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Uveitis Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU.

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Presentation on theme: "Uveitis Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU."— Presentation transcript:

1 Uveitis Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU

2 Def. : - Inflammation of the uveal tract. Classifications : The 4 most useful classifications are :- (1) Anatomical : Anterior Uveitis Iritis Iridocyclitis Intermediate uveitis Posterior uveitis Diffuse uveitis

3 Cont. (2) Clinical : (2) Clinical : (3) Etiological : (3) Etiological : (4) Pathological : (4) Pathological : AcuteChronic ExogenousEndogenous Granulomatous Non-Granulomatous

4 Irido-cyclitis Def. : - Inflammation of the iris & ciliary body. Etiology : A- Primary: Infection: Exogenous Endogenous Allergy Bacterial Non-bacterial Constitutional Syndromes of Unknown etiology Behcet’s Vogt-Koyanagi-Harada

5 N.B. Behcet syndrom: - Oral ulcerations. - Genital ulcerations. - Uveitis. Vogt-Koyanagi-Harada syndrom: - Alopecia. - Poliosis. - Vetiligo. - Uveitis

6 B- Secondary : B- Secondary : Cornea Keratitis Sclera Scleritis Lens Subluxation Or Dislocation Retina R.D. I.O. tumorsI.O.F.B

7 Pathology: 3 phases: Pathology: 3 phases: 1) Vascular Phase: - Dilatation & congestion of the blood vessels to bring more leucocytes. 2) Exudative Phase: - Exudation of inflamm. Fluids from dilated vessels. * The result of this exudation: a- Iris & ciliary body: - Edema of iris & C.B. - Loss of iris pattern - Pressure on the nerves - Spasm of ciliary muscles

8 b- Outside iris & C.B. : - Aquous flare. - Collection of exudates in: Angle, pupil, between iris & lens and behind lens. 3) Cellular Phase: - Keratic Precipitate (KPs): active & passive. - Lenticular Precipitates (LPs): - Vitrous opacities, Vitritis

9 Clinical Picture: usually recurrent. Clinical Picture: usually recurrent. Symptoms: 1) Pain: Dull aching. Why??? -Nerves: Stretch & irritation of nerve ending. - Muscles: Spam of intrinsic muscles & C.M. - Glaucoma: Secondary.

10 2) Photophobia: 3) Lacrimation: 4) Blepharospasm: 5) Diminution of vision: Why??? - Corneal edema. - Aquous flare. - Pupillary memb. - Vitritis - Toxic maculopathy. - Hazziness of the lens. Cont. Reflex irritation of the 5 th N. endings

11 1- Pain. 2- Photophobia3- Lacrimation 4- Blepharospasm 6- Redness of the eye5- Diminution of vision Painful red eye with blurring of vision

12 Signs: 1) Lid: Edema. 2) Conjunctiva: Conj. & ciliary injections. 3) Cornea: Edema & KPs. 4) Iris: Muddy. 5) Ciliarry body: Tender. 6) Anterior chamber: - Aquous flare. - Hypopon. - Hyphaema. Cont.

13 External examination Conjunctival injection

14 7) Pupil: - Constricted. - Irregular. - Sluggish reaction. 8) Lens: - Iris pigment on the capsule (LPs). 9) Intra ocular pressure: raised, 2ry glaucoma. 10) Vitrous: Vitritis. 11) Macula: Toxic maculopathy.

15 Complications: Complications: 1) Cornea: Deep keratitis. 2) Iris: - Post Synaechia. - Atrophy “late” 3) Angle: P.A.S. 4) Lens: Cataract. 5) Cyclitic memb. 6) Secondary glaucoma. 7) Retinitis, optic neuritis & toxic maculopathy. 8) Endophthalmitis or Panophthalmitis in sever cases

16 Differential Diagnosis: Differential Diagnosis: Acute iridocyclitis Acute cong. gl. Corneal ulcer Acute Conjunctivis GradualSuddenRapidGradualOnset: - Dull ache. - Watery. - Diminished. - Bursting. - Watery. - Marked - Pricking. - Watery. - May be "if central" - Burning - Any type - Not affected Symptoms: - Pain: - Discharge: - Vision: - Edema. - Ciliary inject. - Edema, KPs - Flare, Hypopyon. - Muddy. - Constricted. - T++ - Usually normal. - Edema - Ciliary Inject - Edema. - Shallow. - Bomb ē - T+++ - Difficult to be seen - Edema. - Ciliary inject. - +ve fluorescence. - Flare, hypopyn. - Muddy. - Constricted. - Normal or raised. - Normal - Edema - Conj. Injection. - Normal. Signs: - Lid: - Conj.: - Cornea: - A. Ch. - Iris: - Pupil: - Tension: - Fundus:

17 Investigations: Investigations: ClinicallyRadiologicallyLaboratory

18 Treatment Treatment (1) Local: a) Atropine: - Internal eye rest. - Relaxation of the C.M. - Breaking fresh synaechia & dec. formation. b) Cortisone: - Anti-inflammatory. - Anti-Allergic. - Fibrinolytic. c) Hot Fomentation. d) Dark Glasses.

19 (2) General: a) Systemic cortisone: in sever cases. b) Systemic broad spectrum A.B.s. c) Analgesics & anti-inflammatory drugs. - In sever resistant cases - d) Cytotoxic drugs. e) Immunosuppressive drugs. (3) Causal TTT: (4) TTT of complications:

20 Posterior Uveitis - Choroiditis - Def. : - Inflammation of the choroid. Classification: Suppurative Non-suppurative Endophthalmitis Panophthalmitis Exudative Granulomatous

21 Panophthalmitis Panophthalmitis Endophthalmitis Endophthalmitis - Inflamm. Of all tissues of the eye - Inflamm. Of the internal structures of the eye Def. - Perforated corneal ulcer, post intra-ocular op. & penetrating wounds Etiology: - General: Fever, malaise & headache. - General: Fever, malaise & headache. - Local: Pain, FTH & loss of vision - Local: Pain, FTH & loss of vision - Lid: Edema & tender. - Lid: Edema & tender. - Conj. : Injection - Conj. : Injection - Cornea: Cloudy & KPs. - Cornea: Cloudy & KPs. - A.Ch: Hypopyon. - A.Ch: Hypopyon. - Iris: Iritis: - Iris: Iritis: - Vision: No P.L. - Vision: No P.L. - Limitation of ocular motility - Limitation of ocular motility - Proptosis. - Proptosis.C/P: - Symptoms: - Signs: - Atrophia bulbi. Spreading of infection. - Resolution with treatment. - Panophthalmitis. - Atrophia bulbi. Fate:

22 Treatment: 1) E ndophthalmitis: a- Early cases: Anti-biotics, atropine & corticosteroids. b- Late cases: Evisceration. 2) Panophthalmitis: - Evisceration. Cont.

23 Sympathetic Ophthalmitis Def. : - Bilateral inflamm. Of the uveal tract. Etiology: Unclear. a) Allergic theory: b) Infective theory: c) Mixed theory:

24 Clinical picture: - Signs & symptoms of iridocyclitis + trauma in the exciting eye. Complications: As iridocyclitis. Treatment: 1) Prophylactic: 2) Curative: Cont.

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