Beruflich Dokumente
Kultur Dokumente
• Koeppe
– pupil margin
Acute Anterior Uveitis
• Pain, redness, photophobia
• Several days to weeks
• Acute & unilateral
• Recurrences common
• 50-70% idiopathic
Signs of Acute Anterior Uveitis
• Non-pigmented KP’s
• AC cells & flare
• Ciliary injection
• Fibrin
• Hypopyon
• Hypotony
HLA-B27 Assoc’d Uveitides
• HLA-B27 –genotype in short arm Chrom6
• 50-60% in acute iritis px
• Seronegative spondyloarhtropathies
– Ankylosing Spondylitis
– Reiter Syndrome
– IBD
– Psoriatic Arthritis
– Post-infectious or Reactive Arthritis
Ankylosing Spondylitis
• 88% HLA-B27
positive
• Chronic backache &
stiffness during 2nd-3rd
decades
• Sacroiliitis, sclerosis,
narrowing of joint
space
Reiter’s Syndrome
• Non-specific
urethritis,
polyarthritis,
conjunctivitis/iritis
• 85-95% HLA-B27
positive
• Keratoderma
blennorhagicum.
Circinate balanitis
Signs of Chronic Anterior Uveitis
• Band K
• Posterior synechiae
• Pigmented KP’s
• Cataract
• Glaucoma
Juvenile Rheumatoid Arthritis
• Arthritis in a child <
16 y.o
– Mean age : 6 y.o.
• RF (-)
• Low-grade uveitis
– White eye
• Chronic, recurrent
course
• Vision-threatening
– Close follow-up
High Risk Factors
• Girls > Boys
• Pauciarticular (80-90%)
• Wrist-sparing, affects lower extremity
• ANA(+)
Intermediate Uveitis
• Intraocular
inflammation
predominantly
involving the
vitreous &
peripheral retina
• Not part of a
specific disease
entity
Epidemiology
• 4-15 % of uveitis px
• Up to 25% of uveitis in children, mostly
pars planitis
• Usually 2nd to 4th decades of life
• No sex or race predilection
• Familial intermediate uveitis
Pars Planitis
• Subset of intermediate uveitis
• White opacity over pars plana & ora serrata
(snowbank)
• Often with worse vitritis, more severe
macular edema, & worse visual prognosis
Signs & Symptoms
– Reactivation-
satellite lesion
at edge of
previous lesions
– Vasculitis and
optic disc
involvement
• Endpoint: scarring
Treatment
• Self-limited; not all needs to be treated
• Indications for treatment:
– Peripapillary or posterior pole involvement
– Severe vitritis w/ decreased vision
Treatment Regimen
• Regimen 1 • Regimen 3
– Pyrimethamine – Trimethoprim/Sulfame
thoxazole
– Sulfadiazine
• Notes
– Folic Acid
– Prednisone 24 hrs.
• Regimen 2 after Ab
– Clindamycin – Never steroids alone
– Sulfadiazine – Duration of Tx: 2-8
weeks ( ave: 4 wks)
– Endpt: scar formation
Prognosis
• Untreated:
– retinochoroiditis resolves bet 3 wks & 6 mos
( ave: 4.2 mos)
• Treated:
– Clindamycin tx results in a 2-6 wk resolution
and an 8% 3-year recurrence rate
– Daraprim/sulfa results in 15% recurrence rate
Toxoplasmosis vs Toxocara
Toxoplasma Toxocara
Parasite Protozoa Nematode
Def. Host Cat Dog
Humans Int. Host None
Eye Involved Bilateral Unilateral
Lesion RChoroiditis Granuloma
Antiparasites +++ ?
Retinal Vasculitis
• BOV, VF loss,
scotomas, floaters
from secondary vitritis
• May lead to retinal
ischemia, infarction,
hemorrhage,
neovascularization
Involvement of arterioles, venules, or both
Perivascular sheathing or cuffing
Conditions w/ Retinal Vasculitis
• Behcet’s Syndrome • Syphilis
• Collagen-vascular dx • TB
– WG,SLE.PAN • Int. Uveitis
• Sarcoidosis • Toxoplasmosis
• MS • ARN
• IBD • HSV/HZV/CMV
• Birdshot RC
• Eales’ Disease
Behcet’s Disease
• Systemic
obliterative
vasculitis
• Unknown cause
• Common in Japan,
Middle East, Far
East, &
Mediterranean
countries
Diagnostic Criteria
• Major Criteria • Minor Criteria
– Recurrent oral ulcers – Arthritis
– Skin lesions – GI lesions
– Genital ulcers – Epididymitis
– Ocular lesions – Vascular Lesions
• Recurrent hypopyon – CNS Involvement
iritis/iridocyclitis • Brainstem Syndrome
• Chorioretinitis
• Meningoencephalomyel
itic Syndrome
• Confusional Type
Treatment & Prognosis
• Immunosuppressives • 3.4 yrs to bilateral
(Chlorambucil, AZT) blindness +/- steroids
• Systemic • 5-10% go blind in
corticosteroids spite of all known tx
Vogt-Koyanagi-Harada’s Disease
(VKH)
• Bilateral, diffuse granulomatous panuveitis
• Often recurrent
• Multisystemic inflammatory disease
• Involves melanocytes of uvea, retina,
meninges, skin
Epidemiology
• More common in pigmented races
• More common in females (55-78%)
• Most in 2nd to 5th decade of life
Criteria for Diagnosis (AUS,
1978)
• No history of previous ocular trauma or
surgery
• At least 3 of the ff:
1.Bilateral chronic iridocyclitis
2. Posterior uveitis, incl. SRD, disc
hyperemia, subretinal macular edema,
“sunset glow” fundus
3. Neurologic signs of tinnitus, neck
stiffness, cranial nerve or CNS problems,
CSF pleocytosis
4. Cutaneous findings such as alopecia,
poliosis, or vitiligo
Clinical Phases
1. Prodromal Phase
2. Uveitic Phase
3. Convalescent Phase
4. Chronic Recurrent Phase
Traditional Treatment
• Early & aggressive use of systemic steroids,
followed by slow tapering over 3 to 6
months.
• Immunosuppressive drugs used for cases
refractory to steroids or when px cannot
tolerate steroids.
White Dot Syndromes
• Several ocular
disorders
• (+) Discrete light-
colored lesions in
fundus during at least
one phase of the
disease
• May be interrelated
White Dot Syndromes
• Multifocal Choroiditis & Panuveitis (MCP)
• Multiple Evanescent White Dot Syndrome
(MEWDS)
• Acute Retinal Pigment Epithelitis (ARPE)
• Acute Posterior Multifocal Placoid Pigment
Epitheliopathy (APMPPE)
• Birdshot Retinochoroidopathy (BRC)
• Punctate Inner Choroiditis (PIC)
White Dot Syndromes
Sex Age BOV Lateral Vitritis
MCP F 20-40 Acute B +
Mewds F 17-38 Acute U -