Management of Uveitis

1. UVEITIS MANAGEMENT

2. Dr. Mohd N Khan 17-Nov-17

7. 7

11. Dr. Mohd N Khan
ANTI-INFLAMMATORY AGENTS
• TREATMENT : STOP INFLAMMATION
• USE ANTI-INFLAMMATORY DRUGS
• MOST POTENT OF SUCH AGENTS : CORTICOSTEROIDS
• CORTICOSTEROIDS ARE THE MAINSTAY OF THERAPY IN UVEITIS
17-Nov-17

12. Dr. Mohd N Khan
COMPLICATING THE ISSUE
• WHAT IF THE CAUSE IS INFECTIOUS--SPECIFIC ANTI-INFECTIVE AGENT IS
INDICATED AND CORTICOSTEROIDS MAY EVEN WORSEN THE INFECTION WHEN
GIVEN ALONE
• WHEN THE CAUSE IS IMMUNE RELATED-- CORTICOSTEROIDS WILL BE EFFECTIVE
BUT ASSOCIATED SIDE EFFECTS MAYBE SIGNIFICANT
17-Nov-17

13. Dr. Mohd N Khan
FINDING THE ETIOLOGY
• NARROW DOWN LIST OF DIFFERENTIALS BY HISTORY AND EXAMINATION
• APPROPRIATE INVESTIGATIONS (OCULAR AND SYSTEMIC)
• REFERRALS FOR SYSTEMIC ASSOCIATIONS
• TREATING THE INFLAMMATION BY SPECIFIC THERAPY OR NON-SPECIFIC
THERAPY
17-Nov-17

14. Dr. Mohd N Khan
FEW OCULAR INVESTIGATIONS
•FUNDUS FLUORESCEIN ANGIOGRAM --CYSTOID MACULAR EDEMA
(COMPLICATION) • SERPIGINOUS CHOROIDOPATHY (PATTERN OF
LESION)
•OCT –-TO ASSESS MACULAR EDEMA
• ULTRASONOGRAPHY --ESPECIALLY IN CASES OF MEDIA
OPACITIES OCULAR TISSUE ANALYSIS
• AQUEOUS TAP • VITREOUS TAP • CHORIORETINAL BIOPSY
17-Nov-17

15. Dr. Mohd N Khan
COMMONLY ORDERED TESTS
• COMPETE BLOOD COUNT (TLC & DLC)
• BACTERIAL/VIRAL PATHOLOGY/MALIGNANCY
• ESR—NON SPECIFIC FOR INFLAMMATION
• C-REACTIVE PROTEIN
• RHEUMATOID FACTOR
• OTHER TESTS DEPENDING ON CLINICAL SUSPICION
17-Nov-17

16. Dr. Mohd N Khan
FEW SYSTEMIC INVESTIGATIONS
•SARCOIDOSIS-- CHEST X-RAY & CT (HILAR LYMPHADENOPATHY),
SERUM ANGIOTENSIN CONVERTING ENZYME (ACE) BUT NOT
SPECIFIC, RAISED SERUM CALCIUM, ECG (CARDIAC SARCOIDOSIS
WITH VENTRICULAR TACHYCARDIA)
•TUBERCULOSIS-- MANTOUX TEST (PURIFIED PROTEIN DERIVATIVE),
QUANTIFERON-TB GOLD (QFT-G), RAISED SERUM CALCIUM
•SYPHILIS – NON SPECIFIC:VDRL & RAPID PLASMA REAGIN (RPR),
SPECIFIC:FTA-ABS & MHA-TP
17-Nov-17

17. Dr. Mohd N Khan
• TOXOPLASMOSIS—SERUM TITER IGG, IGM
• BRUCELLA
• ANTI NUCLEAR ANTIBODY (ANA)-SLE, JRA
• ELISA-LYME DISEASE
• HLA B27-ANKYLOSING SPONDYLITIS, JRA, REITERS SYNDROME, IBD, REACTIVE
ARTHRITIS
• HLA B51/B5-BEHCETS DISEASE
17-Nov-17

18. Dr. Mohd N Khan
• VARIOUS JOINT X RAY-JRA
• SACROILIAC JOINT X RAY-ANKYLOSING SPONDYLITIS
• CHEST X RAY-TUBERCULOSIS/SARCOIDOSIS
IMAGING
17-Nov-17

19. Dr. Mohd N Khan
DISEASE LABORATORY TESTS X-RAY STUDIES CONSULT/REFERRAL OTHER TESTS
ANKYLOSING SPONDYLITIS ↑ ESR, (+)HLA-B27 SACROILIAC X-RAYS RHEUMATOLOGIST
IBD (+)HLA-B27 INTERNIST OR
GASTROENTEROLOGIST
REITER’S SYNDROME ↑ ESR, (+)HLA-B27 JOINT X-RAYS INTERNIST CULTURES; CONJUNCTIVAL
UROLOGIST, URETHRAL, PROSTATE
RHEUMATOLOGIST
PSORIATIC ARTHRITIS (+)HLA-B27 RHEUMATOLOGIST,
DERMATOLOGIST
HERPES DIAGNOSED CLINICALLY DERMATOLOGIST
BEHCET’S DISEASE (+)HLA-B51 INTERNIST BEHCET’S SKIN
LYME DISEASE ELISA, LYME IMMUNOFLUORESCENT ASSAY INTERNIST,
RHEUMATOLOGIST
JRA ↑ ESR, (+)ANA, JOINT X-RAYS RHEUMATOLOGIST,
(-)RHEUMATOID FACTOR PEDIATRICIAN
SARCOIDOSIS ↑ (ACE) CHEST X-RAY INTERNIST
SYPHILIS (+)RPR OR VDRL; FTA-ABS OR MHATP INTERNIST
TUBERCULOSIS, QUANTIFERON CHEST X-RAY INTERNIST PPD (MANTOUX TEST)
RHEUMATOLOGIST PUNCTURE TEST
17-Nov-17

20. Dr. Mohd N Khan
• COMPLETE BLOOD COUNT (CBC)
• ERYTHROCYTE SEDIMENTATION RATE (ESR)
• ANTINUCLEAR ANTIBODY TEST (ANA)
• RAPID PLASMA REAGIN (RPR) OR(VDRL) OR (FTA-ABS) OR (MHA-TP)
• PURIFIED PROTEIN DERIATIVE (PPD)
• CHEST X-RAY FOR SARCOIDOSIS AND TUBERCULOSIS
• LYME TITER IN ENDEMIC AREAS
• CONSIDER HLA-B27 TESTING
SUGGESTED WORKUP FOR BILATERAL, GRANULOMATOUS OR RECURRENT
ANTERIOR UVEITIS WITH NO INDICATION OF A SYSTEMIC CAUSE
17-Nov-17

21. Dr. Mohd N Khan 17-Nov-17

22. Dr. Mohd N Khan
• TO PRESERVE VISUAL ACUITY
• TO RELIEVE OCULAR PAIN
• TO ELIMINATE THE OCULAR INFLAMMATION OR IDENTIFY THE SOURCE OF
INFLAMMATION
• TO PREVENT FORMATION OF SYNECHIAE
• TO MANAGE INTRAOCULAR PRESSURE.
BASIS FOR TREATMENT—GENERAL GOALS
17-Nov-17

23. Dr. Mohd N Khan
SPECIFIC – ETIOLOGY DEPENDENT
•TUBERCULOSIS-- ATT
•SYPHILIS-- PARENTERAL PENICILLIN
•TOXOPLASMOSIS--SULFA AND PYRIMETHAMINE &
INTRAVITREAL CLINDAMYCIN (1 MG/0.1ML) WITH
DEXAMETHASONE (0.4 MG/0.1ML)
•LYME DISEASE—TETRACYCLINES
•ACUTE RETINAL NECROSIS– I/V ACYCLOVIR
•CMV RETINITIS--IV GANCICLOVIR
MEDICAL THERAPY
17-Nov-17

24. Dr. Mohd N Khan
I. CORTICOSTEROIDS: CORTICOSTEROIDS ARE THE FIRST LINE
OF THERAPY IN PATIENTS WITH NONINFECTIOUS OCULAR
INFLAMMATORY DISEASES.
LOCAL DELIVERY OF CORTICOSTEROIDS:
•TOPICAL CORTICOSTEROIDS
•IONTOPHORESIS
•PERIOCULAR INJECTIONS
•INTRAVITREAL INJECTIONS AND INSERTS
SYSTEMIC ORAL STEROIDS (ORAL AND INTRAVENOUS)
NON-SPECIFIC
17-Nov-17

25. Dr. Mohd N Khan
II. IMMUNOSUPPRESSANTS
III. BIOLOGICS
IV. ADJUVANT THERAPY: CYCLOPLEGICS
• NEWER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
• ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR (ANTI-VEGF) THERAPY
17-Nov-17

26. Dr. Mohd N Khan
• TO RELIEVE PAIN BY IMMOBILIZING THE IRIS
• TO STABILIZE THE BLOOD-AQUEOUS BARRIER AND HELP PREVENT FURTHER
PROTEIN LEAKAGE (FLARE).
• TO RELIEVE CILIARY SPASM AND PAIN
• TO PREVENT POSTERIOR SYNECHIAE
• BREAK THE ONES ALREADY FORMED
• CYCLOPLEGIA RELIEVES PAIN AND A MOBILE PUPIL PREVENTS POSTERIOR
SYNECHIAE
CYCLOPLEGICS AND MYDRIATICS
17-Nov-17

27. Dr. Mohd N Khan
•ATROPINE, 0.5%, 1%, 2%
•HOMATROPINE, 2%, 5%
•SCOPOLAMINE, 0.25%
•CYCLOPENTOLATE, 0.5%, 1%, 2%.
•PHENYLEPHRINE, 2.5%, IS AN ADRENERGIC AGONIST THAT
CAUSES DILATION BY DIRECT STIMULATION OF THE IRIS
DILATOR MUSCLE. BECAUSE PHENYLEPHRINE HAS NEITHER A
CYCLOPLEGIC NOR ANTI-INFLAMMATORY EFFECT AND MAY
CAUSE A RELEASE OF PIGMENT CELLS INTO THE ANTERIOR
CHAMBER, IT IS GENERALLY NOT RECOMMENDED AS AN INITIAL
PART OF THE THERAPEUTIC REGIMEN. PHENYLEPHRINE MAY,
HOWEVER, HELP BREAK RECALCITRANT POSTERIOR SYNECHIA.
17-Nov-17

28. Dr. Mohd N Khan
CYCLOPLEGIC & MYDRIATICS
• SHORTER ACTING --TROPICAMIDE EYE DROPS (EFFECTIVE UP TO 3 HRS) &
CYCLOPENTOLATE DROPS (UP TO 24 HRS)
• LONGER ACTING --HOMATROPINE EYE DROPS (UP TO 4 DAYS) & ATROPINE EYE
DROPS (UP TO 7-14 DAYS)
17-Nov-17

29. Dr. Mohd N Khan
• THE MAINSTAY OF THERAPY
• DEPENDING ON THE SITE OF INFLAMMATION AND SEVERITY  TOPICAL 
PERIOCULAR  SYSTEMIC
• TOPICAL DROPS WILL NOT BE EFFECTIVE FOR INTERMEDIATE, POSTERIOR AND
PANUVEITIS
• ‘USE ENOUGH SOON ENOUGH’
• TO ALWAYS START WITH A HIGHER DOSE AND TAPER BEFORE STOPPING
• TO INVESTIGATE BEFORE STARTING
CORTICOSTEROIDS
17-Nov-17

30. Dr. Mohd N Khan 17-Nov-17
TOPICAL CORTICOSTEROID-FOR ANTERIOR UVEITIS

31. Dr. Mohd N Khan
• ELEVATION OF IOP
• SUSCEPTIBILITY TO INFECTIONS
• IMPAIRED CORNEAL
• SCLERAL WOUND HEALING
• CORNEAL EPITHELIAL TOXICITY
• CRYSTALLINE KERATOPATHY
SIDE EFFECTS OF TOPICAL ADMINISTRATION OF
STEROIDS:
17-Nov-17

32. Dr. Mohd N Khan
Methylprednisolone Prednisone
What class is it? corticosteroid corticosteroid
What are the brand-
name versions?
Medrol, Depo-Medrol,
Solu-Medrol
Rayos
Is a generic version
available?
yes yes
What forms does it
come in?
oral tablet, injectable
solution*
oral tablet, oral
solution
What is the typical
length of treatment?
short-term for flare-
ups, long-term for
maintenance
short-term for flare-
ups, long-term for
maintenance
Is there a risk of
withdrawal with this
drug?
yes yes
17-Nov-17

33. Dr. Mohd N Khan
•A NONINVASIVE METHOD OF APPLICATION OF LOW CURRENT
TO AN IONIZABLE SUBSTANCE (DRUG) TO INCREASE ITS
MOBILITY ACROSS A SURFACE BY ELECTROCHEMICAL
REPULSION.
•DEXAMETHASONE PHOSPHATE (40 MG/ML, EGP-437) IS A
PRODRUG AND IS A GOOD CANDIDATE FOR IONTOPHORESIS
DELIVERY, AS IT POSSESSES TWO ACIDIC PROTONS (PK
VALUES OF 1.9 AND 6.4)
•THE EYE GATE II DELIVERY SYSTEM (EGDS) IS A NOVEL OCULAR
IONTOPHORESIS SYSTEM DESIGNED TO DELIVER
SUBSTANTIAL LEVELS OF DRUG NONINVASIVELY INTO THE
ANTERIOR SEGMENTS OF THE EYE WHILE MINIMIZING
SYSTEMIC DISTRIBUTION.
IONTOPHORESIS-FOR ANTERIOR UVEITIS
17-Nov-17

34. Dr. Mohd N Khan 17-Nov-17
PERIOCULAR STEROIDS-FOR MODERATE TO SEVERE CHRONIC OR RECURRENT UVEITIS,
CYSTOID MACULAR EDEMA, AND IN CASES WITH ANTERIOR CHAMBER INFLAMMATION
NOT RESPONDING ADEQUATELY TO TOPICAL CORTICOSTEROIDS

35. Dr. Mohd N Khan
• INCREASED IOP
• GLAUCOMA
• PTOSIS
• CATARACT
• INADVERTENT GLOBE PERFORATION
SIDE EFFECTS OF PERIOCULAR STEROIDS:
17-Nov-17

36. Dr. Mohd N Khan
• TRIAMCINOLONE ACETONIDE - 4 MG IN 0.1 ML, THE EFFECTS ARE USUALLY SHORT-
LIVED AND MAY LAST FOR 6–8 WEEKS
• RETISERT (BAUSCH AND LOMB)-FLUOCINOLONE ACETONIDE 0.59 MG, REQUIRES A
SURGICAL PROCEDURE TO SUTURE THE IMPLANT TO THE SCLERAL WALL, THAT
ACHIEVES SUSTAINED RELEASE OF APPROXIMATELY 2.5 YEARS, 90% RISK OF
CATARACT FORMATION IN PHAKIC PATIENTS AND ABOUT 40% OF PATIENTS WILL
HAVE TO UNDERGO GLAUCOMA SURGERY AFTER 3 YEARS OF DRUG EXPOSURE
INTRAVITREAL STEROIDS-FOR NON INFECTIOUS INTERMEDIATE AND
POSTERIOR UVEITIS AND CYSTOID MACULAR EDEMA
17-Nov-17

37. Dr. Mohd N Khan
• OZURDEX(ALLERGAN)-DEXAMETHASONE INTRAVITREAL IMPLANT, 0.7 MG, A
SUSTAINED RELEASE OF DEXAMETHASONE OVER 3–6 MONTHS, GIVEN
INTRAVITREALLY VIA AN INJECTOR
• SIDE EFFECTS INCLUDE CATARACT, INCREASED IOP, GLAUCOMA, RETINAL
DETACHMENT, VITREOUS HEMORRHAGE, AND ENDOPHTHALMITIS
17-Nov-17

38. Dr. Mohd N Khan
THE MULTICENTER UVEITIS STEROID TRIAL—WHICH COMPARED RETISERT WITH
IMMUNOMODULATION THERAPIES—
• REPORTED COMPARABLE VISUAL ACUITY OUTCOMES WITH MORE CONTROL OF
INFLAMMATION IN THE LOCAL THERAPY ARM OF THE STUDY
• BUT A HIGHER RATE OF OCULAR COMPLICATIONS WITH THE FLUOCINOLONE
ACETONIDE INTRAVITREAL IMPLANT.
17-Nov-17

39. Dr. Mohd N Khan 17-Nov-17
SYSTEMIC CORTICOSTEROIDS- FOR MODERATE TO SEVERE, BILATERAL,
BEYOND ANTERIOR SEGMENT, RESISTANT TO LOCAL THERAPY, OR
ASSOCIATED WITH SYSTEMIC DISEASE

40. Dr. Mohd N Khan 17-Nov-17

41. Dr. Mohd N Khan
• IN CORTICOSTEROID RESISTANT OR INTOLERANT CASES
• IN VISION THREATENING INFLAMMATIONS - AS FIRST LINE
• SPECIFIC CASES -- BEHCET’S SYNDROME
• SYMPATHETIC OPHTHALMITIS
• VKH SYNDROME
• NECROTIZING SCLEROUVEITIS
• ADVERSE REACTIONS CAN BE SEVERE AND LIFE THREATENING
IMMUNOSUPPRESSIVES
17-Nov-17

42. Dr. Mohd N Khan
•STEROID-SPARING DRUGS ARE EFFICACIOUS, METHOTREXATE,
AZATHIOPRINE, MYCOPHENOLATE MOFETIL, AND CYCLOSPORINE
WERE ALL EVALUATED IN THE SYSTEMIC IMMUNOSUPPRESSION
THERAPY FOR EYE DISEASE STUDY.
•“ALL OF THE DRUGS SHOW ROUGHLY THE SAME EFFICACY—
ABOUT 60% TO 70%—FOR THE ACHIEVING STEROID-SPARING
DOSE OF LESS THAN 10 MG PREDNISONE DAILY
•THESE DRUGS HAVE SERIOUS ADVERSE EFFECTS BUT NOT BE AS
FREQUENT AS MANY BELIEVE
17-Nov-17

43. Dr. Mohd N Khan 17-Nov-17

44. Dr. Mohd N Khan
• BEING STUDIED AND THE DRUG IS EFFECTIVE FOR TREATING INTERMEDIATE AND
POSTERIOR UVEITIS.
• CORNEAL TOXICITY, HOWEVER, IS A POSSIBILITY WITH THE 0.4-MG DOSE.
• THE OPTIMAL DOSE REMAINS UNKNOWN.
• A RECENT STUDY FROM MOORFIELDS EYE HOSPITAL (RETINA. 2013;33:2149-2154)
REPORTED THAT 70% OF PATIENTS WHO RESPONDED TO ONE METHOTREXATE
INJECTION HAD EXTENDED REMISSION OF NON-INFECTIOUS UVEITIS.
INTRAVITREAL METHOTREXATE INJECTION
17-Nov-17

45. Dr. Mohd N Khan
• AMERICAN UVEITIS SOCIETY (2014;121:785-796) RECOMMENDED THESE
DRUGS AS FIRST-LINE THERAPIES AND AS STEROID-SPARING THERAPIES IN
PATIENTS WITH BEHÇET’S DISEASE
• TO BE USED EARLY IN THE TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS IN
PATIENTS FOR WHOM METHOTREXATE WAS NOT SUCCESSFUL
TUMOR NECROSIS ALPHA (TNF-Α) INHIBITORS-
INFLIXIMAB & ADALIMUMAB
17-Nov-17

46. Dr. Mohd N Khan 17-Nov-17
BIOLOGICS-

47. Dr. Mohd N Khan
•DIFLUPREDNATE (DUREZOL, ALCON LABORATORIES) IS A
DIFLUORINATED CORTICOSTEROID EMULSION THAT WAS
APPROVED TO TREAT ANTERIOR UVEITIS.
•IT IS ESPECIALLY POTENT, EXCELLENT PENETRATION AND CAN
TREAT UVEITIC CYSTOID MACULAR EDEMA EVEN IN PHAKIC
PATIENTS.
•“HOWEVER, A SUBSTANTIAL RISK FOR ELEVATED IOP AND
CATARACT FORMATION, ESPECIALLY IN CHILDREN.
•IT REQUIRES CLOSE MONITORING.
NEW APPROVED THERAPIES
17-Nov-17

48. Dr. Mohd N Khan
•SIROLIMUS (SANTEN PHARMACEUTICALS), A MAMMALIAN TARGET
OF RAPAMYCIN INHIBITOR SIMILAR TO CYCLOSPORINE AND
TACROLIMUS, IS IN A PHASE III TRIAL FOR LOCAL OPHTHALMIC USE.
THE 6-MONTH RESULTS OF THE SIROLIMUS (SAVE TRIAL) SHOWED
ENCOURAGING RESULTS.
•VOCLOSPORINE (LX211, LUX BIOSCIENCES)—A CYCLOSPORINE–
FAMILY CALCINEURIN INHIBITOR—WAS TESTED IN A PHASE III
TRIAL OF UVEITIS THAT REQUIRED STEROID-SPARING DRUGS. THE
DRUG DID NOT MEET ITS ENDPOINT OF DECREASED VITREOUS HAZE,
AND THE NEW DRUG APPLICATION WAS WITHDRAWN.
•
17-Nov-17

49. Dr. Mohd N Khan
•RITUXIMAB (ANTI-CD20, RITUXAN, GENENTECH) FOR
SCLERITIS AND GRANULOMATOSIS WITH POLYANGIITIS AND
RHEUMATOID ARTHRITIS,
•AIN457 (ANTI-INTERLEUKIN 17) (NOVARTIS
PHARMACEUTICALS).
•OTHER BIOLOGICS THAT MAY HAVE OFF-LABEL USES FOR
UVEITIS ARE OCLIZUMAB, TOCLIZUMAB, CERTOLIZUMAB,
CANAKINUMAB, ABATACEPT, GOLIMUMAB, AND TOFACITINIB.
NUMEROUS BIOLOGICS-
17-Nov-17

50. Dr. Mohd N Khan
• BROMFENAC OPHTHALMIC SOLUTION 0.09%: IT CAN BE USED (TWICE
DAILY DOSAGE) AS EITHER MONOTHERAPY OR AS AN ADJUNCT
THERAPY TO STEROIDS.
• NEPAFENAC 0.1%: IT IS A PRODRUG. IT PENETRATES THE CORNEA SIX
TIMES FASTER THAN DICLOFENAC. IT IS CONVERTED TO AMFENAC IN
OCULAR TISSUES. IT HAS BEEN APPROVED FOR THRICE DAILY DOSAGE
BEGINNING 1 DAY BEFORE CATARACT SURGERY.
NEWER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS:
BROMFENAC, NEPAFENAC
17-Nov-17

51. Dr. Mohd N Khan 17-Nov-17

52. Dr. Mohd N Khan 17-Nov-17

53. Dr. Mohd N Khan 17-Nov-17

54. Dr. Mohd N Khan 17-Nov-17

55. Dr. Mohd N Khan
HUMIRA IS ADMINISTERED BY SUBCUTANEOUS INJECTION
INITIAL DOSE 80 MG FOLLOWED BY 40 MG GIVEN EVERY
OTHER WEEK STARTING 1 WEEK AFTER THE INITIAL DOSE
17-Nov-17

56. Dr. Mohd N Khan
• CATARACT SURGERY --IF NO ACTIVE INFLAMMATION FOR AT LEAST 3 MONTHS,
PERIOPERATIVE STEROIDS, HEPARIN SURFACE MODIFIED IOLS
• GLAUCOMA --ANTI-GLAUCOMA TOPICAL MEDICATION, PERIPHERAL IRIDOTOMY /
IRIDECTOMY IN IRIS BOMBÉ, TRABECULECTOMY WITH MITOMYCIN C OR 5
FLUOROURACIL, AGV
MANAGEMENT OF COMPLICATIONS
17-Nov-17

57. Dr. Mohd N Khan
• CYSTOID MACULAR EDEMA --CONTROL OF INFLAMMATION WITH
CORTICOSTEROIDS OR NSAIDS
• PARS PLANA VITRECTOMY IF PERSISTENT VITRITIS AND VITREOUS
OPACIFICATION
• HYPOTONY --INTENSIVE CORTICOSTEROIDS AND CYCLOPLEGIA
• PARS PLANA MEMBRANECTOMY FOR CYCLITIC MEMBRANE
17-Nov-17

58. Dr. Mohd N Khan
CASES—
17-Nov-17

59. Dr. Mohd N Khan
35 YR OLD MALE –IN RIGHT EYE
• CILIARY CONGESTION
• FINE KPS, AC FLARE
• PUPIL ROUND
• POSTERIOR SYNECHIAE AND
• HYPOPYON
• SIMILAR HISTORY OF REDNESS A YEAR AGO SPOT.COM
ANTERIOR UVEITIS
17-Nov-17

60. Dr. Mohd N Khan
MANAGEMENT
• HISTORY AND EXAMINATION TO NARROW THE DIFFERENTIALS – NOTHING
SIGNIFICANT
• THE CORE LAB TESTS – MANTOUX HIGHLY SIGNIFICANT
• REFERRAL TO PULMONOLOGIST – CONFIRM DIAGNOSIS OF TUBERCULOSIS
• CO-MANAGEMENT
17-Nov-17

61. Dr. Mohd N Khan
OCULAR MANAGEMENT
• TOPICAL CORTICOSTEROIDS --PREDNISOLONE EYE DROPS HOURLY, TAPERED AS
PER RESPONSE
• HOMATROPINE/CYCLOPENTOLATE EYE DROPS 3 TIMES A DAY
• FOLLOW UP FOR  INFLAMMATION  INTRAOCULAR PRESSURE  COMPLICATIONS
• SYSTEMIC MANAGEMENT --ANTI-TUBERCULOSIS THERAPY
17-Nov-17

62. Dr. Mohd N Khan
3 YEAR OLD GIRL –
• FEVER OF UNKNOWN ORIGIN 1 MONTH
• REDNESS BOTH EYES1 WEEK
• EYE EXAMINATION SPILL-OVER ANTERIOR UVEITIS
• ANTERIOR VITREOUS EXUDATES / SNOWBALLS
• SYSTEMIC EXAMINATION --LYMPHADENOPATHY
INTERMEDIATE UVEITIS
17-Nov-17

63. Dr. Mohd N Khan
MANAGEMENT
• LYMPH NODE BIOPSY --CASEATING GRANULOMATOUS LESIONS
• PHYSICIAN DIAGNOSIS -- TUBERCULOSIS
• SYSTEMIC MANAGEMENT -- ATT
• FEVER RESPONDED WITHIN 4 DAYS
17-Nov-17

64. Dr. Mohd N Khan
OCULAR MANAGEMENT
• ON 1 WEEK FOLLOW UP
• VISION DROP OF 2 LINES
• SYSTEMIC CORTICOSTEROIDS UNDER COVER OF ATT FOR SHORT PERIOD
(1MG/KG BODY WT OF PREDNISONE, TAPERED AND STOPPED WITHIN 4
WEEKS)
17-Nov-17

65. Dr. Mohd N Khan
35 YEAR OLD –
• HIV POSITIVE FEMALE
• SUDDEN PAINLESS LOSS OF VISION RE
• OCULAR EXAMINATION --SPILL OVER FINE KPS AND CMV RETINITIS IN THE
FUNDUS
• CD4 COUNT – 50
POSTERIOR UVEITIS
17-Nov-17

66. Dr. Mohd N Khan
• CMV RETINITIS – GRANULAR RETINAL NECROSIS, FROSTED BRANCH ANGIITIS
• MANAGEMENT WITH ANTIRETROVIRAL THERAPY
• INDUCTION --I/V GANCICLOVIR 5MG/KG BODY WEIGHT/ BID – 2 WEEKS
• MAINTENANCE – 5MG / KG BODY WEIGHT/DAY
17-Nov-17

67. Dr. Mohd N Khan 17-Nov-17

69. Dr. Mohd N Khan 17-Nov-17
THANK YOU