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Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
Panuveitis
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Panuveitis

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www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and …

www.ophthalclass.blogspot.com has the complete class and MCQs on uveitis for undergraduate medical students. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. The clinical feature of each of the disease entities is explained with the help of case studies.

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  • 1. Dr. Anupama Karanth
    www.ophthalclass.blogspot.com
    Panuveitis
  • 2. Classification of uveitis
    Anatomic Classification of Uveitis
    Anterior
    Intermediate
    Posterior
    Panuveitis
    Clinical Classification of Uveitis
  • 3. Anatomic classification
    Panuveitis
    Primary site of inflammation: anterior chamber, vitreous, retina or choroid
  • 4. Clinical Classification of Uveitis
    Infectious
    Bacterial / Viral / Fungal / Parasitic / Others
    Non-infectious
    Known/No known systemic association
    Masquerade
    Neoplastic / Non-neoplastic
  • 5. Panuveitis
  • 6. Definition
    It is a rare, bilateral, granulomatous panuveitis which occurs after penetrating ocular trauma to one eye, the injured eye is referred to as the exciting eye while the uninjured eye is the sympathizing eye.
    Sensitization to some intraocular antigen/s occurs and results in bilateral ocular inflammation
    Sympathetic ophthalmia
  • 7. Penetrating injury is the precursor
    Commoner after non-surgical trauma than surgical trauma
    Incarceration of uveal tissue in the wound is a risk factor
    In 80% of cases, presentation is between 2 weeks to 3 months after injury
    May even occur after 50 years
    Sympathetic ophthalmia
  • 8. Prodromal symptoms in the sympathizing eye (due to iridocyclitis)
    Photophobia
    Blurring to near objects (accommodation affected)
    Redness
    Early signs
    Keratic precipitates
    Retrolental cells and flare
    Sympathetic ophthalmia
  • 9. Granulomatous iridocyclitis
    Mutton-fat KPs
    Plastic iridocyclitis
    Vitritis
    Multiple yellow white nodules in the choroid – Dalen-Fuchs nodules
    Thickening of uveal tract
    Papillitis
    Can result in blindness in both eyes
    Established disease in both eyes
  • 10. Prophylaxis
    Enucleation of the injured eye before onset of sympathetic ophthalmia is the only way of prevention, usually within 2 weeks of injury
    ? Enucleation within 2 weeks of onset
    Therapy
    Corticosteroids – topical, periocular, systemic
    Antimetabolites and cyclosporine
    Therapy
  • 11. A few other common causes of panuveitis….
  • 12. 10 year history of recurrent bilateral granulomatous uveitis with waxing and waning exudative retinal detachments, on steroids and immunosuppressives…
    www.ophthalclass.blogspot.com
    http://www.aao.org/publications/eyenet/200804/am_rounds.cfm
  • 13.
    • Koeppe and Busacca nodules in the iris
    • Koeppe and Busacca nodules in the iris
    • 14. Extensive pigment alterations in the fundus
    • Koeppe and Busacca nodules in the iris
    • 15. Extensive pigment alterations in the fundus
    • 16. Dalen-Fuchs like peripheral nodules
    • Koeppe and Busacca nodules in the iris
    • 17. Extensive pigment alterations in the fundus
    • 18. Dalen-Fuchs like peripheral nodules
    • 19. Subretinal fibrosis
  • Bilateral granulomatous iridocyclitis
    Variable vitritis, exudative retinal detachments
    Commoner in pigmented races
    Associated extraocular features important in diagnosis
    CSF pleocytosis, neck stiffness, seizures, paralysis (CNS)
    Vitiligo, alopecia, poliosis (skin)
    Hearing loss and tinnitus (ear)
    Vogt-Koyanagi-Harada disease
  • 20. Diagnosis
    Classical clinical picture but rule out SO
    CSF lymphocytosis
    Management
    Vigorous use of steroids- local, periocular and systemic
    Immunosuppressives
    Vogt-Koyanagi-Harada disease
  • 21. A 50 year old diabetic with blurry vision…
    http://www.aao.org/publications/eyenet/200710/am_rounds.cfm
  • 22. Peripapillary atrophy
  • 23. Peripapillary atrophy
    Areas of RPE atrophy with underlying large choroidal vessels visible
  • 24. Peripapillary atrophy
    Areas of RPE atrophy with underlying large choroidal vessels visible
    Pigments in a bony spicule pattern adjacent to vessels
  • 25. Hereditary
    Retinitis pigmentosa
    Sequelae of auto-immune disease
    Toxic etiologies
    Chloroquine, thioridazine
    Sequelae of infectious disease
    Tuberculosis
    Syphilis
    Lyme disease
    D/D Pigmentary retinopathies
  • 26. RPR reactive and positive FTA-ABS…… syphilis
  • 27. Secondary syphilis
    Granulomatous iridocyclitis
    Iris roseola, iris papulosa, iris nodosa
    Focal/multifocal choroiditis
    Retinitis, perivasculitis
    Papillitis, neuroretinitis
    Syphilis – the great masquerader
  • 28. Management
    Ocular involvement to be treated as neurosyphilis
    CSF evaluation should be done in any syphilitic uveitis
    Penicillin G 2-5 million units IV 4th hourly – 2 weeks
    Steroids only after effective antibiotic therapy
    Syphilis – the great masquerader
  • 29. A 35 year old male patient with blurry vision…
  • 30. Hypopyon uveitis, nongranulomatous, vitritis
  • 31. Core lab tests…Mantoux highly positive, Chest x-ray suggestive….Tuberculosis
  • 32. Chronic iridocyclitis
    Granulomatous / nongranulomatous
    Choroiditis
    Focal / multifocal / choroidal tubercles
    Retinal vasculitis, vitritis, papillitis
    Difficulty - in establishing the diagnosis and ensuring treatment compliance
    Tuberculosis
  • 33. A 46 year old lady with floaters…
    http://www.aao.org/publications/eyenet/200801/am_rounds.cfm
  • 34. Granulomatous KPs, aqueous flare and cells
  • 35. Infections
    Tuberculosis
    Syphilis
    Lyme disease
    Non-infectious
    Sarcoidosis
    VKH syndrome
    D/D granulomatous iridocyclitis
  • 36. Chest x-ray, serum ACE…… elevated ACE, hilar lymphadenopathySarcoidosis
  • 37. Granulomatous KPs
    Bilateral hilar lymphadenopathy
    Conjunctival follicles
    Noncaseatinggranuloma
  • 38. Multisystem granulomatous disease
    Ocular findings
    Acute / chronic granulomatous iridocyclitis
    Vitreous snowballs
    Retinal periphlebitis, candle wax drippings
    Choroidal small or large granulomas
    Sarcoidosis
  • 39. Suspect in any uveitis
    Chest x-ray or CT, serum ACE and lysozyme
    Biopsy from skin / conjunctiva / lacrimal gland
    Management
    Corticosteroids – topical, periocular and systemic
    Immunosuppressives may be required
    Sarcoidosis
  • 40. Behçet’s disease
    Generalized occlusive vasculitis
    Four major criteria
    Oral aphthous ulcers
    Genital ulcers
    Skin – e.g. erythemanodosum
    Ocular inflammation
    Acute iritis with transient hypopyon
    Retinal arteritis, periphlebitis, vitritis
    Ocular disease recurrent and explosive
    Initial immunosuppressives indicated
  • 41. Aphthous ulcers
    Hypopyoniritis
    Occlusive vasculitis
    Sheathing and optic atrophy

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