Common Causes of Uveitis Part1
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www.ophthalclass.blogspot.com has the complete post. In Part1 the topics discussed are the causes of anterior, intermediate, posterior and panuveitis. There is also a section on the associated features like history, demographics and examination findings that help to narrow down the differential diagnosis.
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Common Causes of Uveitis Part1
- 2. International Uveitis Study Group (IUSG) ◦ Anatomic Classification of Uveitis Anterior Intermediate Posterior Panuveitis www.ophthalclass.blogspot.com
- 3. Infectious ◦ Bacterial / Viral / Fungal / Parasitic / Others Non-infectious ◦ Known/No known systemic association Masquerade ◦ Neoplastic / Non-neoplastic www.ophthalclass.blogspot.com
- 4. Non-infectious can be considered also as immune related causes Masquerade syndromes will be dealt with separately Idiopathic cause is included in all the uveitis www.ophthalclass.blogspot.com
- 5. Anterior uveitis Immune Idiopathic Infectious related www.ophthalclass.blogspot.com
- 6. Intermediate uveitis Immune Idiopathic Infectious related www.ophthalclass.blogspot.com
- 7. Posterior uveitis Immune Idiopathic Infectious related www.ophthalclass.blogspot.com
- 8. Panuveitis Immune Idiopathic Infectious related www.ophthalclass.blogspot.com
- 9. Idiopathic Infectious Immune related • Most common • Herpes simplex • HLA B27+/ seronegative • Diagnosis only • Herpes zoster spondylo- after other • Tuberculosis arthropathies causes are ruled • Syphilis out • Juvenile rheumatoid arthritis (JRA) • Lens or IOL related www.ophthalclass.blogspot.com
- 10. Immune Idiopathic Infectious related • Most • Tuberculosis • Sarcoidosis common • Syphilis • Multiple • Only after sclerosis • Lyme disease other causes are ruled out www.ophthalclass.blogspot.com
- 11. Infectious Immune related Idiopathic • Less common • Toxoplasmosis • Sarcoidosis • Toxocariasis • Collagen vascular diseases • Herpes • Retinochoroidop (ARN/PORN/CMV) athies • Tuberculosis, syphilis www.ophthalclass.blogspot.com
- 12. Idiopathic Infectious Immune related • After ruling out • Tuberculosis, • Sarcoidosis other causes syphilis • Vogt – Kayanagi • Lyme disease – Harada syndrome • Leptospirosis • Sympathetic • Infectious ophthalmitis endophthalmitis • Beh et syndrome www.ophthalclass.blogspot.com
- 13. List of diseases can be very long indeed Patient is NOT investigated for ALL the diseases Narrow down the differential diagnosis before ordering the lab tests www.ophthalclass.blogspot.com
- 14. Narrow down the differential diagnosis with ◦ Time course of disease ◦ Type of inflammation ◦ Characteristic pattern of the lesion ◦ Demographic data – age, sex, race, social history ◦ Associated systemic features www.ophthalclass.blogspot.com
- 15. Anterior uveitis is the most common type of uveitis Idiopathic form is the most common cause of anterior uveitis Infections are more common in posterior uveitis Sarcoidosis, tuberculosis and syphilis can present in any or all locations www.ophthalclass.blogspot.com
- 16. Acute Sudden onset, lasting up to 6 weeks Chronic Insiduous onset, lasting longer than 6 weeks Recurrent Repeated attacks with disease free intervals www.ophthalclass.blogspot.com
- 17. Acute Idiopathic anterior uveitis VKH syndrome Chronic JRA Tuberculous uveitis Sarcoidosis Recurrent Idiopathic anterior uveitis VKH syndrome www.ophthalclass.blogspot.com
- 18. Granulomatous Non-granulomatous Onset Insiduous Acute Keratic precipitates Large, greasy Fine Mutton-fat, white White coloured Macrophages and Lymphocytes and epithelioid cells plasma cells Iris nodules Generally absent Koeppe (at pupillary border) Busacca (on iris surface) www.ophthalclass.blogspot.com
- 19. Granulomatous Non-granulomatous Fundus Uncommon Choroidal nodules/granulomas Course Chronic Maybe self limited Posterior synechiae Broad based Fine Causes Suggestive of few Many anterior uveitic specific conditions diseases More commonly Not helpful in infectious formulating differential diagnosis www.ophthalclass.blogspot.com
- 25. • Tuberculosis, syphilis • Sarcoidosis • Vogt – Koyanagi – Harada Granulomatous syndrome uveitis • Sympathetic ophthalmitis • Intraocular foreign body • Lens induced uveitis www.ophthalclass.blogspot.com
- 26. Children JRA (anterior) Toxocariasis (posterior) Adults Ankylosing spondylitis, Reiter syndrome (anterior) VKH, Beh et syndrome (panuveitis) Elderly Idiopathic Masquerade syndromes www.ophthalclass.blogspot.com
- 27. Any age Toxoplasmosis Tuberculosis Sarcoidosis www.ophthalclass.blogspot.com
- 29. Asians VKH, Beh et syndrome Blacks Sarcoidosis Whites Ankylosing spondylitis, Reiter syndrome HLA B27+ www.ophthalclass.blogspot.com
- 30. Pets / cat feces • Toxoplasmosis contact Contaminated water • Leptospirosis / rodent urine Farmers / • Brucellosis veterinarians • Tuberculosis, syphilis, HIV History of exposure www.ophthalclass.blogspot.com