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Uveitis its clinical features and management.pptx
- 1. UVEITIS OPTO LUCY JOHNSON MOONJELY Bsc Optometry
- 3. CLASSIFICATION BASED ON ANATOMICAL SITE • Iritis • Iridocyclitis • Anterior Cyclitis Anterior Uveitis • Posterior Cyclitis • Hyalitis Intermediate Uveitis • Focal/ multifocal/diffuse choroiditis • Chorioretinitis • Retinochoroiditis • Retinitis • Neuroretinitis Posterior Uveitis Pan Uveitis Standardization of Uveitis Nomenclature (SUN)
- 4. CLASSIFICATION ACCORDING TO INFLAMMATORY ACTIVITY TIMMING Onset • Sudden • Insidious Duration • Limited 3 months/ less • Persistent Clinical Course • Acute • Chronic • Recurrent SUN Acute • Sudden • Limited Recurrent • Repeated episodes with untreated inactive periods Chronic • Persistent with relapse <3 months after discontinuation of treatment.
- 5. CLASSIFICATION BASED ON ETIOLOGY • Bacteria • Fungal • Parasitic • Viral, others etc Infectious • With or without non-systemic associations Non - Infectious • Neoplastic • Non- neoplastic Masquerade INTERNATIONAL UVEITIS STUDY GROUP (IUSG)
- 6. CLASSIFICATION ACCORDING TO PATHOLOGY Feature Granulomatous Non- Granulomatous Onset Insidious/ chronic Acute Pain Mild Marked Photophobia Slight Marked Ciliary congestion Minimal Marked KP Mutton fat Fine Aqueous flare Mild Intense flare Iris Nodules Usually present Absent Posterior Synechiae Thick and broad Thin Fundus Nodular lesions Diffused Area Anterior uvea and choroid equally involved Mainly limited to anterior uvea • Suppurative uveitis • Non- suppuravtive uveitis
- 8. SYMTOMS • Unilateral Sudden eye pain • Redness • Watering • Blurring of Vn • Photophobia • Floaters SIGNS • Visual Acuity Maybe be normal or decreased
- 9. SIGNS CORNEA Keratic Precipitates (KP) Fine KP: herpetic, CMV retinitis.. Mutton fat KP: sarcoidosis, TB, syphilis.. Fine KP:“Stellate” – typically covers the entire endothelium Mutton fat : mostly on inferior cornea Mutton fat Fine d/t toxins nutrition of corneal endothelium is affected Endothelium becomes sticky and oedematous Cells desquamated at places inflammatory cells stick to endothelium as cellular deposits
- 10. Ciliary flush Due to involvement of deeper blood vessels circumcorneal conjunctival hyperemia CONJUNCTIVA Corneal dusting • Endothelial dusting by numerous individual cells precedes the formation of true KP aggregates. Ciliary flush
- 11. IRIS Posterior synechiae Iris atrophy Busaccas nodules Iris nodules Spots of exudate/ pigment derived from the posterior layer of the iris left permanently on the anterior capsule of the lens Adhesions of iris to lens capsule Later adhesion leads to fibrous bands between iris and lens capsule In the early stage, mydriatics can free up the adhesion but not in the late.
- 12. ANTERIOR CHAMBER Cells • Indicator of active inflammation Flare • When blood aqueous barrier breaks down leakage of protein in the aqueous haziness GRADING ACCORDING TO SUN CLASSIFICATION
- 13. IOP Low • Decrease in CB production of aqueous when inflamed or increase in uveoscleral outflow High • Trabiculitis • Debris and inflammatory cells in TM • Pupillary block • Secondary angle closure Hypopyon
- 14. Peripheral anterior synechiae When the aqueous drainage gets hampered collection of aqueous behind the iris iris bulges out contact with cornea at periphery PAS formed
- 15. VITREOUS Vitritis- inflammatory cells and opacities Snowbank- white exudates in the ora serata and pars plana. Snowballs- cellular aggregates floating in the vitreous Snowbanks are typically seen in inferior vitreous
- 16. CHOROID Choroiditis Active lesion- yellow nodule Focal choroiditis- toxocariasis, TB, cat scratch disease Multifocal choroiditis- cat scratch disease Choroidal folds
- 17. RETINA Retinitis Active lesion- whitish retinal opacities with indistinct borders due to surrounding edema. Focal retinitis- toxoplasmosis Multifocal retinitis- syphilis, HSV,CMV Vasculitis- arteries(arteritis), veins (phlebitis) or both are affected
- 18. COMPLICATIONS • CME • Choroidal neovascularization • Glaucoma • Cataract
- 19. INVESTIGATION
- 20. SYSTEMIC • CBC • ESR • CRP • Antitoxoplasma antibody-Toxoplasmosis • Syphilis serology test o Tpha o VDRL • ACE – sarcoidosis, TB, leprosy • ANA- RA • Chest X-ray- sarcoidosis, TB
- 21. • QuantiFERON TB Gold- TB • HIV serology
- 22. OCULAR Imaging techniques Indication Application in uveitis OCT Macular and optic disc pathology Macular edema, retinitis, choroiditis, vitreoretinal disorders OCT-A Retinal or choroidal vascular pathology Retinitis, choroiditis, retinal and choroidal neovascularizations Ultrawide field (optos) Vitreoretinal or choroidal pathology involving the periphery Retinal vasculitis FFA Retinal and retinal pigment epithelium pathology Choroiditis FAF Retinal vascular pathology Retinal vasculitis, macular edema, retinal and choroidal neovascularizations ICGA Choroidal vascular pathology Choroiditis, choroidal neovascularizations
- 24. TREATMENT
- 25. MEDICAL THERAPY • Specific (etiology dependent) o ATT- TB o Parenteral Penincilin- syphilis o Sulfa and Pyrimethamine- toxoplasmosis o Ganciclovir- CMV retinitis • Non- specific o Cycloplegics( Mydriatics) o Corticosteroids o Immunosuppressives o NSAIDs
- 26. Cycloplegics o To relieve pain and ciliary spasm o To prevent posterior synechiae and break the ones already formed Corticosteroids Depending on the site of inflammation and severity o Topical – prednisolone, fluorometholone o Periocular – methylprednisolone, betamethasone o Systemic – prednisone, methylprednisolone Immunosuppressives In corticosteroid resistant and intolerant cases o Antimetabolites – methotrexate, azathioprine o Alkylating agents – cyclophosphamide, chlorambucil o T- cell inhibitors – cyclosporin, tacrolimus
- 27. Anti- VEGF – ranibizumab NSAID – Bromfenac, nepafenac
- 28. SUMMARY ANTERIOR UVEITIS INTERMEDIATE UVEITIS POSTERIOR UVEITIS Anterior chamber Vitreous Retina or Choroid Redness, pain, photophobia, watering and blurred vision Floaters Reduced vision Cells and flare Snowbanks and snowballs Headlight in fog (toxoplasmosis), vitritis, vasculitis and chorioretinitis Topical steroids, cycloplegics Triamcinolone (inj) Systemic steroids, antimicrobials
- 29. THANK YOU