1) This document summarizes different types of uveitis including anterior uveitis, intermediate uveitis, and granulomatous anterior uveitis. It discusses various etiologies and presentations of each type.
2) Treatment recommendations are provided for each condition including topical and systemic medications as well as surgical interventions if needed. Conditions like tuberculosis, toxoplasmosis, sarcoidosis, Behcet's disease, and others are addressed.
3) The author argues that secularism does not answer existential questions about the meaning of life. While it promotes ideas of freedom and rationality, it does not provide spiritual guidance and can lead people to make wrong choices by thinking they have freedom
9. HLA B27
· The most common anterior uveitis 50%
· May be associated with “seronegative spondylo
arthropathies”: Reiter, Ankylosing spondylitis, psoraisis,
IBD.
· Not common in non whites
· Severe pain , injection , fibrinous reaction , posterior
synechiae
· Bacteria such as C hlamydia, Salmonella, Yersinia, and
Shigella have been associated.
10. If indicated:
· MR I : sacroiliac join and lumbar spine
· Swab or chlamydia, Shigella, Yersinia,
· No KPs : just dusting
· Pain on accomodation (pain may precede
the attack).
· Usually bilateral assymmetric and recur
11. causes
1. Idiopathic (1% of HLAB27 will have uveitis).
2. Ankylosing spondylitis : MRI back : most
common cause of AAU in male.
3. IBD : investigate for Calprotectin Sulfasalazine
4. Reiter : Azithromycin single dose ,, urine
and conj swab ( Urethritis →
conjunctivitis→ arthritis → uveitis)
5. Psoraisis → 20% arthritis → 20% AAU ,,
bilateral simultaneous
6. Bacterial infection trigger
15. POSNER-SCHLOSSMAN
SYNDROME (glaucmato cyclitic crisis)
· Male ,, unilateral uveitic glaucoma
· CMV
· Central white KPs with variable size
· No synechie no vitritis no heterochromia
· Between attacks : only optic cup
16.
17. FUCHS’ IRIDOCYCLITIS
· Floaters are he main complain
· Rubella
· FUS is a chronic, anterior, granulomatous
with vitreous involvement .
· unilateral (90% of cases)
· ciliary injection and posterior synechiae are
never present and should be viewed as exclusion
criteria.
· Unilateral nuclear cat and OAG.
18. · Diffuse iris atrophy and
white coloration of the
pupillary border (eroded
pupillary border) .
· Hyphema during cataract
· TTT : glaucoma no
steroids
22. · Fine vessels (arrows) are seen crossing the trabecular meshwork. This neovascularization is
not accompanied by a fibrovascular membrane and does not result in peripheral anterior
synechiae formation and secondary angle closure
42. · Excess cells no flare (iris is seen well)
less pain less injection ,, posterior
synechia with back of the iris
43. Behcet’s disease
· Recurrent oral ulcer + 2 of four :
· Genital ulcer
· Skin lesions
· Uvitis
· Pethergy test
· Hypopyon is not common 25% - short living
– no fibrin
44.
45. · bilateral ( > 70%). Posterior/ panuveitis
is the most common form
· HLA-B 51
· Ocular signs : explosive anterior uveitis
Vitritis, necrotizing retinitis, retinal
vasculitis, retinal hemorrhages, retinal
edema, vitreous hemorrhage, capillary
dropout , retinal neovascularization,
46.
47.
48. TUBULOINTERSTITIAL
NEPHRITIS
· acute, bilateral (DD : behcet ,
psoraisis HLAB27) anterior uveitis
with fever, fatigue, and malaise. It
occurs more often in children < 20
· Generally, the uveitis occurs up o 1
year prior to onset of renal symptoms
49. · Autoantibodies formation in response to certain antibiotics
or NSAID administration is the presumed eitiology.
Diagnosis by tubulointerstitial infiltration and necrosis with
preserved glomeruli and CD4 lymphocytic infiltration
52. Post streptococcal uveitis
· unilateral or bilateral uveitis with positive anti-streptolysin
O titres (ASOT) or anti-deoxyribonuclease (anti-DNase)
titres, throat culture and negative routine investigations for
other causes of uveitis.
· Age < 16 ys
· Mostly 2 weeks after pharyngitis
· Anterior uveitis / intermediate / sclerokeratitis/
papillophlepitis
· TTT as JIA
53. Anterior uveitis in elderly
· DM
· HZO / other infections
· Cancer ( Breast / Meningioma)
· O ischemic $
· lymphoma
54.
55.
56.
57.
58. · Secularism and liberalism do not give us the
answer: Why are we here? Who created the
universe ? What should we do in our life?
Where will we go after life? But it only gives
us false slogans about freedom, conscience,
humanity and rationality, the face of which is
compassion and its interior is the impulse
behind animal instincts, lusts and desires.
60. Patient
· Young adult and children (20% of
pediatric uveitis)
· Bilateral but assymetric > 80% : dilate
both eyes
· 75% will have BCVA > 0.5 after 5 yrs
62. signs
· Anterior segment : low grade cells, Kps
· Vitreous cells (lymphocytes)
· Snowballs : aggregates of cells
· vasculitis of peripheral veins / occlusive
· NVE lead to vit.Hge more in children
· Exaudates on the parsplana then collagen
production lead to snowbank = chronic
· ONH edema / optic neuritis
64. causes
· Idiopathic pars planitis >70%
· MS : anterior uveitis,, posterior synechia,,
vasculitis,, less macular edema,, optic neuritis.
MS can appear years after uvitis
· Sarcoidosis : band keratopathy, symblepharon
and conj deposits, black race, choroidal lesion,
Ex RD
· Others : Lyme/IBD/$/TB/ whipple
65. DD
· ALL Uveitis
· Lymphoma
· Anteror Uvitis spill or treated or
Fuch’s
· Endogenous endophth
· TB / Toxoplasma
66. Lab
· CBC/ VDRL and FTA – ABS
· Old age , suspected lymphoma : MRI // CSF
cytology or diagnostic Vx
· Tropical area : Borreilla borgdorfi antibodies
· Sarcoidosis : CXR // serum ACE , Ca++
· MS : Enhanced MRI
· Toxocara ab
· PPD
68. Vision loss
· CME √√
· RD exaudative / T- rhegmatogenous may be
chronic / NV and traction can produce huge
break or total RD 360
· Vit hge
· ERM
· CNV
· Glaucoma
· Cataract
· Band k
· Cyclitic membrane and atrophia
71. TTT
· Topical steroids : for anterior segment affection
· Periocular TAAC (2-3 injections) for unilateral
cases
· Systemic steroids : for bilateral or cases not
respond to periocular after exx of TB
· Intravitreal TAAC for CME ,, intravitreal
Fluocinolone implant for resistant cases
· Systemic immune suppressive : for resistant
cases and as steroid sparing :
cyclosporine/azathioprine
72. Biologic agents
· Adalimumab ; for pediatric use and
steroid resistant cases
· Infliximab (antiTNF)
· Interferon B for MS
73. · Cryo in patients with NVE and
recurrent vit Hge
· Argon laser is alternative
· PP Vx for steroid responders, resistant
CME and retinal traction
· Cataract surgery after patient is cell
free for 3-6 months and IOL is
controversery
74. · Whoever thinks he has possessed himself by emancipation
from religion is mistaken. A person did not come to the world
with his freedom, and he did not choose his parents, and he
would not leave it with his freedom, and he could not protect
his body from diseases or his immune system from attacking
his eye or control his heartbeat or intestinal movements, so
how can a person possess himself? He only had to answer an
exam that he did not enter voluntarily, and he would not leave
it willingly, and he could not change the questions. Only the
secular person can choose the wrong answer and think that he
owned himself and his freedom ..