This document discusses various types of granulomatous uveitis including tuberculosis (TB), leprosy, and sarcoidosis. It provides details on the etiology, clinical features, signs, course, classifications, and treatments of these conditions. Granulomatous uveitis is characterized by insidious onset, minimal pain, slight photophobia, minimal ciliary congestion, thick and broad-based posterior synechiae, and nodular lesions in the fundus. Specific treatments involve anti-tuberculous drugs for TB, dapsone for leprosy, and topical, periocular or systemic steroids for sarcoidosis depending on severity.

2.  TUBERCULOSIS
 LEPROSY
 SARCOIDOSIS

3.  PHLYCTENULAR KERATO
CONJUNCTIVITIS:
- Etiology: Delayed hypersensitivity type 4 CM
response to endogenous microbial
proteins(tuberculous)
* Presents as whitish raised nodule on bulbar
conjunctiva with hyperaemia of surrounding
conjunctiva in a child living in bad hygiene
conditions

4.  PATHOLOGY:
1. Stage of nodule formation
2. Stage of ulceration
3. Stage of granulation
4. Stage of healing
 CLINICAL FEATURES:
Mild discomfort in eye
Irritation
Reflex watering
 SIGNS: SIMPLE, NECROTIC, MILIARY.

5.  PHLYCTENULAR KERATITIS:
1. Ulcerative phlyctenular keratitis:
a. Sacrofulous ulcer
b. Fascicular ulcer
c. Miliary ulcer
2. Diffuse infiltrative keratitis
 CLINICAL COURSE:
self limiting & phlycten disappears in 8-10 days
.....no trace left. Recurrences are very common.

6.  ANATOMICAL CLASSIFICATION:
 Anterior: iritis, iridocyclitis, anterior cyclitis
 Intermediate
 Posterior
 Panuveitis
 CLINICAL CLASSIFICATION:
 Acute , chronic , recurrent
 PATHOLOGICAL CLASSIFICATION:
 Suppurative/purulent & non suppurative

10.  Wood’s classification...Nongranulomatous &
Granulomatous
 ETIOLOGICAL CLASSIFICATION:
Infective, immune related, toxic, traumatic ,
idiopathic, a/w non infective systemic disease.
* TB, LEPROSY,SARCOIDOSIS ...All are
granulomatous ......sarcoidosis being non
infective.

11.  In response to irritant foreign
body..inorganic/organic material introduced
from outside; hemorrhagic/necrotic tissue
within eye; organisms- non pyogenic & non
virulent.
 C/b granuloma formation...eventually
giantcells aggregate to form nodules.
 Iris nodules near pupillary
border.......KOEPPE’S NODULES
 Near collarette....BUSACCA NODULES

13.  Nodular collection at back of
cornea...mutton fat KERATIC
PRECIPITATES. Aqueos flare minimal.
 Necrosis in adjacent structures leads to
fibrosis & gliosis (reparative process).
 CHARACTERISTICS OF
GRANULOMATOUS UVEITIS:
insidious onset, min pain, slight
photophobia, min ciliary congestion, thick
&broad based posterior synechiae, nodular
lesions in fundus.

15.  NON SPECIFIC Rx:
a. Local therapy- 1.cycloplegic drugs
2.corticosteroids
3.BSA drops
b. Systemic therapy-
1.corticosteroids
2.NSAIDS
3.immunosuppressives
4.azithromycin/tc/
erythromycin

16. c. Physical measures: 1. hot fomentation
2. dark goggles
 SPECIFIC Rx OF THE CAUSE:
 TREATMENT OF COMPLICATIONS:
1. inflammatory glaucoma
2. postinflammatory glaucoma
3. complicated catarct
4. retinal detachment
5. pthisis bulbi

17.  TUBERCULAR UVEITIS:
-Chronic granulomatous infection
-human or bovine tubercle bacilli
-both anterior & posterior uveitis
-common cause of uveitis
- accoumts for 1% of uveitis in developed
countries.
- In India, still a common cause.

18. 1. Tubercular anterior uveitis :
- may occur as acute non granulomatous
iridocyclitis or granulomatous anterior
uveitis (miliary tuberclar iritis / solitary
tuberculoma )
2. Tubercular posterior uveitis:
a) Multiple miliary tubercles: in choroid
-appear as round yellow white nodules
-usually a/w tubercular meningitis.

20. b) Douse or multifocal choroiditis: occurs in
chronic tuberculosis.
c) Choroidal granuloma ....rarely as a focal
lesion.
3. Vasculitis: Eales disease

21.  INTERSTITIAL KERATITIS:
- Form of deep keratitis
- Inflammation of corneal stroma w/o primary
involvement of epithelium/endothelium.
-More frequently unilateral & sectorial(lower part of
cornea).
• CLINICAL FEATURES:
• Initial progressive stage
• Florid stage
• Stage of regression
 Scleritis & Episcleritis also occur .

22.  DIAGNOSIS:
1. X-Ray Chest
2. Mantoux test
3. TLC,DLC,ESR
4. Intractable uveitis – unresponsive to
steroids.
5. Isoniazid test (dramatic response of iritis to
isoniazid).

23.  TREATMENT:
1. Local therapy: Atropine
Antibiotics
Topical steroids
2. Specific therapy: ANTI TUBERCULAR
DRUGS.
* General measures : Vitamins A, C ,D in case of
children along with high protein supplemented
diet (phlyctenular keratoconjuctivitis) .

24.  HANSEN’S DISEASE
 Mycobacterium leprae
 Lepromatous & tuberculoid forms
 Conjunctivitis
 Neurotrophic keratopathy.....loss of corneal
nerve sensations.
 Involves anterior uvea

26.  Lepromatous uveitis may be acute iritis (non
granulomatius) & chronic iritis (
granulomatous).
 Acute : Caused by antigen-antibody
deposition & c/b severe exudative reaction.
 Chronic: Direct organism invasion & c/b
presence of small glistening ‘iris pearls’ near
pupillary margin.....in a necklace form.

28.  small pearls enlarge & coalesce to form
large pearls .
 rarely lepromata nodule may be seen.
 TREATMENT:
 Local therapy of iridocyclitis
 Antileprotic Rx – Dapsone 50-100 mg daily

30.  Sarcoidosis in conjunctiva.
 UVEITIS IN SARCOIDOSIS
- Granulomatous multi-system disease
- affects young adults(20-50); females more
common
- Presents with b/l hilar lymphadenopathy ,
pulmonary infiltration, skin & ocular lesions.

31.  OCULAR LESIONS :
 Occur in 20-50% patients with
sarcoidosis .
 Include-
 sarcoid uveitis
 conjunctival lesions
 lacrimal gland involvement.

32.  SARCOID UVEITIS : 2% cases
 Anterior uveitis : Presents as granulomatous
iridocyclitis c/b iris nodules, large mutton fat
KPs, anterior chamber cells & flare , posterior
synechiae.
 Intermediate uveitis : c/b vitreous cells,
snowball opacities, snow banking.

35.  Posterior / pan uveitis : includes –
choroidal & retinal granulomas , cystoid
macular oedema, periphlebitis retinae with
sheathing....appear as Candle wax
droppings.
* Peripheral multifocal chorioretinitis: c/b small
punched out atrophic spots....highly
suggestive of sarcoidosis.

37.  UVEO PAROTID FEVER ( Heerfordt’s
syndrome):
C/b – b/l granulomatous panuveitis , painful
enlargement of parotid glands, cranial nerve
palsies, skin rashes , fever, malaise.
 COMPLICATIONS :
 complicated cataract
 inflammatory glaucoma
 cystoid macular oedema

39.  Conjunctival lesions :
sarcoid nodules & kerato conjunctivitis sicca
 Lacrimal glands : Enlarged
a/w diffuse swelling of salivary glands –
MICKULICZ’S SYNDROME.

41.  DIAGNOSIS: If suspected clinically, then
supported by- positive Kveim test, abN Xray
chest(90%cases), raised levels of serum
ACE.
 Confirmation- biopsy of conj.nodule,skin
lesion, enlarged LN.
 TREATMENT: Topical , periocular ,
systemic steroids ....depending on severity.