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Anterior UVEitis.pptx
- 2. Uveitis • Inflammation of the uveal tissue CLASSIFICATION Anatomical Anterior Intermediate Posterior Panuveitis Pathological 1.Suppurative 2.Non suppurative a) Granulomatous b) Non Uveitis
- 3. • It is inflammation of the uveal tissue from iris up to pars plicata of ciliary body Anterior Uveitis
- 4. • Iritis • Iridocyclitis • Cyclitis CLASSIFICATION
- 5. • Infectious, traumatic, neoplastic, autoimmune, idiopathic • Inflammation of the uvea • Inflammatory response: chemical mediators result in vasodilation, increased vascular permeability, and chemotaxis of inflammatory cells in eye. PATHOPHYSIOLOGY
- 6. • Infectious uveitis • Non-infectious uveitis ETIOLOGY
- 7. BACTERIA Syphilis Tuberculosis Chronic post-operative endophthalmitis from propiono-bacterium acnes PROTOZOA Toxoplasmosis Toxocariasis VIRUSES Herpes simplex Varicella zoster FUNGI Candida INFECTIOUS UVEITIS
- 8. • Associated with systemic disease • Sarcoidosis • Behcets disease • Juvenile idiopathic arthritis • Collagen vascular disease • Wegener’s granulomatosis • Polyarteritis nodosa • HLA-B27 associated Psoriatic arthropathy, Crohns disease, ulcerative colitis, ankylosing spondylitis, Reiters syndrome Idiopathic Autoimmune
- 9. CLINICAL FEATURES • Acute: Symptoms more severe • Chronic: Signs more severe than signs
- 10. • PAIN: Acute Severe dull aching throbbing Radiates along V1 nerve distribution Worst at night • REDNESS Due to circumcorneal congestion, • PHOTOPHOBIA & BLEPHEROSPASAM . SYMPTOMS
- 11. • DEFECTIVE VISION • TURBID AQUEOUS • Sec. glaucoma • Vitreous exudates • Ciliary spasm • Exudates in pupillary area • Complicated Cataract • Cystoid Macular Edema • LACRIMATION lacrimatory reflex mediated by fifth nerve (afferent) & secretomotor fibres of the seventh nerve (efferent)
- 12. 1) Lid Edema 2) Circumcorneal congestion SIGNS
- 13. 3. CORNEAL SIGNS: a) Corneal edema d/t toxic endothelitis & increased IOP a) Keratitis precipitates • Cellular deposits on the corneal endothelium • Arlt’s triangle
- 14. • Small & medium: − pathognomic of nongranulomatous uveitis − composed of lymphocyte − Small KPs may be hundreds in number endothelial dusting. • large (mutton fat) − occur in granulomatous iridocyclitis − composed of epithelioid cells & macrophages.
- 15. • Red KP: − Inflammatory cells & RBCs − Haemorrhagic uveitis. • Old KP: − Sign of healed uveitis − Ground glass appearance due to hyalinization. C) Posterior corneal opacities
- 16. 1. Aqueous cells − Early feature of iridocyclitis − The cells should be counted in an oblique slit-lamp beam, 3- mm long and 1-mm wide, with maximal light intensity and magnification ANTERIOR CHAMBER SIGNS
- 17. 2) AQUEOUS FLARE − leakage of protein particles into the aqueous humour − point of beam projected on the iris plane − Protein particles seen floating the beam of light:
- 19. 3) HYPOPYON 4) HYPHAEMA 5) IRREGULAR AC DEPTH D/T SYNECHIA 6) DEPOSITS OF DEBRIS IN ANTERIOR CHAMBER ANGLE 7) ANTERIOR SYNECHIA
- 20. • Loss of normal pattern • Changes in iris colour −Muddy in color in active stage & hyper/ hypopigmented • Iris nodules − Aggregations of lymphyocytes and epitheloid cells. IRIS SIGNS
- 22. • POSTERIOR SYNECHIAE Adhesion of post. Surf. Of iris to ant. Surf of lens
- 23. • Segmental • Annular − 360 degree adhesions − Seclusio pupillae –block aq flow from post to ant chamber − Iris bomb • Total Plastering of total posterior surface of iris with the anterior capsule of lens
- 24. • SLUGGISH PUPILLARY REACTION& MIOSIS Irritation of sphincter pupillae by toxin • IRREGULAR PUPIL festooned pupil Pupillary signs
- 25. • OCCULSIO PUPIL Pupil is completely occluded due to organisation of the exudates across the entire pupillary area. • ECTROPION PUPILLAE − Evertion of pupillary margin −It may develop due to contraction of fibrinous exudate on the anterior surface of the iris.
- 26. • Pigment dispersion on lens surface • Fibrin exudates on lens surface • Complicated cataract −Polychromatic lusture Bread crumb appearance −Early posterior subcapsular opacities Changes in the lens
- 27. • Exudates and inflammatory cells Change in the vitreous
- 29. Secondary glaucoma Early glaucoma − In active phase of disease − Due to exudates & inflammatory cells in Ant Chamber angle blocking the Trabecular meshwork − Decreased aqueous flow leading to increased IOP (Hypertensive Glaucoma)
- 30. Late Glaucoma −Post Inflammatory Glaucoma −D/t pupillary block (Seclusio Pupil/Occlusio pupil) −Causes Iris Bombe then occlusion Trabecular Meshwork −Decreased aqueous outflow
- 31. CYCLITIC MEMBRANE − Retrolental, fibrovascular membrane which stretches across the back of the lens
- 32. CHOROIDITIS
- 33. RETINAL SIGNS − Cystoid Macular Degeneration − Macular Degeneration − Serous Retinal Detachment − Secondary periphlebitis retinae. − PAPILLITIS -inflammation of the optic disc. − Band-shaped KERATOPATHY. It occurs as a complication of long-standing chronic uveitis
- 34. • Phthisis bulbi − It is the final stage end result of any form of chronic uveitis − ciliary body is disorganised − aqueous production is hampered. − Eye becomes soft, shrinks and eventually becomes a small atrophic globe
- 36. INVESTIGATION
- 37. Hematological Examination −TLC/DC: Gross idea of inflammatory response of body −ESR: r/o Chronic infection −Blood sugar: r/o DM −Blood Uric Acid: r/o Gout −Seological Test: Syphilis, toxoplasmosis & histoplasmosis −Test : Antinuclear Antibodies, CRP, Rh factor Anti-streptolysin O
- 38. Urine Examination • For WBC, Pus cells, RBS • Culture : r/o Urinary tract infection Stool Examination • For Cysts & ova to r/o parasitic infestations. Radiological Investigation • Skin Tests:Tuberculin test, & Toxoplasmin test.
- 39. RADIOLOGICAL EXAMINATION • CXR, Paranasal sinus, Sacroiliac joints,Lumbar spine. • CT scan high resolution thorax for suspecting sarcoidosis • MRI of head for suspecting sarcoidosis,demyelination & lymphomas
- 40. TREATMENT Non- specific treatment Local therapy Systemic therapy Specific Treatment T/t of Complications
- 41. NON-SPECIFIC TREATMENT:LOCAL THERAPY 1. Cycloplegics 2. Corticosteroids 3. Broad spectrum antibiotics
- 42. CYCLOPLEGICS Short acting cycloplegics Tropicamide 1% e/d (3hrs) Cyclopentolate 1% e/d (24hrs) – 3-4 times a day Long acting cycloplegics Homatropine 2% e/d (4days) – 3-4 times a day Atropine sulphate 1% e/d (7- 14days) – 2-3 times a day 0.25 ml mydricain -mixture of atropine, adrenaline and procaine cycloplegics should be continued for at least 2-3 weeks after the eye becomes quiet, otherwise relapse may occur.
- 43. MODE OF ACTIONS OF CYCLOPLEGICS • Relieves pain: Relieves spasm of iris sphincter & ciliary muscle • Prevents posterior synechiae formation • Breaks posterior synechiae • Reduces hyperemia & vascular permeability which reduces exudation
- 44. Corticosteroids LONG ACTING Dexamethasone Betamethasone Hydrocortisone Prednisolone Triamcinolone SHORT ACTING Fluoromethalone Loteprednol Fluocinolone MOA : Antifibrotic activity, they reduce fibrosis and thus prevent disorganisation and destruction of the tissues
- 45. ROUTE OF ADMINISTRATION • Topical Eye drops 6 times a day • Eye ointments at bed time, • Anterior subtenon injection For severe cases
- 46. BROAD SPECTRUM ANTIBIOTIC • Doesn’t have much role in anterior uveitis • Prescribed with topical steroid preparations to provide an umbrella cover for them.
- 47. SYSTEMIC THERAPY • Corticosteroids • Non-Steroidal Anti- inflammatory Drugs(NSAIDS) • Immunosupressives
- 48. CORTICOSTEROIDS • Indication: Intractable anterior uveitis • Prednisolone: 1mg/kg bd wt & taper gradually according to response • Dosage schedule : prednisolone (60-100mg) Daily therapy : marked inflammatory activity at least 2 week Alternate day therapy : In absence of a/c disease Dose is decreased by a week’s interval & taper completely in about 6-8 week
- 49. NON- STEROIDAL ANTI - INFLAMMATORY DRUGS • Used when steroid are contraindicated or not tolerated. • Phenylbutazone & oxyphenylbutazone
- 50. IMMUNOSUPPRESSIVES • In corticosteroid resistant or intolerant cases • In specific inflammations: Behcet’s syndrome Sympathetic ophthalmitis VKH(Vogt-Koyanagi-Harada) Pars planitis A few available cytotoxic immunosuppressive drugs include cyclophosphamide, chlorambucil, azathioprine and methotrexate.
- 51. SPECIFIC TREATMENT • Tuberculosis: ATT • Parenteral Penicillin: Syphilis • HSV: Acyclovir
- 52. PHYSICAL MEASURES 1. Hot fomentation 2. Dark goggles-Reducing photophobia, lacrimation and blepharospasm
- 53. TREATMENT OF COMPLICATION • Inflammatory Glaucoma Timolol 0.5% BD T.Acetazolamide 250mg BD Contraindicated are Latanoprost & Pilocarpine. • Post-inflammatory Glaucoma(d/t ring synechiea): Laser iridotomy • Complicated Cataract Cataract sx. After 3 mths of quiet period. • Retinal Detachment Anterior vitrectomy • Phthisis bulbi Enucleation
- 54. • Thank you