Uveitis and Floaters - Auckland · Uveitis • Inflammation of uveal tissue o Iris, ciliary body,...
Transcript of Uveitis and Floaters - Auckland · Uveitis • Inflammation of uveal tissue o Iris, ciliary body,...
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Uveitis andFloaters
Dr Corina ChilibeckClinical Research Fellow
Dr Monika Pradhan, Dr Tahira MalikDr Mark DonaldsonConsultant Ophthalmologists
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Uveitis• Inflammation of uveal tissue
o Iris, ciliary body, choroid• Classification
o Anterior - iriso Intermediate – ciliary bodyo Posterior – choroido Panuveitis
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Associations of uveitis• Idiopathic
• HLA B27 +veo Inflammatory bowel diseaseo Ankylosing spondylitiso Psoriatic arthropathyo Reiter’s syndrome
• Juvenille chronic arthritis
• Sarcoidosis
• Behcets
• Collagen vascular disorderso SLEo Polyarteritis nodosao Wegener’s granulomatosis
• Infectiono Toxoplasma, Toxocara, Lymeo HSV, HZV, HIV, CMVo Tuberculosis, syphilis, leprosyo Candidiasis
• Trauma – sympathetic ophthalmia
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Anterior Uveitis - Symptoms
• Aching pain
• Redness
• Photophobia
• Blurring of vision
• Pain on accommodation
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Anterior uveitis- signs
Lens
• Decreased visual acuity
• Circum-ciliary conjunctival injection
• Small or irregular pupil
• Inflammatory products in AC
• Sequelae
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Inflammatory Products• Cells – graded as +1 to +4
• Protein (flare) - +1 to +4
• Fibrin – Grade +4 flare
• Keratic precipitateso Fine, non-granulomatouso Mutton-fat, granulomatous
• Iris nodules – Koeppe, Busacca
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Keratic precipitates• Non-granulomatous • Granulomatous
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Hypopyon
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Sequelae• Posterior synechiae• Seclusio pupillae• Occlusio pupillae• Iris bombè• Sectoral iris atrophy - HZO• Low IOP - hypotony• Glaucoma• Cataract• Cystoid macular oedema• Neovascularisation
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Posterior synechiae
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Glaucoma
• Inflammation of the trabecular meshwork
• Steroid responsive glaucoma – in 20% due to topical treatment
• Mechanical - ‘pupil block’ glaucoma
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Iris bombè – pupil block glaucoma
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Herpes zoster ophthalmicus
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Posterior uveitis - symptoms
• Floaters
• Blurred vision
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Posterior uveitis- signs• Inflammatory products • Visible focus of chorioretinal inflammation• Inflammatory sequelae
o Macular oedemao Vascular sheathing / occlusionso Optic disc swelling
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Inflammatory products - Vitritis
Image used with patient permission
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Retinal vascular sheathing
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Retinal vascular occlusions
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Cystoid macular oedema :changes in blood-retinal barrier
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Inflammatory focus:commonly Toxoplasmosis
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Toxocara
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Sarcoidosis:panuveitis,optic neuropathy
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Management of UveitisAnterior uveitis Posterior/panuveitis
• Topical steroids (intensive and early)
• Cycloplegics (pain relief and prevent posterior synechiae)
• Topical / oral Antivirals (aciclovir) –HSV, HZO
• Local steroid injections (subconjunctival / sub tenons)
• Systemic steroids
• Orbital floor / posterior subtenonsSteroid injection
• Systemic steroids
• Antibiotics, anti-TB therapy
• Antivirals – oral (HZO, CMV, HIV), intravitreal ganciclovir (CMV)
• Immunosuppresion
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Floaters: Causes
• Posterior vitreous detachment - commonest• Blood
oNeovascularisation e.g. diabeteso Torn peripheral retina
• Inflammatory products – intermediate / posterior uveitis
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History...
• Onset• Flashing lights• Reduced vision• Other symptoms e.g. field loss• Other history - ocular e.g. myopia, surgery, trauma
- systemic e.g. diabetes
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Retinal Tear
Floaters –
haemorrhage / PVD
Photopsia / flashes –
traction at edge of tear
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Retinal detachment
• Secondary to PVD and retinal tear
• Floaters / flashes and loss of field
• ‘Curtain’ effect
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Diabetic Eye Disease:neovascularisation at optic disc
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Diabetes: pre-retinal and vitreous haemorrhage due to neovascularisation
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Vitreous haemorrhage:blurred vision and floaters
sub
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The EndMaterial contained in this lecture presentation is
copyright of The Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, and should not be reproduced without first obtaining
written permission