
-disc ,field changes
2-closed angle:
A- with seclusio pupillae:
-IOP
-seclusio pupillae
-iris bombe
-shallow AC
-appositional angle closure
-si...
B-with synechial closure:
-IOP
-shallow AC
- angle closure
-sign of previous epesiod
• D.D:
-Steriod induced
-pig.glaucoma
-neovascular
-PEX
TTT:
• Medical:
The following drug is CI:
1-miotics
2-PG analogue
3-biremonidine
4-metipranolol
• So, the 1st
line of ttt is B-blocker
Then we may use :
-CIA (systemic or topical)
-Alpha agonist
• TTT of uvitis :
• Steriod
• Cycloplegic
• Cyclosporin
• Cytotoxic drugs
Laser PI:
• Should be large &multiple
• Intensive topical steriod
Surgical ttt:
A-pre-op precutions:
1-control uveitis for 3 m
2-topical steriod
3-systemic steriod
Intra –op precautions:
1-aviod combined cat –trab.
Surgery
2- use MMC
3-tight scleral suture to aviod
hypotony
Post op.:
•...
2-GDD:
If trab with MMC failed
Has good result
valves with Small surface area
are preferred
2 step surgery to avoid hypoto...
3-cyclodestruction :
May cause:
-increase inf.
-sever hypotony
Posner-Schlossman:
• unilateral recurrent episodes of
mild cyclitis and heterochromia.
• Its pathogenesis still remains
un...
Symp.:
• Blurring of vision
• Haloes
• No pain
• No redness
Sign:
• The IOP is in the range of 40 – 70
mmHg during an acute attack
• Minimal flare
• Few cells
• Few KPs
• No PAS&PS
•...
D.D:
• Prodromal stage of ACG-----other
eye shallow AC
• Disc form kiratitis------decrease
corneal sensation
Ttt:
• Sterio...
Fuch's Heterochromic
Iridocyclitis
• Def.:chronic non-granulomatous
ant. Uveitis
• age: middle
• Sex: F
• Unilat.
Symp:
• Decrease VA
• Floaters
• heterochoromia
Sign:
• White eye
• Cornea:KPs
• Iris:
-atrophy
-irir nodule
-heterochoromia
-no PS
• Angle:neovasculrization
• Vit.:vitri...
Ttt:
• Posterior subtenon steriod
• vitrectomy
HSV ant. Uveitis:
• Granuloatous ant. Uveitis
• IOP
• Sectoral iris atrophy
• Spontanous hyphema
• Corneal sign
Ttt:
• Ste...
Juvenile idiopathic
arthritis:
• Inf.arthritis lasting at least for
6wks befor the age of 16
• Classification:
-pauciartic...
• Ant.
• Unilat
• Chronic
• Non-granulomatous
Symp.:
• Asymptomatic
• VA
• Floaters
Sign:
• White eye
• Band keratopathy
• KPs
• Flare &cells
• PS
• CAT
• Glaucoma
• Vitritis
Ttt:
• Screening
• Topical ster...
Thank you
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
Inflammatory glaucoma by dr. Nermin
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Inflammatory glaucoma by dr. Nermin

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Transcript of "Inflammatory glaucoma by dr. Nermin"

  1. 1. Inflammatory glaucoma
  2. 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. 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. 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. 5. Classification: 1-open angle 2-closed angle 3-Posner-Schlossman syndrom
  6. 6. 1-open angle: A- acute:either d.t. -trabeculitis -trabecular obestraction
  7. 7. B-chronic: -d.t. trabecular scarring or sclerosis 2ny to trabeculitis -defecult to diagnose
  8. 8. 2-closed angle: A- with seclusio pupillae B-with PAS:mainly in granulomatous inflamation
  9. 9. c/p: 1-open angle : A-aute: -IOP -open angle -sign of uveitis -+/- keratitis
  10. 10. B-chorinic: -IOP -open angle -no active inflammation -sign of pervious episiod -disc ,field changes
  11. 11. 2-closed angle: A- with seclusio pupillae: -IOP -seclusio pupillae -iris bombe -shallow AC -appositional angle closure -sign of previous epesiod
  12. 12. B-with synechial closure: -IOP -shallow AC - angle closure -sign of previous epesiod
  13. 13. • D.D: -Steriod induced -pig.glaucoma -neovascular -PEX
  14. 14. TTT: • Medical: The following drug is CI: 1-miotics 2-PG analogue 3-biremonidine 4-metipranolol
  15. 15. • So, the 1st line of ttt is B-blocker Then we may use : -CIA (systemic or topical) -Alpha agonist
  16. 16. • TTT of uvitis : • Steriod • Cycloplegic • Cyclosporin • Cytotoxic drugs
  17. 17. Laser PI: • Should be large &multiple • Intensive topical steriod
  18. 18. Surgical ttt: A-pre-op precutions: 1-control uveitis for 3 m 2-topical steriod 3-systemic steriod
  19. 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. 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. 21. 3-cyclodestruction : May cause: -increase inf. -sever hypotony
  22. 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. 23. Symp.: • Blurring of vision • Haloes • No pain • No redness
  24. 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. 25. D.D: • Prodromal stage of ACG-----other eye shallow AC • Disc form kiratitis------decrease corneal sensation Ttt: • Steriod Aquas subresent
  26. 26. Fuch's Heterochromic Iridocyclitis • Def.:chronic non-granulomatous ant. Uveitis • age: middle • Sex: F • Unilat.
  27. 27. Symp: • Decrease VA • Floaters • heterochoromia
  28. 28. Sign: • White eye • Cornea:KPs • Iris: -atrophy -irir nodule -heterochoromia -no PS • Angle:neovasculrization • Vit.:vitrites • Fundus : • systemic
  29. 29. Ttt: • Posterior subtenon steriod • vitrectomy
  30. 30. HSV ant. Uveitis: • Granuloatous ant. Uveitis • IOP • Sectoral iris atrophy • Spontanous hyphema • Corneal sign Ttt: • Steriod • Oral aciclovire
  31. 31. Juvenile idiopathic arthritis: • Inf.arthritis lasting at least for 6wks befor the age of 16 • Classification: -pauciarticular -polyarticular -systemic onset
  32. 32. • Ant. • Unilat • Chronic • Non-granulomatous Symp.: • Asymptomatic • VA • Floaters
  33. 33. Sign: • White eye • Band keratopathy • KPs • Flare &cells • PS • CAT • Glaucoma • Vitritis Ttt: • Screening • Topical steriod
  34. 34. Thank you
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