1) This document summarizes different types of uveitis including anterior uveitis, intermediate uveitis, and granulomatous anterior uveitis. It discusses various etiologies and presentations of each type. 2) Treatment recommendations are provided for each condition including topical and systemic medications as well as surgical interventions if needed. Conditions like tuberculosis, toxoplasmosis, sarcoidosis, Behcet's disease, and others are addressed. 3) The author argues that secularism does not answer existential questions about the meaning of life. While it promotes ideas of freedom and rationality, it does not provide spiritual guidance and can lead people to make wrong choices by thinking they have freedom

1. Simple Uveitis
· Mohamed Zaky Elkadim
· Tanta University

2. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

3. ANTERIOR UVEITIS
1) Retro corneal granuloma
2) Acute severe with fibrinous reaction and pain (angry
eye)
3) Uveitic glaucoma / White and quiet
4) Granulomatous anterior uveitis
5) Behcet’s disease

4. 1) RETRO CORNEAL
GRANULOMA

6. Trematode
· History of canal water contact
· Topical and systemic steroids
· TB should be excluded 1st
· Surgical excision of granuloma rarely
used.
· ± shistofast
· ± Verm-1 tab 1 tab / week *2
· ± Ca++

7. 2) ACUTE SEVERE WITH
FIBRINOUS REACTION AND
PAIN (ANGRY EYE)

9. HLA B27
· The most common anterior uveitis 50%
· May be associated with “seronegative spondylo
arthropathies”: Reiter, Ankylosing spondylitis, psoraisis,
IBD.
· Not common in non whites
· Severe pain , injection , fibrinous reaction , posterior
synechiae
· Bacteria such as C hlamydia, Salmonella, Yersinia, and
Shigella have been associated.

10. If indicated:
· MR I : sacroiliac join and lumbar spine
· Swab or chlamydia, Shigella, Yersinia,
· No KPs : just dusting
· Pain on accomodation (pain may precede
the attack).
· Usually bilateral assymmetric and recur

11. causes
1. Idiopathic (1% of HLAB27 will have uveitis).
2. Ankylosing spondylitis : MRI back : most
common cause of AAU in male.
3. IBD : investigate for Calprotectin Sulfasalazine
4. Reiter : Azithromycin single dose ,, urine
and conj swab ( Urethritis →
conjunctivitis→ arthritis → uveitis)
5. Psoraisis → 20% arthritis → 20% AAU ,,
bilateral simultaneous
6. Bacterial infection trigger

12. 3) UVEITIC GLAUCOMA /
WHITE AND QUIET

13. PIOL

15. POSNER-SCHLOSSMAN
SYNDROME (glaucmato cyclitic crisis)
· Male ,, unilateral uveitic glaucoma
· CMV
· Central white KPs with variable size
· No synechie no vitritis no heterochromia
· Between attacks : only optic cup

17. FUCHS’ IRIDOCYCLITIS
· Floaters are he main complain
· Rubella
· FUS is a chronic, anterior, granulomatous
with vitreous involvement .
· unilateral (90% of cases)
· ciliary injection and posterior synechiae are
never present and should be viewed as exclusion
criteria.
· Unilateral nuclear cat and OAG.

18. · Diffuse iris atrophy and
white coloration of the
pupillary border (eroded
pupillary border) .
· Hyphema during cataract
· TTT : glaucoma no
steroids

19. · Diffuse stellate KPs : DD Herpes

20. Iris atrophy lead to prominent sphiecter pupillae and vessels

22. · Fine vessels (arrows) are seen crossing the trabecular meshwork. This neovascularization is
not accompanied by a fibrovascular membrane and does not result in peripheral anterior
synechiae formation and secondary angle closure

23. HS iritis

26. TTT
· Control IOP
· Oral antiviral : Acyclovir 400 tab x5
for 1-2 weeks ,, Monitor kidney f.
· Predforte : taper over 2 months
· Atropine

27. JUVENILE IDIOPATHIC
ARTHRITIS

28. JIA
· Chronic
· Bilateral
· Anterior
· White and quiet
· ANA +ve ,,, -ve RF
· Female < 7ys
· Screening / 2 months

30. Systemic mainfestations of JIA
1. Stills disease : lymphademopathy ,
splenomegally , rash, uvitis rare : no
follow up.
2. Polyarticular : uvitis uncommon ,,
comes more as acute ,, RF +ve :
follow up every 6 months.
3. Pauciarticular : ANA +ve, RF –ve ,
female , 5-7 years, uvitis common

31. TTT
· Steroids / cycloplegics
· Methotrexate
· Biologic agents
· Monitoring (75% severe resistant
uvitis )

32. DD
· Masquarade = retinoblastoma
· Intermediate uvitis = 20% of pediatric uviteitis
· Juvenile HLAB27
· Sarcoidosis
· Others : TB , lyme , $ , toxoplasma

33. 4) GRANULOMATOUS
ANTERIOR UVEITIS

36. · 1st exclude Medical or surgical (lens induced uveitis /
UGH / endophthalmitis/ fungal infection/ Drugs)
· 2nd exclude herpetic keratouveitis :
corneal affection + iris atrophy or ARN
· 3rd search for specific infections and non infections 
(14) : TB , Toxoplasma, syphilis , Sarcoidosis , lyme ,
lymphoma, leukemia, Endogenous endophthamitis, HSV,
HIV, HCV, , VKH , SO, Multifocal choriditis

37. ARN

38. Sarcoidosis
· Bilateral granulomatous
anterior uveitis √√
· Heer fordt ’s syndrome
(uveo-parotid fever):
anterior uveitis, parotid
gland enlargement , facial
palsy, and fever
· ACE (75% of cases) +
hypercalcemia, +ve galium scan

39. Ocular findings
 Lacrimal gland +++ / NLDO
 Conjunctival nodules, calcifications , symblepharon , calcific band
keratopathy, IK, anterior scleritis.
 Anterior granulomatous uveitis (bilateral granulomatous anterior
uveitis = sarcoidosis UPO)
 Intermediate uveitis
 Retina and choroid nodules , Non occlusive peribhlepitis, candle wax
appearance.
 Sarcoid granuloma of the optic disc / optic neuritis.
 Neurosarcoidosis can also manifest as papilledema, nystagmus, and
visual field defects

40. TTT
· Systemic steroids
· IMT
· Biologic agents
· Topical cyclosporine for conjunctival
lesions and dry eye.

41. 5) BEHCET’S DISEASE

42. · Excess cells no flare (iris is seen well)
less pain less injection ,, posterior
synechia with back of the iris

43. Behcet’s disease
· Recurrent oral ulcer + 2 of four :
· Genital ulcer
· Skin lesions
· Uvitis
· Pethergy test
· Hypopyon is not common 25% - short living
– no fibrin

45. · bilateral ( > 70%). Posterior/ panuveitis
is the most common form
· HLA-B 51
· Ocular signs : explosive anterior uveitis
Vitritis, necrotizing retinitis, retinal
vasculitis, retinal hemorrhages, retinal
edema, vitreous hemorrhage, capillary
dropout , retinal neovascularization,

48. TUBULOINTERSTITIAL
NEPHRITIS
· acute, bilateral (DD : behcet ,
psoraisis HLAB27) anterior uveitis
with fever, fatigue, and malaise. It
occurs more often in children < 20
· Generally, the uveitis occurs up o 1
year prior to onset of renal symptoms

49. · Autoantibodies formation in response to certain antibiotics
or NSAID administration is the presumed eitiology.
Diagnosis by tubulointerstitial infiltration and necrosis with
preserved glomeruli and CD4 lymphocytic infiltration

51. · TTT : predinsolone 1mg/kg/d

52. Post streptococcal uveitis
· unilateral or bilateral uveitis with positive anti-streptolysin
O titres (ASOT) or anti-deoxyribonuclease (anti-DNase)
titres, throat culture and negative routine investigations for
other causes of uveitis.
· Age < 16 ys
· Mostly 2 weeks after pharyngitis
· Anterior uveitis / intermediate / sclerokeratitis/
papillophlepitis
· TTT as JIA

53. Anterior uveitis in elderly
· DM
· HZO / other infections
· Cancer ( Breast / Meningioma)
· O ischemic $
· lymphoma

58. · Secularism and liberalism do not give us the
answer: Why are we here? Who created the
universe ? What should we do in our life?
Where will we go after life? But it only gives
us false slogans about freedom, conscience,
humanity and rationality, the face of which is
compassion and its interior is the impulse
behind animal instincts, lusts and desires.

59. INTERMEDIATE UVEITIS
Inflammation localized to the vitreous and
peripheral retina.

60. Patient
· Young adult and children (20% of
pediatric uveitis)
· Bilateral but assymetric > 80% : dilate
both eyes
· 75% will have BCVA > 0.5 after 5 yrs

61. symptoms
· Floaters √√
· Blurred vision

62. signs
· Anterior segment : low grade cells, Kps
· Vitreous cells (lymphocytes)
· Snowballs : aggregates of cells
· vasculitis of peripheral veins / occlusive
· NVE lead to vit.Hge more in children
· Exaudates on the parsplana then collagen
production lead to snowbank = chronic
· ONH edema / optic neuritis

63. · Yellow white masses at inferior retina

64. causes
· Idiopathic pars planitis >70%
· MS : anterior uveitis,, posterior synechia,,
vasculitis,, less macular edema,, optic neuritis.
MS can appear years after uvitis
· Sarcoidosis : band keratopathy, symblepharon
and conj deposits, black race, choroidal lesion,
Ex RD
· Others : Lyme/IBD/$/TB/ whipple

65. DD
· ALL Uveitis
· Lymphoma
· Anteror Uvitis spill or treated or
Fuch’s
· Endogenous endophth
· TB / Toxoplasma

66. Lab
· CBC/ VDRL and FTA – ABS
· Old age , suspected lymphoma : MRI // CSF
cytology or diagnostic Vx
· Tropical area : Borreilla borgdorfi antibodies
· Sarcoidosis : CXR // serum ACE , Ca++
· MS : Enhanced MRI
· Toxocara ab
· PPD

67. Imaging
· FA
· OCT
· US
· UBM
· MRI / CXR

68. Vision loss
· CME √√
· RD exaudative / T- rhegmatogenous may be
chronic / NV and traction can produce huge
break or total RD 360
· Vit hge
· ERM
· CNV
· Glaucoma
· Cataract
· Band k
· Cyclitic membrane and atrophia

69. clinical

71. TTT
· Topical steroids : for anterior segment affection
· Periocular TAAC (2-3 injections) for unilateral
cases
· Systemic steroids : for bilateral or cases not
respond to periocular after exx of TB
· Intravitreal TAAC for CME ,, intravitreal
Fluocinolone implant for resistant cases
· Systemic immune suppressive : for resistant
cases and as steroid sparing :
cyclosporine/azathioprine

72. Biologic agents
· Adalimumab ; for pediatric use and
steroid resistant cases
· Infliximab (antiTNF)
· Interferon B for MS

73. · Cryo in patients with NVE and
recurrent vit Hge
· Argon laser is alternative
· PP Vx for steroid responders, resistant
CME and retinal traction
· Cataract surgery after patient is cell
free for 3-6 months and IOL is
controversery

74. · Whoever thinks he has possessed himself by emancipation
from religion is mistaken. A person did not come to the world
with his freedom, and he did not choose his parents, and he
would not leave it with his freedom, and he could not protect
his body from diseases or his immune system from attacking
his eye or control his heartbeat or intestinal movements, so
how can a person possess himself? He only had to answer an
exam that he did not enter voluntarily, and he would not leave
it willingly, and he could not change the questions. Only the
secular person can choose the wrong answer and think that he
owned himself and his freedom ..