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UVEITIS-Inflammation of the Uveal Tract

  1. Classification
    1. Anatomical  
      1. Anterior uveitis- Inflammation of iris (iritis) and anterior part of ciliary body (pars plicata)  (iridocyclitis)
      2. Intermediate uveitis        
      3. Posterior uveitis           
      4. Panuveitis
Other terminologies:
Retinitis : primry seat of inflammation is retina
Choroiditis : primary seat of inflammation is choroid
Vasculitis : inflammation of retinal vessels
Endophthalmitis : inflammation of all intraocular tissues except sclera
Panophthalmitis : inflammation of entire globe
  1. Clinical    
    1. Acute Uveitis                
    2. Chronic uveitis (> 6 weeks)
  2. Pathological     
    1. Granulomatous        
    2. Non-granulomatous
  1. Etiological classification :
    1. infectious (M/c toxoplasma)      
    2. ​non-infectious (m/c Ankylosing spondylitis)
  1. C/F :-common for uveitis
  1. Photophobia, pain, redness, decreased vision, lacrimation
  2. Circumcorneal (ciliary) congestion
  3. Inflammatony cells on endothelium- Keratic precipitates (KP)

Fine

Non granulomatous

Lymphocytes

Mutton fat

Granulomatous

Macrophages

  1. Iris nodules* ( feature of granulomatous inflammation) ,
  1. Koeppe nodule-pupillary border
  2. Busacca nodule-base of ins
  1. Aqueous flare – Due to leakage of proteins, earliest sign of iridocyclitis-- cells & flare visualised due to tyndall effect

Grade

description

0

None

1+

Faint

2+

Moderate (iris and lens details clear)

3+

Marked (iris and lens details hazy)

4+

Intense (fibrinous aqueous)

  1. Aqueous cells* – sign of active iridocyclitis

Grade

No of cells in field (1 X1mm)

0

<1

0.5

1-5

1+

6-15

2+

16-25

3+

26-50

4+

>50

  1. Posterior synechiae ins attached to lens
  1. Seclusio pupillae – posterior synechiae extending ¯ 3600, Iris bombe ¯PAS (Peripheral anterior synechiae leading to raised intraocular pressure)
  2. Occlusio pupillae – due to inflammatory membrane blocking pupil – raised IOP posteour ins bombe forward bouring of due to 360 AC-funnel shaped
  1. Anterior vitreous cells
  2. ​Pupil constricted. If posterior synechiae, irregular, constricted pupil – Festooned pupil
  3. Complicated cataract (posterior subcapsular )
  4. Most common complication of chronic uveitis is band shaped keratopathy
  5. Macular edema (causes metaomorphopsia) , epiretinal membrane, macular scar , Retinal detachment , chorioretinal scarring
  1. Treatment
  1. Cycloplegics like atropine
  2. Steroids :      
    1. Topical                     
    2. Periocular injections                             
    3. Systemic Steroids
    4. intravitreal steroids: Triamcinolone/ Dexamethasone
  3. Cytotoxic drugs – Indications are
  1. Beh|et’s disease
  2. Sympathetic Uveitis
  3.  Bilateral sight threatening but non-infectious uveitis  
  1. Surgery : pars plana vitrectomy
  2. Photocoagulation if neovascularization occurs
D/d of acute red eye
 
Features Acute anterior uveitis Acute congestive Endophthalmitis
    glaucoma    
Onset Usually gradual Sudden Gradual
Pain Moderate Severe Severe
Coloured halo Absent Present Present
         
Pupil Miotic (small Large and vertically Q    
    oval Q Yellow reflex due to Q
      purulent exudation in
      Vitreous
AC May be deep Very shallow - Hypopyon
Media Hazy due to KPs, Hazy due to edematous - Oedematous,
  aqueous flare and cornea   cloudy and ring
  pupillary exudates     Infiltration
lOP Usually normal Raised - Early stage raised
Iris Muddy     Later decreases




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