Ocular manifestations of AIDS
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This document discusses ocular manifestations of HIV/AIDS. It begins by describing HIV/AIDS etiology, noting that HIV-1 is the most common type worldwide. It then discusses various ocular manifestations associated with different CD4 counts, including Kaposi's sarcoma, CMV retinitis, and HIV retinopathy. Specific conditions of the anterior segment like molluscum contagiosum and of the posterior segment like CMV retinitis are then described in more detail, including characteristics, treatment options, and images. The document emphasizes that CMV retinitis is the most common opportunistic infection and discusses antiviral treatments for it like ganciclovir and foscarnet. It concludes by noting
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Fungal keratitis
Fungal keratitis is a serious ocular infection that can lead to blindness. It is most common in tropical climates and developing nations. Common causative organisms include Aspergillus, Fusarium, and Candida. Risk factors include ocular trauma, contact lens use, and pre-existing ocular surface disease. Symptoms are mild but signs include dry-looking ulcers with feathery margins. Diagnosis involves KOH microscopy and culture of corneal scrapings. Treatment requires prolonged topical antifungals like natamycin or voriconazole alongside debridement. Surgery may be needed for severe or non-resolving cases to prevent blindness.
Ocular manifestations in aids
1) Ocular manifestations occur in around 75% of AIDS patients and can be an early indicator of the disease. They include retinal microvasculopathy, opportunistic infections like CMV retinitis, and unusual neoplasms.
2) Retinal microvasculopathy is caused by a vasoocclusive process due to the direct effects of HIV on blood vessels, presenting as cotton wool spots, hemorrhages, and microaneurysms.
3) Common opportunistic infections affecting the eye are CMV retinitis, the leading cause of blindness in AIDS patients, Candida endophthalmitis, Cryptococcal infections, and Pneumocystis choroiditis.
Ocular toxoplasmosis
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It is the most common cause of infectious posterior uveitis worldwide. The parasite infects one third of humans by ingesting tissue cysts in undercooked meat or oocysts from cat feces. It reproduces sexually in cats and asexually in other hosts. Retinochoroiditis is the most common manifestation and presents as focal necrotizing inflammation. Diagnosis is clinical based on lesions and supported by serology. Treatment involves anti-protozoal medications depending on severity to prevent complications affecting vision.
Interstitial keratitis
Interstitial keratitis, also known as stromal keratitis, is a non-suppurative inflammation of the corneal stroma that can be caused by both infectious and non-infectious diseases. It is characterized by cellular infiltration and vascularization of the corneal stroma with minimal involvement of the corneal epithelium or endothelium. Congenital syphilis is a classic cause of interstitial keratitis. Stromal keratitis associated with congenital syphilis typically begins between ages 5-15, presents bilaterally, and can lead to diffuse corneal inflammation, edema, and neovascularization if left untreated. Acquired syphilis less commonly causes unilateral stromal keratitis, which
Disorders of eyelids
Congenital ptosis, coloboma, epicanthus, and distichiasis are common congenital eyelid anomalies. Blepharitis is a chronic inflammation of the lid margins that can be anterior (squamous or ulcerative) or posterior (meibomitis) in nature. Hordeolum (stye) is an acute suppurative infection of the eyelash follicle or meibomian gland that presents as a tender, red swelling and is usually caused by Staphylococcus aureus. Chalazion is a chronic non-infectious cyst of the meibomian gland that appears as a painless, firm nodule.
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3) It has distinct prodromal, uveitic, chronic, and chronic recurrent stages with characteristic ocular and systemic findings at each stage. International criteria have been developed to classify its complete, incomplete, and probable forms.
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Fungal keratitis
Fungal keratitis is a serious ocular infection that can lead to blindness. It is most common in tropical climates and developing nations. Common causative organisms include Aspergillus, Fusarium, and Candida. Risk factors include ocular trauma, contact lens use, and pre-existing ocular surface disease. Symptoms are mild but signs include dry-looking ulcers with feathery margins. Diagnosis involves KOH microscopy and culture of corneal scrapings. Treatment requires prolonged topical antifungals like natamycin or voriconazole alongside debridement. Surgery may be needed for severe or non-resolving cases to prevent blindness.
Ocular manifestations in aids
1) Ocular manifestations occur in around 75% of AIDS patients and can be an early indicator of the disease. They include retinal microvasculopathy, opportunistic infections like CMV retinitis, and unusual neoplasms.
2) Retinal microvasculopathy is caused by a vasoocclusive process due to the direct effects of HIV on blood vessels, presenting as cotton wool spots, hemorrhages, and microaneurysms.
3) Common opportunistic infections affecting the eye are CMV retinitis, the leading cause of blindness in AIDS patients, Candida endophthalmitis, Cryptococcal infections, and Pneumocystis choroiditis.
Ocular toxoplasmosis
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Interstitial keratitis
Interstitial keratitis, also known as stromal keratitis, is a non-suppurative inflammation of the corneal stroma that can be caused by both infectious and non-infectious diseases. It is characterized by cellular infiltration and vascularization of the corneal stroma with minimal involvement of the corneal epithelium or endothelium. Congenital syphilis is a classic cause of interstitial keratitis. Stromal keratitis associated with congenital syphilis typically begins between ages 5-15, presents bilaterally, and can lead to diffuse corneal inflammation, edema, and neovascularization if left untreated. Acquired syphilis less commonly causes unilateral stromal keratitis, which
Disorders of eyelids
Congenital ptosis, coloboma, epicanthus, and distichiasis are common congenital eyelid anomalies. Blepharitis is a chronic inflammation of the lid margins that can be anterior (squamous or ulcerative) or posterior (meibomitis) in nature. Hordeolum (stye) is an acute suppurative infection of the eyelash follicle or meibomian gland that presents as a tender, red swelling and is usually caused by Staphylococcus aureus. Chalazion is a chronic non-infectious cyst of the meibomian gland that appears as a painless, firm nodule.
Acanthamoeba keratitis
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Viral keratitis
Viral keratitis is commonly caused by herpes simplex virus types 1 and 2 and varicella zoster virus. HSV keratitis typically presents as dendritic ulcers or geographic ulcers on the cornea. It can also cause stromal keratitis. Varicella zoster virus causes herpes zoster infection which presents with a painful rash that follows dermatomal patterns, and can also lead to keratitis. Adenovirus is another common cause and presents as punctate epithelial keratitis that may develop into nummular opacities. Treatment involves topical antivirals and steroids depending on the type and severity of infection.
Congenital corneal disorders
This document discusses the embryology and anatomy of the cornea. It describes how the cornea develops from surface ectoderm in the 4th-5th week of gestation, with mesenchymal cells forming the stroma and endothelium. The cornea continues developing through the fetal period, with layers such as Bowman's membrane forming between 12-26 weeks. The document also discusses the cellular components, functions, and common congenital anomalies of the cornea, including microcornea, megalocornea, cornea plana, keratoconus, and others.
Paralytic squint
PARALYTIC SQUINT
KANISHK DEEP SHARMA
ROLL NO. 50
Uncoordinated eye movement
Angle of squint varies
Motor imbalance
ETIOLOGY
Lesion of nerve
Lesion of muscles
Lesions due to
Injury
Inflammation-syphilis, disseminated sclerosis
Vascular diseases-hemorrhage, aneurysm,arteriosclerosis
Neoplasms-brain tumor
Toxins-alcohol, lead, carbon monoxide
Degeneration-chronic nuclear ophthalmoplegia
Myasthenia gravis
SYMPTOMS
DIPLOPIA
In field of action of paralyzed muscle
Long duration- suppression of false image
Vertigo & nausea
Action required towards paralysed muscle
False projection
Binocular diplopia
Secondry deviation
Defective ocular motility
Complementary head postures
Attempt to lessen diplopia
Head tilt to avoid torsion
SEQUALAE
Weakness of paretic muscle
Overacting contralateral synergistic muscle
Inhibitory palsy of contralateral antagonist
TESTS
Record of visual acuity
Ocular motility
Perimetry
Inspection of compensatory head postures
Diplopia charting
Dark room procedure
Armstrong's glasses
4ft distance, fine linear light
Primary & other positions of gaze measured
Hess charting
Explains muscle paralysis & pathological sequlae
Field of binocular fixation
Forced duction test
MANAGEMENT
Treatment of cause
Conservative measures
Vit B complex, systemic steroids
Diplopia treatment
Occluder on affected eye
SURGERIES
Muscle weakening procedure
Recession, marginal myotomy, myectomy
Muscle strengthening procedures
Resection, tucking advancement
Changing direction of muscle action
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Scleritis1
This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.
Vitreous degeneration
Vitreous degeneration occurs as the vitreous gel in the eye begins to liquefy and shrink with age. This can cause floaters which appear as spots or lines moving in the vision. In advanced cases, the vitreous may detach from the retina. There are three main types: benign floaters which do not affect vision, symptomatic floaters which cause flashes of light and may lead to retinal detachment, and degenerative vitreous syndrome which severely impacts vision. While floaters typically do not require treatment, retinal tears or detachments may require laser treatment or vitrectomy surgery to remove the vitreous gel.
Mooren’s ulcer
Marginal corneal ulcer, also known as Mooren's ulcer, is a rare degenerative ulcer that starts at the corneal margin and spreads circumferentially and axially over the cornea. It is a rapidly progressive and painful ulcerative keratitis that can only be diagnosed in the absence of a systemic cause. It must be differentiated from other corneal abnormalities. Benign cases are unilateral, respond well to treatment, and affect elderly people, while malignant cases are bilateral, respond poorly to treatment, and affect younger people in a progressive manner. It is considered an autoimmune disorder associated with infections and various theories about antigen-antibody reactions and molecular mimicry stimulating an autoimmune response.
Ocular manifestations of hiv
Ocular Manifestations of HIV outlines common eye diseases seen in patients with HIV/AIDS. A study in Ethiopia found 60% of HIV patients had at least one ocular manifestation, most commonly retinal microvasculopathy (24%). Posterior segment manifestations include opportunistic infections like cytomegalovirus retinitis (30-40% of patients) and varicella zoster virus retinitis. Neuro-ophthalmic manifestations occur in 10-15% of patients and include optic neuritis, optic atrophy, and cranial nerve palsies. Children with HIV have fewer ocular manifestations than adults.
Viral corneal ulcer
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
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Sclera is the opaque outer fibrous tunic of the eyeball. Diseases of the sclera include episcleritis, which involves inflammation of the outer episcleral layer, and scleritis, which is a deeper inflammation of the sclera proper. Scleritis can be non-necrotizing or necrotizing, and is often associated with autoimmune disorders. Other scleral conditions include blue sclera seen in certain genetic disorders, and staphylomas which are localized bulgings of a weakened sclera lined by inner ocular layers.
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This document discusses cytomegalovirus retinitis (CMVR), which is caused by cytomegalovirus infection and most commonly affects immunocompromised individuals. It presents the pathogenesis, clinical presentation, diagnosis, differential diagnosis and treatment of CMVR. The clinical presentation of CMVR ranges from asymptomatic to vision loss and includes retinal lesions that progress in a brushfire manner. Diagnosis involves clinical examination supplemented by laboratory tests when needed. Treatment involves antiviral drugs like ganciclovir, foscarnet and cidofovir.
Endopthalmitis
Post-operative endophthalmitis is a severe inflammation of the inner eye that can occur after any eye surgery. It is most common after cataract surgery. Common causes are bacteria such as staphylococcus and streptococcus entering the eye during or after surgery. Symptoms include eye pain, redness, blurred vision and hypopyon within 1 week of surgery. Treatment involves intravitreal injections of antibiotics such as vancomycin and amikacin to achieve high drug levels, along with supportive therapies like steroids to reduce inflammation. Proper surgical technique and antibiotic prophylaxis can help reduce risk of this potentially blinding complication.
Exudative Retinal Detachment
Exudative retinal detachment develops when fluid collects in the subretinal space.
The subretinal space between the photoreceptors and the retinal pigment epithelium is the remnant of the embryonic optic vesicle.
In the developed eye the subretinal space is of minimal size, but it can reopen under pathological conditions that disrupt the integrity of blood-retinal barrier.
Inflammatory, infectious, infiltrative, neoplastic, vascular, and degenerative conditions may be associated with blood-retinal barrier breakdown and the sequential development of exudative retinal detachment.
This elaborate on the pathogenesis and the differential diagnosis of exudative retinal detachment and specifically discuss the spectrum of diseases associated with exudative retinal detachment in uveitis clinics.
Synechia
Ocular synechiae are abnormal adhesions of the iris to other ocular structures that can be caused by inflammation or trauma. Anterior synechiae involve the iris adhering to the cornea, while posterior synechiae involve the iris adhering to the lens or vitreous. This can block the normal flow of aqueous humor and cause glaucoma. Synechiae are generally treated by breaking up adhesions with mydriatic drugs or surgery like laser iridotomy. Managing any underlying conditions like uveitis is also important to prevent future synechiae formation.
Rapd
This document discusses pupillary evaluation techniques including the direct and consensual light reflex test and near reflex test. It describes the anatomy of the pupil and visual pathway. The light reflex and near reflex are examined to assess the integrity of the pupillary light reflex pathway. An afferent pupillary defect can indicate damage anywhere along the visual pathway from the retina to the lateral geniculate body and presents as a reduction in pupil contraction when one eye is stimulated compared to the other. The document grades the severity of relative afferent pupillary defects and lists potential causes.
Floaters and Flashes in the Eye
At Retina Associates in Tucson, Arizona, Dr. Cameron Javid and his colleagues treat a wide variety of conditions related to the vitreous gel and retinal structures. Retina Associates frequently welcomes patients with flashes and floaters.
Viral retinitis
1. Viral retinitis, such as cytomegalovirus (CMV) retinitis, can occur in immunocompromised individuals and requires aggressive treatment.
2. CMV retinitis presents as areas of hemorrhage, whitening, and necrosis of the retina and typically occurs along the retinal arcades.
3. Treatment involves the use of antiviral drugs like ganciclovir, valganciclovir, cidofovir, and foscarnet to treat active infections and prevent recurrence in high-risk patients.
Systemic Eye Diseases
This document discusses several systemic diseases that can affect the eyes, including:
- Hypertensive retinopathy, which can damage the retina, choroid and optic nerve due to high blood pressure. It is classified based on the severity of retinal vascular changes.
- Dysthyroid eye disease, also known as Graves' ophthalmopathy, which is associated with thyroid disease and causes proptosis, lid retraction, and inflammation of extraocular muscles and orbital fat. It can also lead to intraocular issues like choroidal folds.
- Uveitis, which is inflammation of the uveal tract that can be anterior, intermediate, or posterior based on location. It has various causes and presentations.
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Viral keratitis
Viral keratitis is commonly caused by herpes simplex virus types 1 and 2 and varicella zoster virus. HSV keratitis typically presents as dendritic ulcers or geographic ulcers on the cornea. It can also cause stromal keratitis. Varicella zoster virus causes herpes zoster infection which presents with a painful rash that follows dermatomal patterns, and can also lead to keratitis. Adenovirus is another common cause and presents as punctate epithelial keratitis that may develop into nummular opacities. Treatment involves topical antivirals and steroids depending on the type and severity of infection.
Congenital corneal disorders
This document discusses the embryology and anatomy of the cornea. It describes how the cornea develops from surface ectoderm in the 4th-5th week of gestation, with mesenchymal cells forming the stroma and endothelium. The cornea continues developing through the fetal period, with layers such as Bowman's membrane forming between 12-26 weeks. The document also discusses the cellular components, functions, and common congenital anomalies of the cornea, including microcornea, megalocornea, cornea plana, keratoconus, and others.
Paralytic squint
PARALYTIC SQUINT
KANISHK DEEP SHARMA
ROLL NO. 50
Uncoordinated eye movement
Angle of squint varies
Motor imbalance
ETIOLOGY
Lesion of nerve
Lesion of muscles
Lesions due to
Injury
Inflammation-syphilis, disseminated sclerosis
Vascular diseases-hemorrhage, aneurysm,arteriosclerosis
Neoplasms-brain tumor
Toxins-alcohol, lead, carbon monoxide
Degeneration-chronic nuclear ophthalmoplegia
Myasthenia gravis
SYMPTOMS
DIPLOPIA
In field of action of paralyzed muscle
Long duration- suppression of false image
Vertigo & nausea
Action required towards paralysed muscle
False projection
Binocular diplopia
Secondry deviation
Defective ocular motility
Complementary head postures
Attempt to lessen diplopia
Head tilt to avoid torsion
SEQUALAE
Weakness of paretic muscle
Overacting contralateral synergistic muscle
Inhibitory palsy of contralateral antagonist
TESTS
Record of visual acuity
Ocular motility
Perimetry
Inspection of compensatory head postures
Diplopia charting
Dark room procedure
Armstrong's glasses
4ft distance, fine linear light
Primary & other positions of gaze measured
Hess charting
Explains muscle paralysis & pathological sequlae
Field of binocular fixation
Forced duction test
MANAGEMENT
Treatment of cause
Conservative measures
Vit B complex, systemic steroids
Diplopia treatment
Occluder on affected eye
SURGERIES
Muscle weakening procedure
Recession, marginal myotomy, myectomy
Muscle strengthening procedures
Resection, tucking advancement
Changing direction of muscle action
THANK YOU
Vitreous hemorrhage
Vitreous hemorrhage occurs when blood leaks into the vitreous humor of the eye. It can be nondispersed, allowing some retinal view, or dispersed throughout the vitreous. Common causes include diabetic retinopathy, retinal vein occlusion, trauma, and posterior vitreous detachment. Patients experience painless vision loss and floaters. Examination may show a red eye or obscured retina. Treatment focuses on the underlying cause through laser, surgery, or observation depending on severity and risk factors.
Scleritis1
This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.
Vitreous degeneration
Vitreous degeneration occurs as the vitreous gel in the eye begins to liquefy and shrink with age. This can cause floaters which appear as spots or lines moving in the vision. In advanced cases, the vitreous may detach from the retina. There are three main types: benign floaters which do not affect vision, symptomatic floaters which cause flashes of light and may lead to retinal detachment, and degenerative vitreous syndrome which severely impacts vision. While floaters typically do not require treatment, retinal tears or detachments may require laser treatment or vitrectomy surgery to remove the vitreous gel.
Mooren’s ulcer
Marginal corneal ulcer, also known as Mooren's ulcer, is a rare degenerative ulcer that starts at the corneal margin and spreads circumferentially and axially over the cornea. It is a rapidly progressive and painful ulcerative keratitis that can only be diagnosed in the absence of a systemic cause. It must be differentiated from other corneal abnormalities. Benign cases are unilateral, respond well to treatment, and affect elderly people, while malignant cases are bilateral, respond poorly to treatment, and affect younger people in a progressive manner. It is considered an autoimmune disorder associated with infections and various theories about antigen-antibody reactions and molecular mimicry stimulating an autoimmune response.
Ocular manifestations of hiv
Ocular Manifestations of HIV outlines common eye diseases seen in patients with HIV/AIDS. A study in Ethiopia found 60% of HIV patients had at least one ocular manifestation, most commonly retinal microvasculopathy (24%). Posterior segment manifestations include opportunistic infections like cytomegalovirus retinitis (30-40% of patients) and varicella zoster virus retinitis. Neuro-ophthalmic manifestations occur in 10-15% of patients and include optic neuritis, optic atrophy, and cranial nerve palsies. Children with HIV have fewer ocular manifestations than adults.
Viral corneal ulcer
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
viral corneal ulcer
This document discusses various viral and protozoal causes of corneal ulcers, including herpes simplex virus (HSV), herpes zoster virus, and acanthamoeba. It describes the etiology, clinical features, diagnosis, and treatment of these conditions. Primary and recurrent HSV keratitis present with punctate epithelial lesions and dendritic ulcers. Herpes zoster ophthalmicus causes vesicular skin lesions following reactivation of varicella zoster virus in the trigeminal ganglion. Acanthamoeba keratitis is an opportunistic infection associated with contact lens use that presents with epithelial lesions and stromal infiltrates. Treatment involves antiviral medications for viruses and anti-am
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This document provides an overview of central serous chorioretinopathy (CSC), including its pathogenesis, clinical presentation, diagnosis, course and treatment. CSC is characterized by a localized serous retinal detachment in the macula due to leakage of fluid from the choroid. It typically affects men ages 30-50 and can be associated with stress, corticosteroid use, hypertension and type A personality. Diagnosis is usually clinical but can be confirmed with fluorescein angiography showing characteristic leakage patterns or optical coherence tomography identifying subretinal fluid. While most cases resolve spontaneously, laser photocoagulation or photodynamic therapy may be used in persistent or recurrent cases to seal leaking sites and accelerate resolution.
Diseases of sclera ppt ophthalmology
Sclera is the opaque outer fibrous tunic of the eyeball. Diseases of the sclera include episcleritis, which involves inflammation of the outer episcleral layer, and scleritis, which is a deeper inflammation of the sclera proper. Scleritis can be non-necrotizing or necrotizing, and is often associated with autoimmune disorders. Other scleral conditions include blue sclera seen in certain genetic disorders, and staphylomas which are localized bulgings of a weakened sclera lined by inner ocular layers.
Cmv retinitis
This document discusses cytomegalovirus retinitis (CMVR), which is caused by cytomegalovirus infection and most commonly affects immunocompromised individuals. It presents the pathogenesis, clinical presentation, diagnosis, differential diagnosis and treatment of CMVR. The clinical presentation of CMVR ranges from asymptomatic to vision loss and includes retinal lesions that progress in a brushfire manner. Diagnosis involves clinical examination supplemented by laboratory tests when needed. Treatment involves antiviral drugs like ganciclovir, foscarnet and cidofovir.
Endopthalmitis
Post-operative endophthalmitis is a severe inflammation of the inner eye that can occur after any eye surgery. It is most common after cataract surgery. Common causes are bacteria such as staphylococcus and streptococcus entering the eye during or after surgery. Symptoms include eye pain, redness, blurred vision and hypopyon within 1 week of surgery. Treatment involves intravitreal injections of antibiotics such as vancomycin and amikacin to achieve high drug levels, along with supportive therapies like steroids to reduce inflammation. Proper surgical technique and antibiotic prophylaxis can help reduce risk of this potentially blinding complication.
Exudative Retinal Detachment
Exudative retinal detachment develops when fluid collects in the subretinal space.
The subretinal space between the photoreceptors and the retinal pigment epithelium is the remnant of the embryonic optic vesicle.
In the developed eye the subretinal space is of minimal size, but it can reopen under pathological conditions that disrupt the integrity of blood-retinal barrier.
Inflammatory, infectious, infiltrative, neoplastic, vascular, and degenerative conditions may be associated with blood-retinal barrier breakdown and the sequential development of exudative retinal detachment.
This elaborate on the pathogenesis and the differential diagnosis of exudative retinal detachment and specifically discuss the spectrum of diseases associated with exudative retinal detachment in uveitis clinics.
Synechia
Ocular synechiae are abnormal adhesions of the iris to other ocular structures that can be caused by inflammation or trauma. Anterior synechiae involve the iris adhering to the cornea, while posterior synechiae involve the iris adhering to the lens or vitreous. This can block the normal flow of aqueous humor and cause glaucoma. Synechiae are generally treated by breaking up adhesions with mydriatic drugs or surgery like laser iridotomy. Managing any underlying conditions like uveitis is also important to prevent future synechiae formation.
Rapd
This document discusses pupillary evaluation techniques including the direct and consensual light reflex test and near reflex test. It describes the anatomy of the pupil and visual pathway. The light reflex and near reflex are examined to assess the integrity of the pupillary light reflex pathway. An afferent pupillary defect can indicate damage anywhere along the visual pathway from the retina to the lateral geniculate body and presents as a reduction in pupil contraction when one eye is stimulated compared to the other. The document grades the severity of relative afferent pupillary defects and lists potential causes.
Floaters and Flashes in the Eye
At Retina Associates in Tucson, Arizona, Dr. Cameron Javid and his colleagues treat a wide variety of conditions related to the vitreous gel and retinal structures. Retina Associates frequently welcomes patients with flashes and floaters.
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Viral retinitis
1. Viral retinitis, such as cytomegalovirus (CMV) retinitis, can occur in immunocompromised individuals and requires aggressive treatment.
2. CMV retinitis presents as areas of hemorrhage, whitening, and necrosis of the retina and typically occurs along the retinal arcades.
3. Treatment involves the use of antiviral drugs like ganciclovir, valganciclovir, cidofovir, and foscarnet to treat active infections and prevent recurrence in high-risk patients.
Systemic Eye Diseases
This document discusses several systemic diseases that can affect the eyes, including:
- Hypertensive retinopathy, which can damage the retina, choroid and optic nerve due to high blood pressure. It is classified based on the severity of retinal vascular changes.
- Dysthyroid eye disease, also known as Graves' ophthalmopathy, which is associated with thyroid disease and causes proptosis, lid retraction, and inflammation of extraocular muscles and orbital fat. It can also lead to intraocular issues like choroidal folds.
- Uveitis, which is inflammation of the uveal tract that can be anterior, intermediate, or posterior based on location. It has various causes and presentations.
Bacterial eyelid infections and blepharitis.
This document discusses bacterial infections and blepharitis that can affect the eyelids. It begins by covering the anatomy of the eyelid and then describes several specific bacterial infections including external hordeolum, impetigo, erysipelas, necrotizing fasciitis, anthrax, and syphilis. It then discusses blepharitis in detail, describing the different types (staphylococcal, seborrheic, posterior), associated conditions like meibomian gland dysfunction, symptoms, signs, treatment, and complications.
Sarcoidosis
Sarcoidosis is a chronic multisystem inflammatory disorder characterized by non-caseating granulomas in affected tissues. Common organs involved are the lungs, lymph nodes, eyes, skin and heart. Ocular involvement occurs in 40% of sarcoidosis patients, most commonly presenting as uveitis. Uveitis manifestations include anterior uveitis, intermediate uveitis, posterior uveitis, scleritis, conjunctivitis, keratopathy and optic nerve involvement. Treatment involves topical, periocular or intraocular corticosteroids. Systemic corticosteroids or immunosuppressive drugs are used for more severe or treatment resistant disease.
ACUTE CONJUNCTIVITIS pptn.pptx
1. Acute conjunctivitis is an inflammation of the conjunctiva that is usually caused by bacterial or viral infections. It is characterized by redness, swelling, and discharge from the eye.
2. Ocular defenses against infection include tears, the tear film, conjunctival and corneal epithelia, immune cells, and normal bacterial flora.
3. Conjunctivitis is classified based on onset, type of discharge, and conjunctival response. Etiologies include infectious agents like bacteria, viruses, and parasites as well as non-infectious causes.
4. Bacterial conjunctivitis is often acute and contagious, requiring topical antibiotic treatment.
Cornea -immune mediated disorders
This document summarizes various corneal pathologies and diseases. It discusses corneal opacities, edema, ulcers caused by bacteria, viruses, fungi and parasites. It also covers immunologically mediated corneal diseases like phlyctenular keratitis, chronic serpiginous ulcer, interstitial keratitis and disciform keratitis. The document provides details on the presentation, signs, symptoms, diagnosis and treatment of these conditions.
Diabetic retinopathy
Diabetic retinopathy can cause vision loss in two main ways: by damaging blood vessels that leak and blur vision, or by fluid leakage into the macula from the damaged vessels causing swelling and blurring. Regular eye exams are important for all people with diabetes, as they are at risk. Early signs of retinopathy include microaneurysms and hemorrhages. Laser treatment can be used to seal leaking blood vessels and prevent further vision loss from proliferative retinopathy. Newer treatments include anti-VEGF drugs that inhibit abnormal blood vessel growth. Tight blood sugar and blood pressure control are also important to prevent and slow the progression of diabetic retinopathy.
MICROBIAL AND PARASITIC INFECTIONS OF THE EYE.pptx
This document discusses various microbial and parasitic infections that can affect the eye. It covers lid infections like styes, hordeolums, and chalazions caused by staphylococcal or meibomian gland infections. It also discusses blepharitis, demodex, and parasitic infections like phthiriasis palpebrum. Orbital cellulitis and its complications are described. Infections of the lacrimal system like dacryocystitis and dacryoadenitis are covered. The document concludes with details on various types of conjunctivitis including bacterial, viral like adenovirus, and parasitic forms such as trachoma.
Uveitis its clinical features and management.pptx
uveitis condition mainly focusing on its basic anatomy, basic general classification and its clinical features including common symptoms and signs along with pathology, common complications, investigations including both systemic and ocular, treatment and a short summary.
POST UVEITIS SEMINAR.pptx
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Viral keratitis
This document discusses viral keratitis, specifically herpes simplex virus (HSV) keratitis. It describes that HSV is a common cause of corneal blindness. HSV can cause a variety of ocular manifestations including dendritic ulcers, geographic ulcers, neurotrophic keratitis, stromal keratitis, and endothelitis. Treatment involves topical antiviral medications like acyclovir. Recurrent infections may lead to complications such as stromal scarring.
Intermediate uveitis
This document discusses intermediate uveitis (IU), which involves inflammation in the anterior vitreous, pars plana, and peripheral retina. IU accounts for 8-22% of uveitis cases. Clinically, it is characterized by "snowballs" or yellow-white exudates in the peripheral vitreous. Treatment involves topical/periocular steroids initially, with cryotherapy, vitrectomy or immunosuppressants for non-responsive cases. Complications include cystoid macular edema, cataracts, glaucoma, and retinal detachment. Proper diagnosis requires excluding other causes like syphilis, Lyme disease, multiple sclerosis and sarcoidosis.
Herpetic viral retinitis
This document discusses different types of herpetic viral retinitis, including acute retinal necrosis (ARN) syndrome, progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis, and non-necrotizing herpetic retinopathies (NNHR). It provides details on the clinical characteristics, pathogenesis, diagnosis, and treatment of each condition. The conditions vary in symptoms, affected immune status of patients, lesion location and progression, and treatment approaches including antiviral medications and corticosteroids. Diagnosis involves analysis of clinical features along with PCR or antibody testing of ocular fluids.
A case of submandibular swelling
This case report describes a 22-year-old male presenting with a painful swelling in the right submandibular region for 7 days that was aggravated by eating. Clinical examination revealed a sublingual hard mass that was mobile with an irregular surface. Ultrasound showed a sialolithiasis measuring 20 x 8 mm in the right Wharton's duct with secondary sialadenitis of the right submandibular gland. The patient underwent transoral excision of the sialolithiasis and was discharged after recovery with no complications.
HIV associated ocular disease.pptx
1. Ocular manifestations occur in 75% of HIV/AIDS patients and may be the only presenting feature of infection.
2. HIV associated ocular diseases include retinal microvasculopathy, opportunistic infections like CMV retinitis, and unusual neoplasms like Kaposi's sarcoma.
3. CMV retinitis is the most common ocular opportunistic infection and presents as indolent retinitis, fulminating retinitis, or perivascular retinitis. It is treated with valganciclovir, ganciclovir, or foscarnet.
Diabetic retinopathy
This document provides an overview of diabetic eye disease and its treatment. It begins with an introduction and discusses pathogenesis, classification, signs, and advanced complications such as retinopathy and macular edema. Risk factors for progression are described, including duration of diabetes, glycemic control, hypertension, and nephropathy. Treatment focuses on glycemic and blood pressure control as well as laser photocoagulation, intravitreal anti-VEGF agents, and steroids to treat macular edema. Several major clinical trials are summarized that demonstrate the benefits of tighter glucose and blood pressure control, as well as anti-VEGF therapies, on slowing progression of diabetic retinopathy and vision outcomes.
Parisitic infection
Toxoplasmosis is caused by the protozoan Toxoplasma gondii. It commonly infects intermediate hosts such as humans through contact with cat feces or consumption of undercooked meat containing cysts. In the eye, it most often causes retinochoroiditis which can lead to vision loss. Diagnosis is usually based on clinical findings, though serology and imaging tests provide supporting evidence. Treatment involves anti-protozoal medications such as sulfadiazine combined with pyrimethamine and corticosteroids to reduce inflammation. Recurrences are common in immunocompromised patients.
Ophthalmology Revision
This document summarizes various ophthalmological conditions including:
- Diabetic retinopathy which can cause retinal changes and is staged from background to proliferative retinopathy. Laser photocoagulation and vitrectomy are treatments.
- Hypertensive retinopathy graded from mild arteriolar constriction to severe hemorrhages and exudates reflecting hypertension severity.
- Common red eye conditions like conjunctivitis treated with antibiotics, uveitis which is an inflammatory condition treated with topical steroids, and acute angle closure glaucoma needing urgent treatment to reduce pressure.
Retinal Vasculitis
Retinal vasculitis is an inflammatory eye disease affecting the retinal vasculature. It can present as periphlebitis (vein involvement), periarteritis (artery involvement), or angiitis (combination). Symptoms include gradual vision loss, floaters, and photopsia. Signs include vascular sheathing, hemorrhages, edema, and neovascularization. It can be caused by infections, autoimmune diseases, malignancies, or be idiopathic. Treatment involves identifying and treating the underlying cause, along with corticosteroids, laser photocoagulation, and vitrectomy if needed. Intermediate uveitis is a chronic form characterized by vitritis, snowballs,
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MICROBIAL AND PARASITIC INFECTIONS OF THE EYE.pptx
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- It is classified based on etiology such as strabismic, anisometropic, form deprivation, and organic causes.
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Ocular trauma simplified
This document discusses the classification and management of ocular trauma. It covers various types of injuries including burns, chemical injuries, extraocular foreign bodies, blunt trauma, penetrating injuries, and their signs, symptoms, and treatments. Specific injuries to structures like the cornea, iris, lens, vitreous, and retina are described. The risks of infection and sympathetic ophthalmia are also outlined. The document provides an overview of evaluating and managing different types of penetrating ocular injuries and retained intraocular foreign bodies.
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Ocular manifestations of AIDS
- 1. AIDS -OCULAR MANIFESTATIONS By Dr Nitish
- 2. ETIOLOGY • HIV-1 & HIV-2 • Lenti virus sub family of retrovirus • HIV-1 Most common • HIV-1 two sub types M & O • Sub types of M –A to H • B,C,A – found in India
- 3. • CD4 < 200 cells/ul • Blood borne disease • Heterosexual , infected blood transfusion , transplacental ,iv drug abuse • 36 million • 70% develop ocular manifestations
- 5. OCULAR MANIFESTATIONS CD4 COUNT DISEASE 1000 cells/mm3 Normal <500 Kaposi sarcoma Lymphoma , T.B. <250 Toxoplasma , Pneumocystis carni <100 C.M.V. Retinitis VZ Retinitis,HIV retinopathy, sicca s syndrome
- 6. ANTERIOR SEGMENT MOLLUSCUM CONTAGIOSUM • Pox virus - DNA virus • Umblicated nodules • Treatment- Excision , currettage or cryotheray
- 7. MOLLUSCUM CONTAGIOSUM OF EYE LID
- 8. HYPERTRICHOSIS • Exaggerated growth of eye lashes • Cause unknown • Treatment- trimming of eye lashes - plucking
- 9. TRICHOMEGALY
- 10. HERPES ZOSTER OPHTHALMICUS • Herpes Zoster virus • Reactivation • Dermatomal pain -> Rash • Keratitis • Conjunctivitis, episcleritis ,scleritis, uveitis, glaucoma, pthisis bulbi Treatment-Acyclovir 3 % e/o 5 t/d Tab Acyclovir 800mg 5t/d
- 12. KAPOSI’S SARCOMA • Vascular neoplasm • Commonest anterior segment lesion • Herpes virus – 8 • Eyelids - purple nodules • Conjunctiva – red mass • Uncommon in India • Treatment Of Choice -RT
- 13. KAPOSI’S SARCOMA
- 14. CONJUNCTIVAL SQUAMOUS CELL CARCINOMA• Interaction b/w HIV , sunlight , HPV • Pink gelatinous growth • Temporal bulbar conjunctiva • Feeding blood vessel • TREATMENT- Excision & cryotherapy • Exenteration – if orbit inolved
- 16. KERATOCONJUNCTVITIS SICCA • Destruction of lacrimal glands • Burning uncomfortable red eyes • TREATMENT-artficial tear drops - lubricating e/o
- 17. ANTERIOR UVEITIS • Herpes simplex • Herpes Zoster • C.M.V. • Toxoplasmosis • Syphilis • Drug induced - Rifabutin
- 18. POSTERIOR SEGMENT • Posterior segment > Anterior segment • MC –CMV Retinitis
- 19. HIV RETINOPATHY • > ½ -3/4 patients • Microangiopathy • Asymptomatic • Cotton wool spots • Retinal haemorrhages • Microaneurysms • Differentiate from DM & HTN Retinopathy
- 20. HIV Retinopathy
- 21. CMV RETINITIS • Commonest opportunistic infection • Floaters – earliest to occur • DOV , floaters , flashes or asymptomatic • Cottage cheese with tomato ketchup appearance • Progress in brushfield pattern • Retinal detatchment • Treatment – Photocoagulation • Silicon oil tamponade
- 22. TREATMENT OF CMV RETINITIS • Gancyclovir 5mg/kg 12 hrly iv x 2-3 weeks 5mg /kg 24 hrly iv x stable retinitis Oral 300-450 mg OD • Gancyclovir implant- 1ug/hr x6-8 months • Intravitreal injections – 200 -2000ug/0.1 ml Every week S/E - Bone marrow supression Therefore TC –twice weekly
- 23. • Foscarnet – gancyclovir resistant cases 60 mg/kg iv 8 hrly x2-3 weeks 90-200 mg/kg iv 24 hrly Intravitreally – twice /week –induction (2.4mg/0.1 ml)once /week – maintainence • Valgancyclovir – induction-900mg BD - maintainence–900mg OD • Cidofovir-5mg /kg iv once weeklyx2 wks + probenecid
- 24. CMV RETINITIS
- 25. ACUTE RETINAL NECROSIS • Herpes Zoster infection • Peripheral whitening lesions • Vitritis & macular odema • Resolution - multiple sieve like holes • Confirmed by PCR assay of vitreal sample • Treatment – acyclovir iv 10mg/kg 8hrly X10-14 days Oral acyclovir 5t/d x6-12 weeks
- 27. PROGRESSIVE OUTER RETINAL NECROSES (PORN)• Varicella Zoster virus • White lesions in mid & peripheral retina • Rapid loss of vision • Treatment– iv gancyclovir or G+Foscarnet • Or intravitreal foscarnet • Poor prognosis • resolution- cracked mud appearance
- 29. TOXOPLASMA CHORIORETINITIS • Toxoplasma gondii – protozoan • Less common than encephalitis • Floaters , flashes , DOV • Head light in fog appearance • Treatment – systemic steroids 1mg/kg + 1 Clindamycin 300 mg qid x 3-4 weeks 2 Sulphadiazine 1gm qid x 3-4 weeks + pyrimethamine + folinic acid
- 32. SYPHILIS • MC - Uveitis • Retinitis ,Optic neuritis , papillodema • Treatment – high dose iv penicillin
- 34. FUNGAL INFECTION • Candida & cryptococcus - MC • Snowball like lesions • Cryptococcus meningitis – papilledema , optic neuropathy • DOC – Amphotericin B + Fluconazole
- 36. TREATMENT • Along with specific HAART therapy • HAART = Highly active anti retroviral therapy • 3 drugs • 2 nucleoside reverse transcriptase inhibitors + 1 protease inhibitor or 1 NNRTI
- 37. THANK YOU