Transcript ADENOVIRAL KERATOCONJUNCTIVITIS

RED EYE- UVEITIS
Brig Mazhar Ishaq
Advisor in Ophthalmology,
Comdt Armed Forces Institute Of Ophthalmology,
Rwp
ANATOMICAL
CLASSIFICATION
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ANTERIOR UVEITIS
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IRITIS
IRIDOCYCLITIS
INTERMEDIATE
UVEITIS
POSTERIOR
UVEITIS
PANUVEITIS
POSTERIOR UVEITIS
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Involves the fundus posterior to the
vitreous base
- Retinitis
- Choroiditis
- Vasculitis
SARCOIDOSIS
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Presentation
- Acute
- Insidious
 Ocular features
- AAU
- CAU
- Intermediate
- Candlewax drippings’
- Multifocal choroiditis
- Retinal granulomas
TUBERCULOSIS
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Anterior segment involvement
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Tuberculous uveitis
- Anterior uveitis,
- Choroiditis
- Periphlebitis
TOXOPLASMOSIS
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Presentation
- Unilateral sudden onset of floaters
 Signs
- Spill-over’ anterior uveitis
- Satellite lesion
- Multiple foci are uncommon
- Severe vitritis (‘headlight in the fog’)
TOXOPLASMOSIS
BEHCET SYNDROME
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Recurrent oro-genital ulceration
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Ocular features
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AAU - cold abscess
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Retinitis
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Retinal vasculitis
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Vitritis,
BEHCET SYNDROME
FUNGAL UVIETIS
INVESTIGATIONS
Indications
 Recurrent granulomatous anterior uveitis
 Bilateral disease
 Systemic manifestations with out a specific
diagnosis
 Confirmation of suspective ocular picture
such as HLA-A29 testing in birdshort
chorioretinopathy
NOT NECESSARY
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Single attack of mild unilateral acute
anterior uveitis
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A specific uveitis entity
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When a systemic diagnosis compatible
with the uveitis is already apparent
INVESTIGATIONS
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Obtain a history, attempting to define the
etiology.
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Complete ocular examination, including an
IOP check and a dilated fundus
examination.
SKIN TESTS
1.
Tuberculin skin test (montoux & Heaf)
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Intradermal inj of purified protein
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Positive
Induration of 5-14 mm with in 48 hours
Negative
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Excludes TB
May occure in advanced disease
PATHERGY TEST
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Increased dermal sensitivity to needle trauma
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Behcet syndrome
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Rarely positive in absence of systemic activity
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Pustule formation
SEROLOGY
SYPHILIS
1.
Non-treponemal tests
RPR or VDRL
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Primary infection
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Monitor disease activity
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Response to therapy
2.
Immunofluorescent antibody test
3.
Haemagglutination test
Enzyme-linked Immunosorbent Assay
(ELISA)
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Antibodies in aqueous (more specific)
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Other conditions (cat-scratch fever & toxocariasis
Antinuclear Antibody (ANA)
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In children with JIA who are at high risk of
developing ant uveitis
ENZYME ASSAY
1.
Angiotensin converting enzyme (ACE)
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Nonspecific test
Granulomatous disease like
- Sarcoidosis (elevated in 80% & in acute)
- TB
- Leprosy
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2.
Lysozyme
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Good sensitivity but less speceficity for
sarcoidosis
HLA TISSUE TYPING
HLA type
Associated disease
B27
Spondyloarthropathies
A29
Birdshot chorioretinopathy
B51
Behcet syndrome
HLA-B7 &
POHS & APMPPE
HLA-DR2
IMAGING
1.
Fluorescein angiography (FA)
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Retinal vasculitis
CMO
2.
Indocyanine angiography (ICG)
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Better for choroidal disease
3.
Ultrasonography (US)
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It is useful in opaque media especially in
excluding a RD or intraocular mass
4.
Optical coherence tomography(OCT)
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Detecting CMO
Identify vitreoretinal traction as a mechanism
of CMO
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BIOPSY
Histopathology still remains the gold-standard
1. conjunctiva And Lacrimal gland
- Sarcoidosis
2.
Aqueous samples
- For (polymerase chain reaction) PCR
- Viral retinitis (occasionally)
3.
Vitreous biopsy
- Infectious endophthalmitis
RADIOLOGY
1.
Chest X-rays
- To exclude TB and Sarcoidosis
2.
Sacro-illiac joint X-Rays
- Diagnosis of spondyloarthropathy
3.
CT & MRI
- Sarcoidosis
- Multiple sclerosis
- Primary intraocular lymphoma
TREATMENT
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AIM
Prevent vision threatening complications
 Relieve patients discomfort
 Treat the underlying cause
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FOUR GROUP OF DRUGS
Mydriatics
 Steroids
 Cyclosporine
 Cytotoxic agents
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TREATMENT
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Mydriatics
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To give comfort
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To prevent formation of posterior synechia
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To break down synechia
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Drugs (atropine, homatropine, scopolamine,
tropicamide)
TREATMENT
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Steroids (mainstay of treatment)
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Topical administration
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Complications (glaucoma, posterior sub capsular
cataract, corneal complications, systemic side
effects)
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Periocular injections
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Severe acute anterior uveitis
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Adjuvant to topical/systemic
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Poor compliance
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Pre op
TREATMENT
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Systemic therapy
Preparations
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Prednisolone 5mg
Indications
Rules
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Start with large dose then reduce
Initial dose 1-1.5 mg/kg BW
Before breakfast
Taper off
Less than 2 weeks abrupt stop
TREATMENT
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Side effects
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Short term
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Long term
TREATMENT
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Cyclosporin
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Steroid sparing agent
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Complications are hypertension and nephrotoxicity
Cytotoxic drugs
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Potentially blinding bilateral reversible uveitis
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Intolerable side effects from systemic steroids
therapy.
THANK YOU