This document provides an overview of uveitis, including:
- Definitions of uveitis and the structures of the eye involved
- Classification of uveitis into anterior, intermediate, posterior, and pan-uveitic types
- Signs and symptoms, causes like infections and autoimmune diseases, and pathophysiology involving immune and genetic factors
- Diagnosis through examination and testing, as well as treatment using steroids, immunosuppressants, mydriatics, and natural products like turmeric
- Prognosis being generally good with treatment but potential for vision loss, and epidemiology with uveitis affecting approximately 1 in 5,000 people.
This document discusses pterygium, a non-cancerous growth of fleshy tissue on the eye. It begins by defining pterygium and describing its characteristics and causes. It then discusses risk factors like UV exposure, prevalence based on age, sex and geography. Clinical presentation and staging is explained. Histopathology and recurrence are also covered. Treatment involves surgery like conjunctival autografting along with preventative measures and adjuvants to reduce recurrence. Complications and outcomes of different techniques are compared.
This document discusses various types of microbial keratitis, including bacterial, fungal, and viral keratitis. It describes common pathogens that can cause bacterial keratitis and their characteristic clinical features. The management of bacterial keratitis involves identifying the causative organism, administering topical antibiotics, and addressing complications. Fungal keratitis requires reculturing, antifungal therapy, and sometimes keratoplasty. Viral keratitis from herpes simplex virus can cause dendritic ulcers. Corneal ectasias like keratoconus and keratoglobus are also briefly mentioned.
Blepharitis is a common eyelid inflammation that can be caused by bacterial infections or dry eye conditions. It is characterized by scaling or crusting of the eyelashes and eyelid margins. There are two main types - anterior blepharitis, which involves inflammation at the base of the eyelashes, and posterior blepharitis, which affects the glands of the eyelid. Symptoms include burning, irritation, tearing and worsening in the morning. Treatment focuses on eyelid hygiene through warm compresses and lid scrubs to remove scales and debris. Blepharitis can exacerbate dry eye and may cause long-term eyelid changes if left untreated. It may also increase risks of certain inflammatory
Uveitis refers to inflammation of the uvea, which is the middle layer of the eye that includes the iris, ciliary body, and choroid. Uveitis can be classified based on the location of inflammation as anterior, intermediate, posterior, or panuveitis. Common causes include infection, autoimmune disorders, and malignancy. Symptoms include eye redness, pain, blurred vision, and sensitivity to light. Diagnosis involves examination with a slit lamp and tests to identify underlying causes. Treatment focuses on managing inflammation with corticosteroids and treating any underlying condition. Complications can include cataracts, glaucoma, cystoid macular edema, hypotony, and retinal detachment if uve
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.
This document provides information on entropion, including anatomy of the eyelid, causes of entropion, classification, symptoms, assessment, differential diagnosis, and surgical and non-surgical management. Entropion is defined as inward rotation of the eyelid margin. It discusses various procedures for correcting entropion such as Quickert-Rathbun eversion sutures, lower lid retractor advancement combined with lateral tarsal strip or wedge resection, tarsal fracture/transverse tarsotomy, and use of posterior lamellar grafts for severe cicatricial entropion. Non-surgical management includes artificial tears, bandage contact lenses, lower lid taping, and botulinum
Myopia, or nearsightedness, is a refractive condition where parallel rays of light focus in front of the retina. There are several types of myopia based on etiology. Simple myopia is the most common type and results from axial elongation of the eyeball. Pathological myopia can lead to degenerative changes in the retina and choroid over time like myopic crescents if left untreated. Treatment options include optical correction with glasses or contacts, refractive surgeries like LASIK, and low vision aids for advanced cases. Proper diet and genetic counseling can help manage risk of progression.
This document provides an overview of uveitis, including:
- Definitions of uveitis and the structures of the eye involved
- Classification of uveitis into anterior, intermediate, posterior, and pan-uveitic types
- Signs and symptoms, causes like infections and autoimmune diseases, and pathophysiology involving immune and genetic factors
- Diagnosis through examination and testing, as well as treatment using steroids, immunosuppressants, mydriatics, and natural products like turmeric
- Prognosis being generally good with treatment but potential for vision loss, and epidemiology with uveitis affecting approximately 1 in 5,000 people.
This document discusses pterygium, a non-cancerous growth of fleshy tissue on the eye. It begins by defining pterygium and describing its characteristics and causes. It then discusses risk factors like UV exposure, prevalence based on age, sex and geography. Clinical presentation and staging is explained. Histopathology and recurrence are also covered. Treatment involves surgery like conjunctival autografting along with preventative measures and adjuvants to reduce recurrence. Complications and outcomes of different techniques are compared.
This document discusses various types of microbial keratitis, including bacterial, fungal, and viral keratitis. It describes common pathogens that can cause bacterial keratitis and their characteristic clinical features. The management of bacterial keratitis involves identifying the causative organism, administering topical antibiotics, and addressing complications. Fungal keratitis requires reculturing, antifungal therapy, and sometimes keratoplasty. Viral keratitis from herpes simplex virus can cause dendritic ulcers. Corneal ectasias like keratoconus and keratoglobus are also briefly mentioned.
Blepharitis is a common eyelid inflammation that can be caused by bacterial infections or dry eye conditions. It is characterized by scaling or crusting of the eyelashes and eyelid margins. There are two main types - anterior blepharitis, which involves inflammation at the base of the eyelashes, and posterior blepharitis, which affects the glands of the eyelid. Symptoms include burning, irritation, tearing and worsening in the morning. Treatment focuses on eyelid hygiene through warm compresses and lid scrubs to remove scales and debris. Blepharitis can exacerbate dry eye and may cause long-term eyelid changes if left untreated. It may also increase risks of certain inflammatory
Uveitis refers to inflammation of the uvea, which is the middle layer of the eye that includes the iris, ciliary body, and choroid. Uveitis can be classified based on the location of inflammation as anterior, intermediate, posterior, or panuveitis. Common causes include infection, autoimmune disorders, and malignancy. Symptoms include eye redness, pain, blurred vision, and sensitivity to light. Diagnosis involves examination with a slit lamp and tests to identify underlying causes. Treatment focuses on managing inflammation with corticosteroids and treating any underlying condition. Complications can include cataracts, glaucoma, cystoid macular edema, hypotony, and retinal detachment if uve
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.
This document provides information on entropion, including anatomy of the eyelid, causes of entropion, classification, symptoms, assessment, differential diagnosis, and surgical and non-surgical management. Entropion is defined as inward rotation of the eyelid margin. It discusses various procedures for correcting entropion such as Quickert-Rathbun eversion sutures, lower lid retractor advancement combined with lateral tarsal strip or wedge resection, tarsal fracture/transverse tarsotomy, and use of posterior lamellar grafts for severe cicatricial entropion. Non-surgical management includes artificial tears, bandage contact lenses, lower lid taping, and botulinum
Myopia, or nearsightedness, is a refractive condition where parallel rays of light focus in front of the retina. There are several types of myopia based on etiology. Simple myopia is the most common type and results from axial elongation of the eyeball. Pathological myopia can lead to degenerative changes in the retina and choroid over time like myopic crescents if left untreated. Treatment options include optical correction with glasses or contacts, refractive surgeries like LASIK, and low vision aids for advanced cases. Proper diet and genetic counseling can help manage risk of progression.
Corneal ulcer refers to corneal tissue excavation associated with an epithelial defect, usually with infiltration and necrosis. Corneal ulcers can be classified based on etiology, location, or involvement of corneal layers. Common causes include infection, trauma, dry eye, or contact lens overuse. Signs include pain, redness, tearing, photophobia, and a gray infiltrate. Diagnosis involves corneal scraping and culture. Treatment depends on cause but generally includes topical antibiotics, antifungals, antivirals, or amoebicides with cycloplegics. Complications include hypopyon, perforation, scarring, or endophthalmitis. Timely diagnosis and proper management can save vision.
This document discusses hyperopia (farsightedness), which occurs when parallel rays of light focus behind the retina at rest. It defines different types of hyperopia such as physiological and pathological. Symptoms include eye strain, headaches, and blurred near vision. Diagnosis involves visual acuity tests, retinoscopy, and subjective refraction. Treatment options include convex lenses, contact lenses, and refractive surgery like LASIK. The prevalence of hyperopia changes with age, from high levels in infants to low levels in adults that may increase again in older age.
Chalazion is a chronic inflammatory nodule of the meibomian gland in the eyelid. It is the most common benign eyelid lesion, occurring more often in adults. Chalazions start as small, tender swellings and are caused by obstruction and retention of secretions in the meibomian gland. On pathology, they show chronic inflammation with lipid-filled giant cells. Clinically, they appear as painless, hard swellings of the eyelid that can cause blurry vision. Treatment involves warm compresses, antibiotics, steroids, or incision and curettage for larger lesions. Complications include infection, cyst formation, or recurrence.
This document defines astigmatism as a condition where light rays are not focused to a single point on the retina due to irregular curvature or refractive index of the cornea or lens. It classifies astigmatism based on etiology, orientation of refractive meridians, and location of focal points relative to the retina. Signs include distorted vision and headaches. Clinical tests include refraction, keratometry, and retinoscopy. Management options are spectacles, contact lenses, and refractive surgery to correct the astigmatism.
This document discusses subconjunctival haemorrhage and uveitis. A subconjunctival haemorrhage occurs when a blood vessel breaks underneath the conjunctiva and causes blood to collect. It can be caused by coughing, sneezing, lifting heavy objects, vomiting, or eye infections. Uveitis is inflammation of the middle layer of the eye that can be caused by autoimmune disorders, infections, injuries, or cancers. Symptoms include eye pain, sensitivity to light, tearing, and blurred vision. Treatment involves anti-inflammatory medications, antibiotics if caused by infection, and immunosuppressive drugs if the uveitis is severe.
Trichiasis is a condition where eyelashes are misdirected toward the eye, causing irritation, pain, photophobia, and foreign body sensation. It can be caused by chronic inflammatory conditions or develop idiopathically. Left untreated, trichiasis can lead to recurrent corneal abrasions, opacities, vascularization, and non-healing ulcers. Treatment involves epilation, electrolysis or cryoepilation to remove misdirected eyelashes.
Presbyopia is the loss of accommodation that occurs with aging. It results in a decreased ability to focus on near objects and is caused by lenticular and extralenticular changes within the eye. Symptoms typically begin around age 40 and accommodation is completely lost by ages 50-60, affecting 100% of the population. Treatment options include reading glasses, bifocal and multifocal contact lenses, refractive surgery such as LASIK, and intraocular lens implants. Newer treatments being researched include corneal inlays and injectable accommodating intraocular lenses.
Hypertensive retinopathy refers to changes in the retina and choroid that occur due to high blood pressure. There are three main factors that contribute to its pathogenesis: vasoconstriction, arteriosclerotic changes, and increased vascular permeability. Clinically, it presents as arteriolar narrowing, AV nicking, cotton wool spots, hemorrhages, and hard exudates. It can be chronic or malignant, with malignant seeing a more rapid progression. Treatment involves strict blood pressure control.
This document discusses various types of secondary glaucoma caused by underlying ocular diseases and conditions. It describes the mechanisms of increased intraocular pressure, clinical features, and treatment approaches for different forms of secondary glaucoma including lens-induced glaucoma, inflammatory glaucoma, pigmentary glaucoma, neovascular glaucoma, and steroid-induced glaucoma among others. Management involves treating the underlying condition causing secondary glaucoma as well as lowering intraocular pressure through medical, laser, or surgical means.
This document provides an overview of cataracts, including:
- Definitions and types of cataracts such as developmental, acquired, congenital, and secondary.
- Causes of cataracts including age, genetics, trauma, toxins, and medical conditions.
- Classification systems for cataracts based on location, shape, degree of opacity.
- Symptoms such as decreased vision and glare.
- Stages of cortical and nuclear cataracts.
- Secondary cataracts that develop due to underlying ocular diseases.
This document provides an overview of pterygium, including:
1. The anatomy and histology of the conjunctiva where pterygium develops.
2. Risk factors for pterygium include ultraviolet light exposure, which may cause genetic mutations in limbal stem cells through oxidative stress and altered expression of growth factors.
3. Pterygium is believed to develop from these genetically altered limbal stem cells, disrupting the normal balance between corneal and conjunctival epithelium and allowing conjunctiva to grow onto the cornea.
This document discusses strabismus (misalignment of the eyes) including:
1. Definitions of strabismus, heterophoria (latent squint), and heterotropia (manifest squint).
2. Types of strabismus including esotropia (inward turning), exotropia (outward turning), and vertical deviations.
3. Extraocular muscles that control eye movement and their nerve supply.
4. Medical and surgical treatments for strabismus including occlusion therapy, prisms, botulinum toxin injections, and different surgical procedures.
This document provides an overview of ocular trauma, including classifications, signs, symptoms, and management approaches. It discusses various types of trauma such as blunt trauma, penetrating trauma, chemical injuries, and orbital fractures. Key points include:
- Ocular trauma can be caused by physical injury, chemicals, heat, or radiation. It is a leading cause of monocular blindness.
- Trauma is classified based on etiology (accidental, self-inflicted, occupational) and nature (physical, chemical, thermal, radiation). Physical trauma includes perforating, non-perforating, and blunt injuries.
- Complications depend on the type and location of trauma but can include corneal abrasions,
Strabismus, also known as crossed eyes, occurs when the eyes are misaligned and do not look in the same direction. It can be caused by problems with eye muscles, nerves that control the muscles, or the brain's control center for eye movement. Strabismus can cause double vision, eye fatigue, and vision loss if not treated. It is diagnosed through a comprehensive eye exam assessing vision, eye alignment and health, and treated through optical correction, eye exercises, or muscle surgery depending on the cause.
Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa invading and damaging the cornea. Bacterial ulcers involve lymphocyte infiltration and necrosis, leading to stages of active ulceration, regression as phagocytosis occurs, and eventual cicatrization. Fungal ulcers provoke a severe inflammatory response, stromal necrosis, and potential perforation if filamentous fungi penetrate the descement's membrane. Symptoms include pain, photophobia, blurred vision, discharge, and redness. Treatment depends on the causative agent and involves topical or systemic antibiotics, antifungals, antivirals, or anti-amoebic medications, as well as debride
Orbital cellulitis is an infection behind the orbital septum that can spread from adjacent sinuses or bloodstream. It is classified by Chandler into 5 groups based on location and severity. Group 1 is preseptal cellulitis anterior to the septum. Group 2 is orbital cellulitis within the orbit. Group 3 is a subperiosteal abscess between the bone and periosteum. Group 4 is an orbital abscess within orbital contents. Group 5 is cavernous sinus thrombosis spreading bilaterally. Symptoms include eyelid swelling, pain, and vision issues. Imaging helps locate the infection and guide treatment which involves intravenous antibiotics, analgesics, and sometimes surgery.
Ocular injuries can be classified as open globe, closed globe, or periocular injuries. Open globe injuries involve a full thickness break in the eye wall, while closed globe injuries do not penetrate the full thickness. Periocular injuries involve the tissues surrounding the eye. Common closed globe injuries include conjunctival and corneal abrasions, hyphema, and retinal detachment. Lid lacerations may require repair depending on their location. Blunt eye trauma requires examination of visual acuity and eye anatomy to check for injuries like ruptured globe or optic nerve damage. Suspected open globe injuries or those with vision loss require emergent ophthalmology referral.
This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
This document discusses pseudophakia, which is the condition where aphakia (absence of the natural lens) is corrected through implantation of an intraocular lens (IOL). It defines key terms like phakia, aphakia, and pseudophakia. The document also covers calculation of IOL power using the SRK formula, potential refractive outcomes like emmetropia, consecutive myopia or hypermetropia, and astigmatism. It serves as an introduction to pseudophakia for optometry students.
This document provides an overview of evaluating and treating uveitis. It begins by outlining the workflow of examining a patient with uveitis and classifying the type and severity. A targeted approach to ocular and systemic investigations is recommended based on determining the etiology. Treatment involves addressing the inflammation with topical, periocular, or systemic corticosteroids depending on severity, with alternatives for steroid-sparing such as immunosuppressants. Side effects of the different treatment approaches are also reviewed.
Endophthalmitis is an inflammation of the inner eye structures that can be infectious or non-infectious. Infectious endophthalmitis can develop from exogenous sources like injuries or surgeries, endogenous sources like bloodborne infections, or extensions from surrounding structures. Common causative organisms include staphylococci, streptococci, and fungi. Acute post-operative bacterial endophthalmitis presents with pain, redness, photophobia, and vision loss and is treated with intravitreal and systemic antibiotics along with possible vitrectomy. Delayed postoperative endophthalmitis is often caused by Propionibacterium acnes trapped in the capsular bag and presents with
Corneal ulcer refers to corneal tissue excavation associated with an epithelial defect, usually with infiltration and necrosis. Corneal ulcers can be classified based on etiology, location, or involvement of corneal layers. Common causes include infection, trauma, dry eye, or contact lens overuse. Signs include pain, redness, tearing, photophobia, and a gray infiltrate. Diagnosis involves corneal scraping and culture. Treatment depends on cause but generally includes topical antibiotics, antifungals, antivirals, or amoebicides with cycloplegics. Complications include hypopyon, perforation, scarring, or endophthalmitis. Timely diagnosis and proper management can save vision.
This document discusses hyperopia (farsightedness), which occurs when parallel rays of light focus behind the retina at rest. It defines different types of hyperopia such as physiological and pathological. Symptoms include eye strain, headaches, and blurred near vision. Diagnosis involves visual acuity tests, retinoscopy, and subjective refraction. Treatment options include convex lenses, contact lenses, and refractive surgery like LASIK. The prevalence of hyperopia changes with age, from high levels in infants to low levels in adults that may increase again in older age.
Chalazion is a chronic inflammatory nodule of the meibomian gland in the eyelid. It is the most common benign eyelid lesion, occurring more often in adults. Chalazions start as small, tender swellings and are caused by obstruction and retention of secretions in the meibomian gland. On pathology, they show chronic inflammation with lipid-filled giant cells. Clinically, they appear as painless, hard swellings of the eyelid that can cause blurry vision. Treatment involves warm compresses, antibiotics, steroids, or incision and curettage for larger lesions. Complications include infection, cyst formation, or recurrence.
This document defines astigmatism as a condition where light rays are not focused to a single point on the retina due to irregular curvature or refractive index of the cornea or lens. It classifies astigmatism based on etiology, orientation of refractive meridians, and location of focal points relative to the retina. Signs include distorted vision and headaches. Clinical tests include refraction, keratometry, and retinoscopy. Management options are spectacles, contact lenses, and refractive surgery to correct the astigmatism.
This document discusses subconjunctival haemorrhage and uveitis. A subconjunctival haemorrhage occurs when a blood vessel breaks underneath the conjunctiva and causes blood to collect. It can be caused by coughing, sneezing, lifting heavy objects, vomiting, or eye infections. Uveitis is inflammation of the middle layer of the eye that can be caused by autoimmune disorders, infections, injuries, or cancers. Symptoms include eye pain, sensitivity to light, tearing, and blurred vision. Treatment involves anti-inflammatory medications, antibiotics if caused by infection, and immunosuppressive drugs if the uveitis is severe.
Trichiasis is a condition where eyelashes are misdirected toward the eye, causing irritation, pain, photophobia, and foreign body sensation. It can be caused by chronic inflammatory conditions or develop idiopathically. Left untreated, trichiasis can lead to recurrent corneal abrasions, opacities, vascularization, and non-healing ulcers. Treatment involves epilation, electrolysis or cryoepilation to remove misdirected eyelashes.
Presbyopia is the loss of accommodation that occurs with aging. It results in a decreased ability to focus on near objects and is caused by lenticular and extralenticular changes within the eye. Symptoms typically begin around age 40 and accommodation is completely lost by ages 50-60, affecting 100% of the population. Treatment options include reading glasses, bifocal and multifocal contact lenses, refractive surgery such as LASIK, and intraocular lens implants. Newer treatments being researched include corneal inlays and injectable accommodating intraocular lenses.
Hypertensive retinopathy refers to changes in the retina and choroid that occur due to high blood pressure. There are three main factors that contribute to its pathogenesis: vasoconstriction, arteriosclerotic changes, and increased vascular permeability. Clinically, it presents as arteriolar narrowing, AV nicking, cotton wool spots, hemorrhages, and hard exudates. It can be chronic or malignant, with malignant seeing a more rapid progression. Treatment involves strict blood pressure control.
This document discusses various types of secondary glaucoma caused by underlying ocular diseases and conditions. It describes the mechanisms of increased intraocular pressure, clinical features, and treatment approaches for different forms of secondary glaucoma including lens-induced glaucoma, inflammatory glaucoma, pigmentary glaucoma, neovascular glaucoma, and steroid-induced glaucoma among others. Management involves treating the underlying condition causing secondary glaucoma as well as lowering intraocular pressure through medical, laser, or surgical means.
This document provides an overview of cataracts, including:
- Definitions and types of cataracts such as developmental, acquired, congenital, and secondary.
- Causes of cataracts including age, genetics, trauma, toxins, and medical conditions.
- Classification systems for cataracts based on location, shape, degree of opacity.
- Symptoms such as decreased vision and glare.
- Stages of cortical and nuclear cataracts.
- Secondary cataracts that develop due to underlying ocular diseases.
This document provides an overview of pterygium, including:
1. The anatomy and histology of the conjunctiva where pterygium develops.
2. Risk factors for pterygium include ultraviolet light exposure, which may cause genetic mutations in limbal stem cells through oxidative stress and altered expression of growth factors.
3. Pterygium is believed to develop from these genetically altered limbal stem cells, disrupting the normal balance between corneal and conjunctival epithelium and allowing conjunctiva to grow onto the cornea.
This document discusses strabismus (misalignment of the eyes) including:
1. Definitions of strabismus, heterophoria (latent squint), and heterotropia (manifest squint).
2. Types of strabismus including esotropia (inward turning), exotropia (outward turning), and vertical deviations.
3. Extraocular muscles that control eye movement and their nerve supply.
4. Medical and surgical treatments for strabismus including occlusion therapy, prisms, botulinum toxin injections, and different surgical procedures.
This document provides an overview of ocular trauma, including classifications, signs, symptoms, and management approaches. It discusses various types of trauma such as blunt trauma, penetrating trauma, chemical injuries, and orbital fractures. Key points include:
- Ocular trauma can be caused by physical injury, chemicals, heat, or radiation. It is a leading cause of monocular blindness.
- Trauma is classified based on etiology (accidental, self-inflicted, occupational) and nature (physical, chemical, thermal, radiation). Physical trauma includes perforating, non-perforating, and blunt injuries.
- Complications depend on the type and location of trauma but can include corneal abrasions,
Strabismus, also known as crossed eyes, occurs when the eyes are misaligned and do not look in the same direction. It can be caused by problems with eye muscles, nerves that control the muscles, or the brain's control center for eye movement. Strabismus can cause double vision, eye fatigue, and vision loss if not treated. It is diagnosed through a comprehensive eye exam assessing vision, eye alignment and health, and treated through optical correction, eye exercises, or muscle surgery depending on the cause.
Corneal ulcers can be caused by bacteria, fungi, viruses, or protozoa invading and damaging the cornea. Bacterial ulcers involve lymphocyte infiltration and necrosis, leading to stages of active ulceration, regression as phagocytosis occurs, and eventual cicatrization. Fungal ulcers provoke a severe inflammatory response, stromal necrosis, and potential perforation if filamentous fungi penetrate the descement's membrane. Symptoms include pain, photophobia, blurred vision, discharge, and redness. Treatment depends on the causative agent and involves topical or systemic antibiotics, antifungals, antivirals, or anti-amoebic medications, as well as debride
Orbital cellulitis is an infection behind the orbital septum that can spread from adjacent sinuses or bloodstream. It is classified by Chandler into 5 groups based on location and severity. Group 1 is preseptal cellulitis anterior to the septum. Group 2 is orbital cellulitis within the orbit. Group 3 is a subperiosteal abscess between the bone and periosteum. Group 4 is an orbital abscess within orbital contents. Group 5 is cavernous sinus thrombosis spreading bilaterally. Symptoms include eyelid swelling, pain, and vision issues. Imaging helps locate the infection and guide treatment which involves intravenous antibiotics, analgesics, and sometimes surgery.
Ocular injuries can be classified as open globe, closed globe, or periocular injuries. Open globe injuries involve a full thickness break in the eye wall, while closed globe injuries do not penetrate the full thickness. Periocular injuries involve the tissues surrounding the eye. Common closed globe injuries include conjunctival and corneal abrasions, hyphema, and retinal detachment. Lid lacerations may require repair depending on their location. Blunt eye trauma requires examination of visual acuity and eye anatomy to check for injuries like ruptured globe or optic nerve damage. Suspected open globe injuries or those with vision loss require emergent ophthalmology referral.
This is a seminar presentation conducted by 4th year medical student under supervision of a lecturer. This is for ophthalmology posting seminar. Source of information are from google, few textbooks and also based on previous ophthalmology posting group's seminar.
This document discusses pseudophakia, which is the condition where aphakia (absence of the natural lens) is corrected through implantation of an intraocular lens (IOL). It defines key terms like phakia, aphakia, and pseudophakia. The document also covers calculation of IOL power using the SRK formula, potential refractive outcomes like emmetropia, consecutive myopia or hypermetropia, and astigmatism. It serves as an introduction to pseudophakia for optometry students.
This document provides an overview of evaluating and treating uveitis. It begins by outlining the workflow of examining a patient with uveitis and classifying the type and severity. A targeted approach to ocular and systemic investigations is recommended based on determining the etiology. Treatment involves addressing the inflammation with topical, periocular, or systemic corticosteroids depending on severity, with alternatives for steroid-sparing such as immunosuppressants. Side effects of the different treatment approaches are also reviewed.
Endophthalmitis is an inflammation of the inner eye structures that can be infectious or non-infectious. Infectious endophthalmitis can develop from exogenous sources like injuries or surgeries, endogenous sources like bloodborne infections, or extensions from surrounding structures. Common causative organisms include staphylococci, streptococci, and fungi. Acute post-operative bacterial endophthalmitis presents with pain, redness, photophobia, and vision loss and is treated with intravitreal and systemic antibiotics along with possible vitrectomy. Delayed postoperative endophthalmitis is often caused by Propionibacterium acnes trapped in the capsular bag and presents with
This document provides information on uveitis, including its definition, causes, classification, signs and symptoms, diagnosis, and treatment. Uveitis is defined as inflammation of the uveal tract of the eye. It can be caused by infection, drugs, non-infectious factors, or be associated with systemic diseases. Uveitis is classified anatomically based on which part of the eye is affected (anterior, intermediate, posterior, panuveitis), and can also be classified clinically, pathologically, or based on etiology. Common signs and symptoms include eye pain, redness, blurred vision, and floaters. Diagnosis involves examination and potential laboratory testing. Treatment aims to relieve symptoms and prevent sight loss,
This document discusses osteomyelitis, an inflammation of bone caused by an infecting organism. It begins by providing the etymology and definition of osteomyelitis. It then discusses various classifications of osteomyelitis including acute vs chronic duration, and classifications based on mechanism (hematogenous, contiguous) and host response (pyogenic, non-pyogenic). The document provides details on the presentation, risk factors, pathogenesis, diagnosis, and treatment of acute hematogenous osteomyelitis as well as chronic osteomyelitis. It also briefly discusses other types such as Brodie's abscess and tuberculous osteomyelitis.
This document provides guidelines for the medical management of uveitis. It discusses evaluating patients for infectious vs immunological causes and determining when further workup is needed. The basic therapeutic principles are treating any infectious causes specifically and using corticosteroids to control non-infectious inflammation, with immunomodulatory agents as adjuvants. It then details treatment approaches and medications for different types of uveitis including anterior, intermediate, posterior with or without vitritis, and retinal vasculitis.
Dr. Prabin Kumar Bam, MBBS
Endophthalmitis: Definition, Etiology,
Pathogenesis, Clinical Features, Complications, Treatment, Modern Technology..
Endophtalmitis power point presentation for MBBS and MD
Endophthalmitis for MD ophthalmology
Prabin Kumar Bam
Chitwan Medical College
1) The document presents two case studies of patients who developed endophthalmitis following cataract surgery and intravitreal injection respectively.
2) For initial treatment, samples were collected via vitreal tap or vitrectomy for microbiology testing. Empirical intravitreal antibiotics were also administered along with intravenous antibiotics in severe cases.
3) Common causative organisms of post-operative endophthalmitis include coagulase-negative staphylococci and streptococci. Management involves diagnostic testing, intravitreal and possibly intravenous antibiotics, and follow up examinations.
1) The document discusses diseases of the orbit including anatomy, causes of proptosis, orbital infections like cellulitis, dysthyroid ophthalmopathy, and orbital inflammatory pseudotumors.
2) Evaluation of proptosis involves taking history of onset and symptoms, examining for signs of inflammation, restricted eye movement, and proptosis measurement. Investigations include imaging and biopsy.
3) Orbital cellulitis is a serious infection behind the orbital septum treated with intravenous antibiotics and possibly surgery. Dysthyroid ophthalmopathy causes eye changes like proptosis and diplopia managed initially with oral steroids.
This document summarizes various types of orbital inflammation including preseptal cellulitis, orbital cellulitis, idiopathic orbital inflammatory disease, orbital myositis, dacryoadenitis, thyroid orbitopathy, Tolosa-Hunt syndrome, and rhino-orbital mucormycosis. It describes the presentations, risk factors, pathogenesis, diagnostic evaluations, and treatment approaches for each condition. The document emphasizes that orbital inflammatory diseases encompass a broad spectrum and can affect people of all ages, with varying degrees of visual impairment, proptosis, ophthalmoplegia, and pain depending on the specific condition and extent of inflammation present.
This document discusses and classifies acute and subacute osteomyelitis. It begins by defining osteomyelitis as a bone or bone marrow infection. It then classifies osteomyelitis based on timing of onset (acute <2 weeks, subacute 2-6 weeks, chronic >6 weeks) and method of spread (exogenous or hematogenous). Key points include: acute osteomyelitis most commonly spreads hematogenously while staphylococcus aureus is the most common cause; subacute osteomyelitis has an indolent course and is often an incidental finding on imaging. Treatment involves antibiotics, surgery if abscess or lack of response, and immobilization.
The corneal diseases are one of the leading causes of blindness in the world. in most cases, these infections are preventable or treatable.
This seminar provides an overview of the anatomy and physiology of the cornea, as well as an overview of common conditions.
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.
Malignant otitis externa is an aggressive infection that starts in the external ear canal and spreads quickly to surrounding soft tissues and skull base bones. It is caused most commonly by Pseudomonas aeruginosa bacteria and patients with diabetes or AIDS are more susceptible. Diagnosis involves examination finding of ear pain, drainage and swelling supported by positive bone scans. Treatment requires prolonged high dose antibiotic therapy directly into veins or muscles along with surgery to remove dead tissue when needed.
Endophthalmitis is an intraocular inflammatory reaction caused by bacterial or fungal infection. It can be exogenous from direct inoculation through ocular procedures/trauma or endogenous from hematogenous spread. Treatment involves intravitreal antibiotic injections with or without vitrectomy depending on visual acuity. Prognosis depends on causative organism, time to treatment, and underlying patient health issues. Proper surgical technique and systemic infection control can help prevent this potentially vision-threatening condition.
This document discusses acute post-operative endophthalmitis, including its definition, epidemiology, clinical features, and methods for prevention. It notes that endophthalmitis is an inflammation of the internal coats of the eye caused by bacterial or fungal infection. The incidence of post-operative endophthalmitis has been increasing in recent decades due to newer surgical techniques. Proper prevention techniques like pre-operative povidone iodine application and intra-operative antibiotic use, particularly intracameral cefuroxime, have been shown to significantly reduce risk. Early recognition and treatment are important if infection does occur.
Ocular manifestations of tuberculosis infectionShahid Manzoor
Ocular manifestations of TB can affect any part of the eye. Secondary ocular TB results from hematogenous spread from a distant site. Presentations include adnexal lesions like lupus vulgaris and eyelid granulomas. Anterior segment involvement includes conjunctivitis, granulomas, keratitis and iridocyclitis. Posterior segment manifestations are choroidal tubercles, tuberculomas, serpiginous-like choroiditis and subretinal abscesses. Neuro-ophthalmic signs consist of optic nerve tubercles or neuritis. Complications include cataracts, glaucoma, cystoid macular edema and retinal detachment. Treatment involves antitubercular drugs
The document describes the anatomy and structure of the iris, ciliary body, choroid, and vascular pigmented layer. It discusses iridocyclitis (inflammation of the iris and ciliary body), its causes, signs, symptoms, diagnosis, and treatment options which include medications like atropine and corticosteroids as well as procedures like paracentesis. Complications of chronic iridocyclitis mentioned include band keratopathy, synechiae formation, glaucoma, and cataracts.
The document describes the anatomy and structure of the iris, ciliary body, choroid, and vascular pigmented layer. It discusses iridocyclitis (inflammation of the iris and ciliary body), its causes, symptoms, signs, and treatment options. Chronic iridocyclitis is characterized by vision loss, dust-like vitreous opacities, and formation of synechiae between the iris and lens. Diagnosis involves examining onset/course, medical history, clinical presentation, and lab tests. Treatment focuses on the underlying cause, symptoms, and preventing complications like glaucoma.
The document describes the anatomy and structure of the iris, ciliary body, choroid, and vascular pigmented layer. It discusses iridocyclitis (inflammation of the iris and ciliary body), its causes, symptoms, signs, and treatment options which include medications like atropine and corticosteroids to reduce inflammation and prevent complications. Chronic iridocyclitis can lead to posterior synechiae, band keratopathy, and secondary glaucoma if not properly treated.
The document describes the anatomy and structure of the iris, ciliary body, choroid, and vascular pigmented layer of the eye. It discusses iridocyclitis (inflammation of the iris and ciliary body) and its causes, signs, symptoms and treatment. It also describes suppurative choroiditis, endophthalmitis, and panophthalmitis, forms of posterior uveitis involving inflammation of the choroid.
This document discusses various corneal causes of decreased vision. It begins with an introduction to the anatomy and function of the cornea. There are then several sections covering common corneal conditions like injuries, keratitis, dry eye, and corneal dystrophies. Specific causes of decreased vision are explored such as infections, nutritional deficiencies, inflammation, inherited conditions, degeneration, and trauma. Important corneal conditions like keratitis, trachoma, xerophthalmia, peripheral ulcerative keratitis, and corneal dystrophies are described in more detail. The document concludes with a section on diagnostic approaches for corneal conditions.
1) Secondary ectasia refers to corneal shape changes caused by external factors like previous refractive surgery or corneal transplantation.
2) Post-LASIK ectasia is a rare complication characterized by progressive myopia and astigmatism due to thinning and protrusion of the cornea. Risk factors include young age and pre-existing thin corneas.
3) On Pentacam, early post-LASIK ectasia shows mild corneal thinning and elevation changes mostly in the inferior cornea, while advanced cases resemble keratoconus with significant steepening and irregularity.
Refractive surgery for beginners which surgery for which patien.pptxAmr Mounir
This document discusses different types of refractive surgery, including surface ablation techniques like PRK as well as LASIK. It notes that while LASIK became popular initially due to faster recovery times, surface ablation procedures have advantages in safety and corneal stability since they do not create a flap. The document outlines some risks of LASIK like flap complications and long term safety issues. It also discusses problems with early surface ablation like haze and healing issues. More advanced surface ablation techniques like LASEK and Epi-LASIK are highlighted as safer alternatives to LASIK that avoid flap risks. The use of femtosecond lasers to create thinner, more precise flaps for LASIK is also discussed as a way to increase its safety profile.
This document discusses referencing styles, citations, and figure and table legends. It provides examples of references in APA, MLA, Harvard, and ACS styles. Key points covered include:
- References should provide necessary information for readers to identify cited works and be accurate and complete.
- Common referencing styles are MLA, APA, Harvard and MHRA.
- Figure and table legends should include a title, methods, results, and any necessary definitions to explain the materials, methods and key findings shown. Legends are usually short phrases placed above tables.
The h-index is a metric developed by J.E. Hirsch to quantify an individual researcher's scientific impact. It is calculated based on the number of papers they have published and the number of citations received, with the h-index being the number of papers that have been cited at least that same number of times. Specifically, the h-index looks at a researcher's most cited papers ranked in descending order by citations, and the h-index value is equal to the number of papers that have received that same number or more citations.
This document provides an overview of cataract management, including causes, types, preoperative preparation, surgical techniques, and complications. A cataract is a cloudy area in the lens that decreases vision, with common symptoms including blurred or double vision. Causes include age, trauma, medications, and diseases. Preoperative preparation involves visual acuity testing, slit lamp examination, and imaging of the eye and lens. Surgical techniques include phacoemulsification, the most common, manual small incision surgery, extracapsular extraction, and intracapsular extraction. Potential complications are complications of anesthesia, posterior capsular tear, endophthalmitis, toxic anterior segment syndrome, and retinal detachment.
This document discusses non-contact meibography, a technique used to image the meibomian glands of the eyelid. It can be performed easily using a slit lamp equipped with an infrared camera. Meibography allows visualization of the glands and quantification of gland dropout. Normal glands appear as hypoilluminant grape-like clusters while dropout glands do not traverse the entire tarsal plate. The technique has advantages of being non-invasive while allowing documentation over time. Grading systems have also been developed to objectively analyze meibography images. The document outlines several studies where meibography was used to evaluate gland changes in various ocular surface disorders like blepharitis, contact lens use, and
This document provides guidance on writing the discussion section of a research article. The discussion section analyzes the meaning and importance of results, relating them to the literature review and research questions. It should include interpretation of results, implications, limitations, and recommendations. When interpreting results, the author should identify patterns in the data, compare findings to hypotheses and previous research, and explain unexpected results. The discussion should also discuss implications for theory and practice, acknowledge limitations, and make recommendations for further research based on results. The author is advised to summarize key findings, interpret results in light of other research without exaggerating claims, and avoid introducing new results or undermining their own research.
This document discusses retinal detachment, which occurs when the retina separates from the underlying tissue. The most common type, rhegmatogenous retinal detachment, results from a tear or break in the retina that allows fluid to seep in. Symptoms include floaters, visual field defects, and flashes of light. Diagnosis involves examinations of the eye and ultrasound. Treatment depends on the type but generally aims to seal retinal breaks, relieve traction, and reattach the retina using procedures like cryotherapy, laser photocoagulation, pneumatic retinopexy using gas bubbles, or vitrectomy surgery to remove the vitreous gel.
This document discusses various eyelid malpositions including entropion, ectropion, ptosis, and trichiasis. Entropion is when the eyelid rolls inward causing eyelashes to rub the eye, potentially damaging the cornea. Ectropion is when the eyelid rolls outward. Causes, symptoms, evaluations, and treatments are described for each condition. Conservative treatments include taping, lubricants, and botulinum toxin injections. Surgical treatments aim to tighten or reposition the eyelid depending on the specific malposition and its underlying cause. Prompt treatment is important to prevent corneal complications.
Blepharitis is a common eye condition characterized by inflamed, scaly, red eyelids. It is caused by bacteria, dandruff, or other skin conditions. There are different types of blepharitis that affect the front or back of the eyelids. Symptoms include gritty or burning eyes, excessive tearing, and eyelid crusting. While blepharitis itself is not sight-threatening, it can lead to permanent eyelid changes if left untreated. Treatment focuses on keeping eyelids clean through warm compresses and scrubbing, with antibiotics or steroids possibly prescribed depending on the underlying cause.
This document outlines ophthalmic manifestations of COVID-19 reported in the literature. It discusses how SARS-CoV-2 interacts with ACE2 receptors in ocular tissues, potentially causing immune-mediated damage and coagulopathy. Common anterior segment manifestations include conjunctivitis (in up to 8% of patients), keratoconjunctivitis, hemorrhagic conjunctivitis, and episcleritis. Posterior segment and neuro-ophthalmic manifestations as well as orbital involvement are also reviewed. The document examines evidence that the eye may serve as a route of COVID-19 infection transmission and discusses evaluations and management according to clinical presentation.
Ptosis, or drooping of the upper eyelid, can have several causes including paralysis or disease (myogenic, neurogenic), or be congenital (aponeurotic). Myogenic ptosis may be congenital due to poor levator muscle contraction/relaxation, or acquired like in myasthenia gravis where the myoneural junction is defective. Neurogenic ptosis includes third nerve palsy or Horner's syndrome. Aponeurotic ptosis includes senile or postoperative changes. Treatment depends on the cause and degree of ptosis, and may involve frontal sling surgery using the frontalis muscle, levator resection/advancement for moderate ptosis, or Whitnall sling or
Non-infectious corneal ulcers can be caused by local factors like punctate marginal keratitis due to hypersensitivity to medications or peripheral keratitis associated with blepharitis, or systemic immune-mediated diseases like rheumatoid arthritis. Marginal keratitis is characterized by chronic blepharitis and subepithelial marginal infiltrates separated from the limbus by a clear zone. Mooren's ulcer is a rare autoimmune disease seen as progressive peripheral circumferential stromal ulceration. Terrien marginal degeneration is an idiopathic thinning of the peripheral cornea. Peripheral ulcerative keratitis can be associated with underlying systemic autoimmune diseases like rheumatoid arthritis.
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
This presentation describes all clinical aspects of infectious corneal ulcers
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=okWDPG3C34g&list=PLZ_mM13I_TrhwqZuGjB6M9Z3n7MntrURd
This presentation describes all clinical aspects of glaucoma medications.....you can watch this presentation in video form at the following link
https://www.youtube.com/watch?v=92xurWP41dA
This presentation describes all clinical aspects of congenital glaucoma....you can watch this presentation in video form at the following link
https://www.youtube.com/watch?v=Y5YA2CYzb5c
Femtolasik...Indications and limitationsAmr Mounir
This presentation describes all indications and limitations of femtosecond laser surgery.....you can watch the illustrated video presentation in the following link:
https://youtu.be/vCwu-_hpWxA
This presentation describes all clinical aspects about primary open angle glaucoma ......
you can watch the illustrated video presentation at the following link : https://youtu.be/eA44Pu4l8Ow
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
4. Anterior uveitis
:Includes iridocyclitis
and iritis.
Iritis is the
inflammation of
the anterior
chamber and iris.
Iridocyclitis presents
the same symptoms as
iritis, but also includes
inflammation in
the ciliary body
6. Intermediate uveitis
also known as pars planitis, consists of
vitritis—which is inflammation of cells in the
vitreous cavity, sometimes with snowbanking,
or deposition of inflammatory material on
the pars plana. There are also "snowballs,"
which are inflammatory cells in the vitreous.
7. Posterior uveitis
- Posterior uveitis:
Chorioretinitis
is the inflammation of
the retina and choroid.
- Pan-uveitis is the
inflammation of all
layers of the uvea
8. Clinical picture
o Respiratory symptoms ……..TB, Sarcoidosis.
o Skin problems accompanied by uveitis
erythema nodosum (arms +chin) >>>> Sarcoid & Bechet
oral & genital ulcers >> Bechet
o Joint disease
AS……….20% ant.uveitis
juvenile chronic arthritis
Reiter syndrome………..
Bowel problems
9. Signs
• Visual acuity may reduced
• ciliary injection
• Anterior uveitis:
• Keratitic precipitates
• Inflam. Cells maybe visible as clumps on endothelial of
cornea (mostly Inferior)
• On slit lamp exam.
Flare & hypopyon in severe inflammation.
Posterior synechia
12. • Intermediate and posterior uveitis
• Cells in the vitreous
• Macular edema
13. • Grading of aqueous cells
• Slit-lamp grading of aqueous cells (1 mm ×
3–4 mm beam)
Trace……………… 1-5 cells
+1 …………………. 6-15
+2 …………………. 16-25
+3 ……………………. 26-50
+4 …………………….. >50
14.
15.
16. Etiology
• Idiopathic
• Infections
• Systemic immune-mediated disease (40%)
• Syndromes confined primarily to the eye
• Masquerade syndromes
• 30% of patients don’t fit an well-defined
disease category
17. Investigations
Main aim : determine systemic association
Investigation should be guided by medical
History & General Examination:
1. Pt with first episode of non granulomatous iritis with no past
medical History & no systemic signs…so investigations are
not indicated
2. Recurrent persistent iritis with unusual severity, not
responsive to medical therapy or bilateral……….so here
investigation is needed
18. Ancillary tests
1- Ultrasound biomicroscopy (UBM): Ciliary body involvement
can best be confirmed by ultrasound biomicroscopy (UBM).
2- Fundus fluorescein angiography (FA): is mandatory for retinal
and choroidal lesions.
The FA allows identification of active inflammation of the retinal
vessels as seen in vasculitis.
The pattern of staining and leakage provides diagnostic clues.
Vascular occlusions can also be detected
Complications of uveitis that are best studied on FA include
cystoid macular edema (CME), neovascularization of retina
3-Indocyanine green angiography (ICGA): is the technique of
choice for imaging the choroid.
19. 4-Optical coherence tomography (OCT):
CME, neovascularization of retina, epiretinal membrane, or
Vitreomacular traction syndrome can be demonstrated well
21. Imaging studies
1. Chest X ray to rule out sarcoidosis & TB
2. Chest CT done if we have –ve chest X
ray but sarcoidosis still highly
suspected
3. Sacroiliac radiograph , if AS is suspected
22.
23.
24.
25.
26.
27. 10 Clinical Pearls for Treating
Uveitis By American A.O
1-Anatomical location of the inflammation.
2- Patient’s current treatments and medications.
3-A targeted review of systems.
4-A careful examination for depth of inflammation.
5-The workup.
6-Corticosteroids are the mainstay of therapy.
7- Prolonged therapy with prednisone, especially at doses
greater than 10 mg daily, can have significant side effects.
8-Uveitis patients are frequently steroid responders.
9-New approaches in immunotherapy involve more cellular-
specific targeting, such as T-cells.
28. Lastly:
.110-Helpful reference articles
.2include:
1- Guidelines for the use of immunosuppressive drugs in
patients with ocular inflammatory disorders. Am J
Ophthalmol. 2000; 130:492-513.
•2- The Standardization of Uveitis Nomenclature (SUN)
Working Group. Am J Ophthalmol. 2005; 140:509-516.
29. Aims:
1. relief pain & inflammation
2. prevent ocular structural damage
3. prevent visual loss & retinal or optic
damage
Include:
Cycloplegia
Long acting cycloplegic agents (cyclopentolate ,
hematropine )used to relief pain& photophobia by
mydriasis
30. I. Corticosteroids:
A. Local delivery of corticosteroids:
Topical corticosteroids:
Iontophoresis
Periocular injections
Intravitreal injections and inserts
B. Systemic oral steroids (oral and intravenous)
31. II. Immunosuppressants
III. Biologics
IV. Adjuvant therapy:
Cycloplegic
Newer nonsteroidal anti-inflammatory agents
Anti-vascular endothelial growth factor (anti-VEGF) therapy
bevacizumab , ranibizumab
V. Current concepts in infectious uveitis management
32. Corticosteroids
1. Topical , is the mainstays of therapy used aggressively esp. in
initial phases of therapy ,
- “soft steroids” eg: fluorometholone, rimexolone, and
loteprednol etabonate
-difluprednate (0.05%) (difluoroprednisolone butyrate acetate)
-has greater glucocorticosteroid receptor binding
2. Subconjunctival injection , used if patient poorly complies
to topical type or iritis not respond to topical ttt alone
3. Oral corticosteroid maybe necessary in severe cases of iritis
and post uveitis
35. Immunosuppressive agents
Immunosuppressive drugs can be classified as antimetabolites,
T cell inhibitors, and alkylating agents.
These drugs take many weeks to have an effect, so initial
therapy of ocular inflammation typically include high dose of
systemic steroids.
Immunosuppressive therapy can be started simultaneously with
corticosteroids in severe cases or during the tapering of oral
corticosteroids 4–8 weeks later in cases of chronic uveitis.
36.
37. Biologics
Anti-tumor Necrosis Factor-alpha (Anti TNFα) Therapies:
etanercept, infliximab, and adalimumab
Interferons (IFN)
Intravenous Immunoglobulin
Anti-interleukin Therapies:
Daclizumab is a humanized monoclonal antibody against the
interleukin (IL)-2 receptor.
Biologic therapy provides new options for the treatment
of refractory uveitis, showing a favorable safety and
efficacy profile.
38. Adjuvant Therapy
To provide symptomatic relief for pain and discomfort and
break the posterior synechiae, the following cycloplegics can be
used:
Short acting cycloplegics:
Tropicamide (0.5 and 1%) has a duration of 6 hours
Cyclopentolate (0.5 and 1%) has a duration of 24 hours
Long acting cycloplegics:
Homatropine 2% has a duration of up to 2 days
Atropine 1% is the most powerful cycloplegic and mydriatic with
duration of up to 2 weeks.
39. NSAIDs
Newer Nonsteroidal Anti-Inflammatory Agents: Bromfenac,
Nepafenac
They are used for reduction of ocular pain and inflammation
following cataract surgery and in scleral inflammation.
-Bromfenac ophthalmic solution 0.09%
-Nepafenac 0.1%
41. Vitrectomy
1- Diagnostic vitrectomy combined with PCR in idiopathic
uveitis
2- Therapeutic vitrectomy:
Indications :
1) Uveitis persists despite maximum tolerable medical
treatment
2) In complications of long standing inflammations, a densely
opacified vitreous, scar tissue pulling on the ciliary body causing
hypotony, cystoid macular edema, an epiretinal membrane, a
dense posterior lens capsule opacification or a Tractional retinal
detachment
3) Vitrectomy removes the lodged lymphocytes in the vitreous,
inflammatory debris, immune complexes and autoantigens.