MISCELLANEOUS ANTERIOR

AND POSTERIOR UVEITIS

Capt SHOAIB MUHAMMAD

FUCHS UVEITIS SYNDROME Fuch heterochromic iridocyclitis Chronic non-granulomatous specific

uveitis usually unilateral 90% 3rd – 4th decades M:F – 1:1 4% all cases of uveitis

Presentation Chronic annoying vitreous floatersGradual blurring of visionColour difference between two eyes Incidental detection

General signsAbsent posterior synechiaeKPSmall iris nodulesAC—faint flare,mild cellular reactionVitritis

FUCHS UVEITIS SYNDROME

Diffuse iris atrophyLoss of iris cryptsStromal atrophyPosterior pigment layer atrophy

Heterochromia iridisDetermined by

Degree of atrophy Natural iris colour

Hypochromia Reverse heterochromia

FUCHS UVEITIS SYNDROME

GonioscopyRadial twig like vesselsAmsler signPeripheral anterior synechiae

ComplicationsCataractGlaucoma

TreatmentPosterior sub tenon steroidsVitrecomy

FUCHS UVEITIS SYNDROME

LENS-INDUCED UVEITIS1. Phacoanaphylactic endophthalmitis

Presentation Days to weeks after rupture of lens capsule

Signs Granulomatous anterior uveitis Raised IOP

Differential diagnosis Bacterial endophthalmitis Prolonged

surgery Toxic reaction

Treatment Removal of lens matter Intensive steroid therapy

Phacogenic non-granulomatous uveitisSigns

Within 2-3 weeks of capsule rupture Less severe

Differential diagnosis Lowgrade bacterial and fungal endophthalmitis SO or IOL-induced inflammation

Treatment Mild – Topical steroids Intense inflammation- Periocular or systemic

steroids

LENS-INDUCED UVEITIS

ACUTE RETINAL PIGMENT EPITHELITIS (KRILL DISEASE) Presentation

3rd decadeSudden diminution of central vision

Signs 1 to 2 weeks after symptomsResolve 6 to 12 weeks

FFAHyperfluorscence without leakage

EOGSubnormal

Treatment

Differential diagnosis

Rubella retinitis

Acute macular neuroretinopathy

Punctate inner choroidopathy

Central serous retinochoroidopathy

ACUTE RETINAL PIGMENT EPITHELITIS (KRILL DISEASE)

ACUTE IDIOPATHIC MACULOPATHY Presentation

2nd to 4th decadeSudden severe loss of central vision

SignsRD at macula with irregular outline Intraretinal hemorrhages Iritis, papillitis and mild vitritisResolve with in few weeks

FFAEarly phase-mild hyperfluorescenceVenous phase-staining of SRF

Treatment

Differential diagnosis Idiopathic choroidal neovascularizationCentral serous chorioretinopathyVKH syndromeSerpiginous choroidopathyPosterior scleritisPlacoid syphilitic retinitisRPE detachmentAcute posterior multifocal placoid pigment

epitheliopathy

ACUTE IDIOPATHIC MACULOPATHY

ACUTE MULTIFOCAL RETINITIS Presentation

3rd to 4th decadeSudden onset mild visual loss

Signs Multiple areas of retinitisMild vitritis,disc edemaMacular starRecovery – 2-4 months

Treatment

SOLITARY IDIOPATHIC CHOROIDITIS/ UNIFOCAL HELOID CHOROIDITIS

PresentationMild visual loss and floaters

SignsDiscrete choroidal elevationsSRF and macular star

Treatment Active vision threatning-systemic steroids Inactive – resolve spontaneously

Differential diagnosis Inflammatory lesions

Sarcoid choroiditis Tuberculosis

Histoplasma choroiditisToxoplasma retinochoroiditisNodular posterior scleritisAmelanotic tumour e;g melanomaMetastasis

SOLITARY IDIOPATHIC CHOROIDITIS/ UNIFOCAL HELOID CHOROIDITIS

FROSTED BRANCH ANGIITIS (FBA) Primary FBA

Children and young adults Secondary FBA

Associated with infectious retinitis,CRVO Presentation

Sub acute visual loss Floaters and/or photopsia

Signs Florid translucent perivascular sheathing Anterior uveitis,vitritis and retinal edema

Treatment Systemic or topical steroids

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