Miscellaneous anterior and posterior uveitis
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Miscellaneous anterior and posterior uveitis
- 2. Fuch heterochromic iridocyclitis Chronic non-granulomatous specific uveitis usually unilateral 90% 3rd – 4th decades M:F – 1:1 4% all cases of uveitis
- 3. Presentation Chronic annoying vitreous floaters Gradual blurring of vision Colour difference between two eyes Incidental detection General signs Absent posterior synechiae KP Small iris nodules AC—faint flare,mild cellular reaction Vitritis
- 4. Diffuse iris atrophy Loss of iris crypts Stromal atrophy Posterior pigment layer atrophy Heterochromia Determined by iridis Degree of atrophy Natural iris colour Hypochromia Reverse heterochromia
- 5. Gonioscopy Radial twig like vessels Amsler sign Peripheral anterior synechiae Complications Cataract Glaucoma Treatment Posterior sub tenon steroids Vitrecomy
- 6. Phacoanaphylactic endophthalmitis 1. Presentation Signs Granulomatous anterior uveitis Raised IOP Differential diagnosis Days to weeks after rupture of lens capsule Bacterial endophthalmitis Toxic reaction Treatment Removal of lens matter Intensive steroid therapy Prolonged surgery
- 7. Phacogenic Signs Within 2-3 weeks of capsule rupture Less severe Differential diagnosis non-granulomatous uveitis Lowgrade bacterial and fungal endophthalmitis SO or IOL-induced inflammation Treatment Mild – Topical steroids Intense inflammation- Periocular or systemic steroids
- 8. Presentation 3rd decade Sudden diminution of central vision Signs 1 to 2 weeks after symptoms Resolve 6 to 12 weeks FFA Hyperfluorscence without leakage EOG Subnormal Treatment
- 9. Differential diagnosis Rubella retinitis Acute macular neuroretinopathy Punctate inner choroidopathy Central serous retinochoroidopathy
- 10. Presentation 2nd to 4th decade Sudden severe loss of central vision Signs RD at macula with irregular outline Intraretinal hemorrhages Iritis, papillitis and mild vitritis Resolve with in few weeks FFA Early phase-mild hyperfluorescence Venous phase-staining of SRF Treatment
- 11. Differential diagnosis Idiopathic choroidal neovascularization Central serous chorioretinopathy VKH syndrome Serpiginous choroidopathy Posterior scleritis Placoid syphilitic retinitis RPE detachment Acute posterior multifocal placoid pigment epitheliopathy
- 12. Presentation 3rd to 4th decade Sudden onset mild visual loss Signs Multiple areas of retinitis Mild vitritis,disc edema Macular star Recovery – 2-4 months Treatment
- 13. Presentation Mild visual loss and floaters Signs Discrete choroidal elevations SRF and macular star Treatment Active vision threatning-systemic steroids Inactive – resolve spontaneously
- 14. Differential Inflammatory lesions diagnosis Sarcoid choroiditis Tuberculosis Histoplasma choroiditis Toxoplasma retinochoroiditis Nodular posterior scleritis Amelanotic tumour e;g melanoma Metastasis
- 15. Primary FBA Children and young adults Secondary FBA Associated with infectious retinitis,CRVO Presentation Sub acute visual loss Floaters and/or photopsia Signs Florid translucent perivascular sheathing Anterior uveitis,vitritis and retinal edema Treatment Systemic or topical steroids
Editor's Notes
- Chronic,usuallyunilateral,low grade pan uveitis with rapid cataract formation and high risk of sec open angle glaucoma.
- Blurring sec to cataract formationKP—characteristic small ,round or stellate and grey white,,scattered throughout endothelium,,often ass with feathery fibrin filamentsVitritis may be dense enugh to reduce vision
- Earliest—loss of iris cryptsAdvanced stromal atrophy---particularly in pupillary zone---prominent radialn iris blood vesselsPost p layer --- best seen on reteroilluminationHeterochromia---prominent in day light---easily seen in green eyes----frequently hypochromic effected eyeReverse heterochromia---in blue eyes---stromal atrophy—post pigment layer prominent
- Amsler sign---vessels in angle cause filliform hemorrhages on ant chamber paracentesisPAS---are small irregular non confluentCataract---extremely common,commences at post capsule ,, results of surgery with PCIOL are goodGlaucoma—late menifestation,,after several years,,,usually controlled on topical therapyRx –long acting steroids triamcinolone acetonoid improvement is temporaryVitrectomy—for severe vitreous opacification===topical steroids are ineffective/mydriatics unnecessary coz no post synechae
- It is triggered by immune response to lens proteins following rupture of lens capsule due to trauma or incomplete cataract extractionPresentation-sudden pain ful diminution of visionIf mild inflammation trial of topical steroid therapy and early review 6 to 24 hrs---if no improvement—rx bacterial uveitis
- Rare ,idiopathic ,,self limiting ,, unilateral in 75%Macula---2-4 discrete clusters of subtle grey spots at the level of RPE surrounded by hypopigmented yellow halosAfter resolution vision return to normal--- recurrence is un commonTreatment not required
- 1.Salt and pepper pigmentary disturbance involving periphery and post pole2.Brown red wedge shaped lesion at macula,,,FFA– faint hypofluorescence,,,ERG –normal 3.Multiple small yellow-white spots at post pole,resolve after few weeks,,,ERG- normal4.Round to oval detachment of sensory retina at macula,,,FFA—smoke stack pattern of hyperfluorescence
- Very rare ,,self limiting,,frequently unilateral may be preceded by a flu like illnessSigns--- small greyish subretinalthickning at the level of RPE bulls eye appearance may develop following resolution,,,may be ass with visual loss
- VKH syndrom—multifocal detachment of sensory retina and in chronic phase –RPE atrophy—FFA—multifocalhyperFSerpiginous—grey white lesion start at disc spread to macula –FFA—inactive lesion hyperF window defectPost scleritis—exudative RD,choroidal foldsPost placoid syphilitic---bilateral,largesolitary,placoid pale yellow subretinal lesionsAPMPPE– multiple large,yellowwhite,placoid lesions at post pole—lead to RPE disturbance----FFA –late hyperF due to staining
- Very rare,,frequentlybilateral,,selflimiting,,typically affect healthy individuals,,,may be preceded by flu like illness signs----multiple areas of retinitis post to equatorRecovery ---fundus lesion resolve and vision recoversRx –not required
- Signs---discrete post equitorial dull yellow choroidal elevations with ill defined margins associated with adjacent SRF and Macular star away from lesioninflammatiom resolves---better defined margins with resolution of SRF and exudate
- Sarcoid– multifocal choroiditis,,retinal granulomas-small discrete yellow white lesionsTB—unilateral focal or less frequently multifocal choroiditis,,large solitary choroidal granulomas are un commonHistopl—acute lesion islocalisedchoroidal swelling,,histo spots—round yellow white 200 um ,,mid peripheryToxopl—solitary inflammatory focus ,multiple foci r un commonMelanoma—solitary elevated subretinal dome shaped mass,,ass with exudative RD adjascentMets—fast growing creamy white placoid lesions---
- Usually bilateral occur in 2 formsSigns—florid translucent perivascular sheathing both arteries and veins uncommon findings---papilitis ,hard exudate, retinal hemorrhage and venous occlusionTeatment= no optimal regimen is estb.Primary form has good visual prognosis but significant visual loss may occur in secondary form