dr hab.n. med. lidia puchalska-niedbał anterior uveitis

dr dr hab.hab.n. med. Lidia Puchalska-Niedbałn. med. Lidia Puchalska-Niedbał

anterior uveitis

The four main classifications are:1. anatomical2. clinical3. aetiological4. pathological

Classification of uveitis

anterior uveitis - iritis the infammation affects the iris intermediate uveitis involvment of the posterior part of the ciliary body posterior uveitis inflammation located behind the posterior border

of the vitreus base panuveitis involved of the entire uveal tract

Anatomical classification

Acute uveitis sudden symptomatic onset, persist for 6 weeks or less

Recurrent acute

Chronic uveitis persist for months or years, be asymptomatic,

occasionally acute

Clinical classification

Aetiological classification

Exogenous uveitis

- external injury to the uvea - invasion of micro-organisms or other agents

Aetiological classification

Endogenous uveitiscause by micro-organisms or other agents from within the patient

• associated with systemic disease (ankylosing spondylitis)• infections with bacteria (tuberculosis) • fungi (candidiasis) • viruses (herpes zoster) • protozoans (toxoplasmosis) • roundworms (toxocariasis)

Aetiological classification

Idiopathic specific uveitis Fuchs syndrom

Idiopathic non-specific uveitis they make up about 25% of all cases of uveitis

granulomatous

granuloma formation in the tissues

epithelioid cells, lymphocytes

Langhans giant cells

non-granulomatous

Pathological classification of uveitis

Symptoms of anterior uveitis

Acute anterior uveitis photophobia pain redeness decreased vision lacrimation

Chronic anterior uveitis minimal symptoms the eye may be white

Acute anterior uveitis

Signs of acute anterior uveitis

injection

is circumcorneal „ciliary” and has a violaceous hue

keratitis precipitates

cellular deposits on the corneal endothelium

Sings of acute anterior uveitis

Koeppe’s nodules Busacca’s nodules

Iris nodules

Sings of acute anterior uveitis

aqueous cells

fibrinous exudate

a sign of active inflammation

Sings of acute anterior uveitis

Posterior synechiae

adhesions between the anterior lens surface and the iris

Sings of acute anterior uveitis

• secondary glaucoma - iris bombe

• secondary cataract

Complicatiom of anterior uveitis

Diagnosable cause of microbe induced uveitis

BACTERIA

Syphilis Tuberculosis Brucellosis Leprosy

FUNGI

Candidosis

Histoplasmosis

Coccidomycosis

Cryptococcus

Aspergillosis

VIRUS

Herpes simplex

Herpes zoster

Epstein–Barr virus

Cytomegalovirus

Rubella

PARASITE

Amebiasis

Trypanosomisis

Cysticercosis

Toxoplasmosis

Toxocarosis

Toxoplasmosis accompanies the retinal lesions

Signs mild and painless, keratic percipitates „mutton-fat” on the corneal endothelium flare in the anterior chamber iris nodules

diagnostic proceduresserologic toxoplasma dye testfree toxoplasma antigen by modification of the ELISA technique

Protozoan Disease

Herpes Simplex Uveitis

sings keratic percipitates atrophy of the iris stroma as key-hole shaped segmented pattern atrophy may affect the sphincter or dilator muscles

diagnostic procedures dendritic keratitis and disciform keratitis are characteristic in their gross morphology to allow rapid identification

Viral Disease

herpes zoster virus resides only in the trigeminal ganglion

the vasculitis affect iris vessels, retina and sclera as well

segnental iris atrophy

Herpes Zoster Ophthalmicus

Viral Disease

Tuberculosis

clinical characteristics granulomatous iritis

stromal -Bussaca and pupillary -Kaeppe nodules)

posterior synechiae complicated cataracta

pathogenesisMycobacterium tuberculosis

diagnostic procedures of tuberculosisthe chest roentgenogram and the tuberculin skin test

Bacterial infections

Toxocariasis

clinical characteristics the presence of larval forms of Toxocara canis or cati in the

ocular tissues of man

manifestation• pars planitis• pseudoglioma (posterior pole of the eye)• endophthalmitis (often confused with retinoblastoma in infants)• chronic inflammation of the peripheral retina

diagnosis ELISA test, USG

treatment corticosteroid drugs, vitrectomy

Helminthic Diseases

Fuchs’ Heterochromic Iridocyclitis

clinical characteristics the color change in one iris keratic percipitates Koeppe nodules posterior synechiae posterior subcapsular cataract secondary glaucomaPathogenesis unknow

diagnostic procedures is a clinical one

Noninfectious Entites

Rheumatoid Artritis

clinical characteristicsanterior uveitis is associated with scleral or peripheral corneal inflammation

pathogenesis deposition of immune complex and complement in the vessel wall

diagnostic procedures X-ray studies of the affected joints, HLA – B27 antigens

Eye and Joint Disease

Ankylosing Spondylitis affects young males in the age group of 15 to 40 years

clinical characteristics acute uveitis, recurrent iridocyclitis sudden onset of pain redness photophobia fibrinous exudate in the anterior chamber posterior synechiae keratic precipitatescomplication cataract, seclusion of the pupil, iris bombe, secondary glaucoma and rarely, macular edemapathogenesis: the connection between inflammatory disease of the sacroiliac joints and of the anterior uvea is incompletely understood, 88% of patients with spondylitis-associated iridocyclitis possess the HLA gene B-27.

Eye and Joint Disease

Ankylosing Spondylitis

• complication • cataract • seclusion of the pupil • secondary glaucoma• macular edema

Topical

Cycloplegics atropine, mydriacyl Antibiotics gentamycin, tobramycin are effective against a wide range of organism

Steroid drops dexamethason, hydrocortison administered 6 - 12 times dailySystemic

antibiotics corticosteroid (Encorton, Dexamethazon) citostatics (Endoksan, Imuran) immune therapy (TFX, FIBS, Biostymin)

Treatment of the anterior uveitis

Iritis in rheumatoid artritis

topical Steroids mydriatic drops

systemic sreroids and /or cytotoxic drugs

Treatment

Tuberculosis iritis

topical • steroids,• antibiotic • mydriatic drops

Systemic Isoniazid 300 mg daily and pyridoxine hydrochloride 10 mgdaily combined with one other anti-tuberculous drug as rifampicin for 6 months.

Toxoplasmosis - treatment

Topical steroids, mydriatic drops

systemic Clindammycin 300 mg four times daily orally 3 weeks or vancomycin 500 mg 6-hourly for 10 days, Biseptol (sulphatriad) 2 g Daraprim (Pyrimethamine) 75-150 mg followed by 25-50

mg daily for 10 days

Fungal infection

Topicalmydriatic drops, Natamycin dropsSystemic Nystatin

Viral infection Topical mydriatic drops, antiviral ointment - ZoviraxSystemic acyclovir 800 mg tablets administered five times daily for 7 days

Treatment

Mydriasis and cycloplegia

Mydriasis and cycloplegia

1% atropina

0,5% tropikamid

3% cyklopentolat

2% homatropina

0,5% skopolamina

max. efect

40 min/10 days

30 min/3 h

60 min/1 day

60 min/3 days

60 min/7 days

Mydriasis

2,5% fenylefryna (neosynefryna)

max. efect

20 min/3 h