17. Synptom/Sign of uveitis Sign/Symptom Description Pathogenic Mechanisms Flare Milkiness of aqueous humor Protein is transudate from uveal vessels Cells Inflammatory and pigmented cells in AC White blood cells released from uveal vessels Fibrin (cyclytic membrane) Coagulation of exudates in AC (only seen in severe cases) Extreme inflammation with accumulation of fibrin Iris nodules: Koeppe and Busacca Fluffy white nodular precipitates on inner surface of pupillary margin (Koeppe) or on surface of iris (Busacca) (seen in some systemic based diseases) Inflammatory cellular infiltration into iris stroma Keratic precipitates (KP's) Deposits of inflammatory cells on endothelium. inferiorly; fine white (non-granulomatous) to giant waxy mutton fat (granulomatous); may be pigmented Inflammatory cells from iris and uveal vessels which stick to corneal endothelium Hypopyon Purulent exudate in lower AC (seen in severe cases) Purulent Exudation from inflamed uveal vessels
18. Grading Cells and Flare Dense Haze: With Obvious Fibrin Collecting on Iris 4 Dense Cells in Beam, More Than You Can Count 4 Marked: Iris Details Becoming Hazy 3 Cells Scattered Through Out Beam 20 or More 3 Moderate: But Iris Detail Still Clear 2 5-10 Cell Seen at Once 2 Faint: Haze or Not Equal Bilaterally 1 2-5 Cells Seen in 45 Seconds or One Minute 1 Optically Empty Compared Bilaterally 0 None 0 Flare Grade Aqueous Cells Grade
19. Synptom/Sign of uveitis IOP variation Low IOP is characteristic; glaucoma may develop as complication Low IOP from decreased aqueous production; high IOP is seen if TM becomes clogged with inflammatory debris Synechiae Adhesions of the iris to the lens in the pupillary zone (posterior synechiae) or of iris to angle structures (peripheral anterior synechiae) -- these develop during acute phase and persist indefinitely if not broken heavy exudation of protein (posterior); shallowing of AC from pupillary block, organization of exudates in angle, or from swelling of iris root (PAS) Conjunctival and perilimbal injection Pink to violet circumlimbal episcleral vessels (ciliary flush) Inflammatory vasodilation of radial episcleral vessels Cataract Opacification of crystalline lens From nutritional deprivation of lens fibers; or as a toxic response to inflammatory cell breakdown; or from topical or systemic steroid use Small pupils Not always present; miosis relative to other pupil Vasodilation of iris vessels; prostaglandin release
32. Diagnosis MAJOR CRITERIA MINOR CRITERIA Recurrent Oral Aphthous Ulcers (pain) Arthritis (heat, effuse, limitation) Skin Lesions: **Erythema nodosum-like lesions **Folliculitis Epididymitis Genital Ulcers( Gastrointestinal Involvement Ocular Disease : **Iridocyclitis with hypopyon **Posterior Uveitis with retinal vasculitis Vascular Involevement: **Thrombophlebitis Neurologic Symptoms Complete Presence of all major criteria Incomplete 3 major criteria 2 major + 2 minor criteria ocular disease + 1 major criterion ocular disease + 2 minor criteria Suspect 2 major criteria Possible 1 major criterion
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41. Episcleritis: episcleral tissue inflammation S/S: red eye episcleral vessel engorgement (between the conjunctiva and the sclera) Eti: allergy, unknown,… DD: epinephrine => bleach Tx: steroid
42. Scleritis Scleritis: an inflammation of the sclera stroma S/S: red eye Eti: unknown, 50% associated with immune disease such as : rheumatoid arthritis, Crohn’s disease, Wegener’s granulomatosis, metabolic disorders, infections and chemical or physical injuries. DD: epinephrine => scleral vessel bleach do not bleach Tx: 1. Steroid 2 immunosuppressor 3 scleral graft
