ocular - systemic

2.  TUBERCULOSIS
 LEPROSY
 SARCOIDOSIS

3.  PHLYCTENULAR KERATO
CONJUNCTIVITIS:
- Etiology: Delayed hypersensitivity type 4 CM
response to endogenous microbial
proteins(tuberculous)
* Presents as whitish raised nodule on bulbar
conjunctiva with hyperaemia of surrounding
conjunctiva in a child living in bad hygiene
conditions

4.  PATHOLOGY:
1. Stage of nodule formation
2. Stage of ulceration
3. Stage of granulation
4. Stage of healing
 CLINICAL FEATURES:
Mild discomfort in eye
Irritation
Reflex watering
 SIGNS: SIMPLE, NECROTIC, MILIARY.

5.  PHLYCTENULAR KERATITIS:
1. Ulcerative phlyctenular keratitis:
a. Sacrofulous ulcer
b. Fascicular ulcer
c. Miliary ulcer
2. Diffuse infiltrative keratitis
 CLINICAL COURSE:
self limiting & phlycten disappears in 8-10 days
.....no trace left. Recurrences are very common.

6.  ANATOMICAL CLASSIFICATION:
 Anterior: iritis, iridocyclitis, anterior cyclitis
 Intermediate
 Posterior
 Panuveitis
 CLINICAL CLASSIFICATION:
 Acute , chronic , recurrent
 PATHOLOGICAL CLASSIFICATION:
 Suppurative/purulent & non suppurative

10.  Wood’s classification...Nongranulomatous &
Granulomatous
 ETIOLOGICAL CLASSIFICATION:
Infective, immune related, toxic, traumatic ,
idiopathic, a/w non infective systemic disease.
* TB, LEPROSY,SARCOIDOSIS ...All are
granulomatous ......sarcoidosis being non
infective.

11.  In response to irritant foreign
body..inorganic/organic material introduced
from outside; hemorrhagic/necrotic tissue
within eye; organisms- non pyogenic & non
virulent.
 C/b granuloma formation...eventually
giantcells aggregate to form nodules.
 Iris nodules near pupillary
border.......KOEPPE’S NODULES
 Near collarette....BUSACCA NODULES

13.  Nodular collection at back of
cornea...mutton fat KERATIC
PRECIPITATES. Aqueos flare minimal.
 Necrosis in adjacent structures leads to
fibrosis & gliosis (reparative process).
 CHARACTERISTICS OF
GRANULOMATOUS UVEITIS:
insidious onset, min pain, slight
photophobia, min ciliary congestion, thick
&broad based posterior synechiae, nodular
lesions in fundus.

15.  NON SPECIFIC Rx:
a. Local therapy- 1.cycloplegic drugs
2.corticosteroids
3.BSA drops
b. Systemic therapy-
1.corticosteroids
2.NSAIDS
3.immunosuppressives
4.azithromycin/tc/
erythromycin

16. c. Physical measures: 1. hot fomentation
2. dark goggles
 SPECIFIC Rx OF THE CAUSE:
 TREATMENT OF COMPLICATIONS:
1. inflammatory glaucoma
2. postinflammatory glaucoma
3. complicated catarct
4. retinal detachment
5. pthisis bulbi

17.  TUBERCULAR UVEITIS:
-Chronic granulomatous infection
-human or bovine tubercle bacilli
-both anterior & posterior uveitis
-common cause of uveitis
- accoumts for 1% of uveitis in developed
countries.
- In India, still a common cause.

18. 1. Tubercular anterior uveitis :
- may occur as acute non granulomatous
iridocyclitis or granulomatous anterior
uveitis (miliary tuberclar iritis / solitary
tuberculoma )
2. Tubercular posterior uveitis:
a) Multiple miliary tubercles: in choroid
-appear as round yellow white nodules
-usually a/w tubercular meningitis.

20. b) Douse or multifocal choroiditis: occurs in
chronic tuberculosis.
c) Choroidal granuloma ....rarely as a focal
lesion.
3. Vasculitis: Eales disease

21.  INTERSTITIAL KERATITIS:
- Form of deep keratitis
- Inflammation of corneal stroma w/o primary
involvement of epithelium/endothelium.
-More frequently unilateral & sectorial(lower part of
cornea).
• CLINICAL FEATURES:
• Initial progressive stage
• Florid stage
• Stage of regression
 Scleritis & Episcleritis also occur .

22.  DIAGNOSIS:
1. X-Ray Chest
2. Mantoux test
3. TLC,DLC,ESR
4. Intractable uveitis – unresponsive to
steroids.
5. Isoniazid test (dramatic response of iritis to
isoniazid).

23.  TREATMENT:
1. Local therapy: Atropine
Antibiotics
Topical steroids
2. Specific therapy: ANTI TUBERCULAR
DRUGS.
* General measures : Vitamins A, C ,D in case of
children along with high protein supplemented
diet (phlyctenular keratoconjuctivitis) .

24.  HANSEN’S DISEASE
 Mycobacterium leprae
 Lepromatous & tuberculoid forms
 Conjunctivitis
 Neurotrophic keratopathy.....loss of corneal
nerve sensations.
 Involves anterior uvea

26.  Lepromatous uveitis may be acute iritis (non
granulomatius) & chronic iritis (
granulomatous).
 Acute : Caused by antigen-antibody
deposition & c/b severe exudative reaction.
 Chronic: Direct organism invasion & c/b
presence of small glistening ‘iris pearls’ near
pupillary margin.....in a necklace form.

28.  small pearls enlarge & coalesce to form
large pearls .
 rarely lepromata nodule may be seen.
 TREATMENT:
 Local therapy of iridocyclitis
 Antileprotic Rx – Dapsone 50-100 mg daily

30.  Sarcoidosis in conjunctiva.
 UVEITIS IN SARCOIDOSIS
- Granulomatous multi-system disease
- affects young adults(20-50); females more
common
- Presents with b/l hilar lymphadenopathy ,
pulmonary infiltration, skin & ocular lesions.

31.  OCULAR LESIONS :
 Occur in 20-50% patients with
sarcoidosis .
 Include-
 sarcoid uveitis
 conjunctival lesions
 lacrimal gland involvement.

32.  SARCOID UVEITIS : 2% cases
 Anterior uveitis : Presents as granulomatous
iridocyclitis c/b iris nodules, large mutton fat
KPs, anterior chamber cells & flare , posterior
synechiae.
 Intermediate uveitis : c/b vitreous cells,
snowball opacities, snow banking.

35.  Posterior / pan uveitis : includes –
choroidal & retinal granulomas , cystoid
macular oedema, periphlebitis retinae with
sheathing....appear as Candle wax
droppings.
* Peripheral multifocal chorioretinitis: c/b small
punched out atrophic spots....highly
suggestive of sarcoidosis.

37.  UVEO PAROTID FEVER ( Heerfordt’s
syndrome):
C/b – b/l granulomatous panuveitis , painful
enlargement of parotid glands, cranial nerve
palsies, skin rashes , fever, malaise.
 COMPLICATIONS :
 complicated cataract
 inflammatory glaucoma
 cystoid macular oedema

39.  Conjunctival lesions :
sarcoid nodules & kerato conjunctivitis sicca
 Lacrimal glands : Enlarged
a/w diffuse swelling of salivary glands –
MICKULICZ’S SYNDROME.

41.  DIAGNOSIS: If suspected clinically, then
supported by- positive Kveim test, abN Xray
chest(90%cases), raised levels of serum
ACE.
 Confirmation- biopsy of conj.nodule,skin
lesion, enlarged LN.
 TREATMENT: Topical , periocular ,
systemic steroids ....depending on severity.