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