The document discusses signs of intraocular inflammation and distinguishes between granulomatous and non-granulomatous uveitis. It describes key signs of acute anterior uveitis including redness, pain, photophobia, aqueous cells and flare, hypopyon, iris signs like synechiae, and lens complications. Granulomatous uveitis is characterized by mutton fat KPs, iris nodules, and thick synechiae, while non-granulomatous uveitis presents with fine KPs, no iris nodules, and fine synechiae with more cells and flare. The document also notes the distinction between acute versus chronic conditions as causes of red eye

1. RED EYE (UVEITIS V/S OTHER
CAUSES OF RED EYE)
Dr. Gariyashee Lahkar

2. • Describe the signs of intraocular inflammation
• Granulomatous v/s non-granulomatous
• Acute iridocyclitis from chronic condition
THINGS TO LEARN

3. INTRODUCTION
“RED EYE” is a general term use to describe an eye that appears to be red
due to illness, allergy, infections, injury or some other conditions.

4. Describe the signs of
intraocular inflammation

6. • Pain
• Redness
• Photophobia & blepharospasm
• Lacrimation
• Visual disturbances
SYMPTOMS:

7. SIGNS:
• LID OEDEMA: usually mild.
• CIRCUMCORNEAL HYPERAEMIA/INJECTION:
due to involvement of deeper blood vessels.
• MIOSIS due to pupillary sphincter spasm predisposes to
the formation of posterior synechiae.
• CORNEAL OEDEMA : due to toxic rise in IOP.
Circumcorneal injection
Miosis

8. • KERATIC PRECIPITATES (KP)
Small KP
Mutton fat KPs
•Keratic precipitates (KP) are deposits
on the corneal endothelium composed
of inflammatory cells such as
lymphocytes, plasma cells and
macrophages. They are usually
concentrated inferiorly, often in a
triangular pattern with the apex
pointing up (Arlt triangle) under the
influence of gravity and aqueous
convection currents.
Types:
1. Mutton fat KPs
2. Small & medium KP (granular)
3. Fine KPs
4. Old KPs

9. AQUEOUS CELLS and AQUEOUS FLARE
They are a dependable indicator of
inflammatory activity. Grading (SUN
Working Group) is performed by
estimating the number of cells in a 1
mm by 1 mm slit beam .
AQUEOUS FLARE
It is the haziness of the normally
clear fluid in the anterior chamber,
reflecting the presence of protein
due to breakdown of the blood–
aqueous barrier.
AQUEOUS CELLS

11. HYPOPYON:
Whitish purulent exudate composed of
inflammatory cells in the inferior part of the
anterior chamber (AC)
Hypopyon Hyphema
HYPHEMA:
Presence of blood in anterior chamber.
May be seen in traumatic cases.

12. IRIS SIGNS
• Loss of normal pattern.
• Muddy looking iris
• Iris nodules
• Posterior synechiae
• Iris atrophy
• Heterochromia iridis
• Iris neovascularization (rubeosis iridis) Muddy looking iris

13. • IRIS NODULES :
It can occur in both
granulomatous and
non-granulomatous
anterior uveitis.
Busacca nodules
involve the iris stroma
and are a feature of
granulomatous uveitis.
Koeppe nodules are
located on the
pupillary margin and
may be the site of
posterior synechiae
formation

14. • POSTERIOR SYNECHIAE (PS) : Inflammatory adhesions between the pupil margin and the anterior lens capsule.
Posterior synechiae
Posterior synechiae can be:
1. Segmental : Part of pupillary margin
attached to lens capsule.
2. Annular(ring) synechiae : Whole circle
of pupillary margin attached to lens
capsule.
3. Total: The posterior chamber is filled
with exudates which ties down the iris to
the lens capsule.

15. Sluggish or absent pupillary reaction
Irregular pupil due to segmental posterior synechiae
Festooned Pupil
Seclusio Pupillae: Due
to presence of annular
synechiae, Whole
circle of pupillary
margin attached to lens
capsule.
Occlusio pupillae:
Exudates organize
across the pupillary
area, forming a film of
opaque fibrous
tissue,leading to a
blocked pupil or
occlusio pupillae.
Seclusio Pupillae
PUPILLARY SIGNS:

16. LENS SIGNS
COMPLICATED CATARACT
• Pigment dispersion on lens surface.
• Fibrin exudates on lens surface.
• COMPLICATED CATARACT
(Polychromatic lustre/
bread crump appearance)

18. Acute anterior uveitis
• Lids show slight oedema.
• Marked Circumcorneal
congestion.
• Cornea is slightly hazy.
• Anterior chamber shows aqueous
cells and aqueous flare.
• Hypopyon is present.
• Iris shows loss of normal pattern,
muddy colour, posterior
synechiae.
• Pupil is irregular and sluggishly
reacting.

19. Granulomatous v/s non-
granulomatous

20. Once diagnosis of iridocyclitis is established, an
attempt should be made to know whether the
condition is of granulomatous or non-granulomatous
type.
PATHOLOGICAL CLASSIFICATION:
• Granulomatous.
• Non- Granulomatous.
Granulomatous versus non-granulomatous uveitis:

21. Granulomatous uveitis
• Caused by invasion of living organisms or Autoimmune etiology.
• Type IV Hypersensitivity reaction.
• Onset is usually insidious but prolonged due to quiescent inflammatory reaction.
• Inflammation is mild.
• Commonly involves choroid, retina with vitreous exudates and nodular lesions.

22. Characterised by :
• Dense nodular infiltration of the tissues.
• Mutton fat greasy KPs are seen.
• Iris nodules seen.
• Synechiae are broad based and thick.
Granulomatous uveitis

23. Non-granulomatous uveitis:
• Onset is acute.
• Short duration
• Diffuse in extension.
• Inflammation is marked.
• Choroid/ retina / vitreous opacities are absent or fine.

24. • Multiple fine dispersed KP’s are seen, composed of lymphoid cells and polymorphs.
• Iris nodules are absent.
• Synechiae are fine and filamentous.
• Considerable flare and cells present in Anterior Chamber.
Non-granulomatous uveitis:

25. Granulomatous v/s non-granulomatous

26. Acute iridocyclitis from
chronic condition

33. VARIOUS CAUSES OF RED EYE

34. THANK YOU!