Date post: | 14-Apr-2017 |
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UVEA -2 Dr. K. SrikanthDept.Ophthal
MGMCRI
Intermediate Uveitis• Pars planitis ( Pars plana & periphery of choroid)
• Children, young adults
• Bilateral in 80%
• Cause unknown-non specific inflammation
• Insidious onset
• Resolve spontaneously/prolonged course
Intermediate UveitisSymptoms: Deterioration of vision Floaters
Signs: Spill over anterior uveitis(min. flare,occ.KPs) Anterior vitritis White snow-ball exudates near ora Snow banking Peripheral Periphlebitis
Intermediate Uveitis• Complications: Macular edema Disc edema Papillitis Cyclitic membrane Vitreous hemorrhage TRD
• D/D: Toxoplasmosis/peripheral Toxocariasis/Syphilis/MS/Sarcoidosis
Posterior Uveitis• Isolated/Diffuse involvement• Involves retina secondarily
Symptoms:• Floater• Diminished vision• Metamorphopsia• Photopsia• Scotoma
Posterior UveitisSigns:• Vitritis (Cells, exudates)• Infiltration/Exudation of retina, choroid• Edema of retina, choroid• Sheathing of vessels• Spill over anterior uveitis• Disc edema• Retinal hemorrhages
Complications:• Complicated cataract,• Glaucoma, • RD, • CNVM
• Retinitis:– Fluffy white retina with diffuse borders and lots of vitritis.
• Choroiditis:– Yellow or grey retinal elevation with demarcated borders and no
vitritis.
• Chorioretinitis:– Choroiditis with a little vitritis.
• Old Choroiditis:– Punched Out Scars, may vary in size & shape
• Focal:– Single lesion, may be localized like in Toxoplasma or
spread like CMV retinitis.
• Multifocal:– Multiple lesions, I.e: MEWDS.
• Diffuse: – Sympathetic Ophthalmia
ChoroiditisActive Healed
Retinitis
Investigations• Single• Unilateral NO INVESTIGATIONS• Anterior• Non Granulomatous
• Posterior• Bilateral CBC,ESR,HLA-B27
• Recurrent ACE,ANA,RPR,VDRL• Granulomatous CXR, Lyme titre
Treatment GoalsSymptom Relief
– Pain, photophobia, blurred vision
Prevent Visual Loss
Prevent Complications
Treatment1. Cycloplegia – giving rest to ciliary body, prevents + breaks Synechiae, decreases hyperemia Atropine, Homatropine, cyclopentolate,
Mydricaine – SC inj.of 0.3 ml Atr,Procaine,Adr
2. Cortico steroids- topical, subconj, subtenon’s, systemic
3. Immunosuppressants
4. Specific Rx- TB, Syphilis, leprosy, etc.
Treatment of complications• Secondary glaucoma: Intensify uveitis trt Anti glaucoma medications Laser iridotomy(Ring synechiae)
• Complicated cataract: Surgery after 3 months
• Band Keratopathy: PTK, Chelation with EDTA
• CME: Oral steroids, Diamox
• Intermediate uveitis:SteroidsImmunosuppressants
• Posterior Uveitis:SteroidsImmunosuppressantsSpecific treatment of cause
Approach to Treatment
Anterior UveitisTopical:
Steroid drops
Cycloplegics
Systemic:CorticosteroidsSteroid sparing
agents
Posterior UveitisLocal:
Periocular steroid injections
Systemic:CorticosteroidsSteroid sparing
agents
Possible Questions
• How would you investigate a case of intermediate uveitis
• List the pathological features of Sympathetic ophthalmia & its prevention