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