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The Ophthalmic disorder : Uveitis Presented by Abdulaziz . M. Al - Saad Introduction Definition : Inflammation of the uveal tract ( the iris, ciliary body and choroid ). Anatomical Classification : 1. Inflammation of the iris ( iritis or anterior uveitis ).
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Abdulaziz . M. Al - Saad
Definition :Inflammation of the uveal tract ( the iris, ciliary body and choroid ).
Anatomical Classification :
1. Inflammation of the iris ( iritis or anterior uveitis ).
Accompained by increase vascular permeability:
2. Inflammation of the pars plana ,posterior ciliary body, ( Cyclitis or Intermediate uveitis ).
3. Inflammation of the posterior segment ( Posterior uveitis ) .
4. Inflammation of choroid or retina ( choroiditis and retinitis ).
5- Inflammation of anterior and posterior uveitis together ( Panuveitis ).
15 per 100 000 people.
75 % of these are Interior uveitis.
- About 50 % of patients, have an associated systemic disease.
The patient complain , include :
1- Ocular pain ( less with posterior uveitis or choroiditis )
2- Photophobia .
3- Blurred vision .
4- Redness of the eye .
Note :The patient must be questioned about relevant symptoms , that may help in the determination of whether or not there is associated systemic disease :
1- Respiratory System :
Shortness of breath, Cough, Nature of sputum ( associated sacoidosis or tuberclusis).
2- Bowel Disease :
Occasionallyt uveitis may be associated with ulcerative colitis, cron,s disease and whipples disease.
1. Erythema nodosum ( Painfull raised red lesions on the arm and legs ), present in agranulomatous disease such as sarcodosis and Behcet,s disease .
2. Patint with Behcets disease may also have : thrombophlebitis, dermtographia, oral and genital ulceration .
3. Psoriasis ( in association with arthritis ) may be accompained by uveitis .
4- Joint disease :
AAU : associated with Ankylosing spondylitis with back pain .
In children : juvenile chronic arthritis may be associated with uveitis
Reiter,s disease ( classically urethritis, conjunctivitis and seronegative arthritis ) may be associated with anterior uveitis .
5- Infectious Disease :
Syphilis with its protean manifestation can cause uveitis ( es. Posterior choroiditis )
Herpetic disease ( shingles ) may cause uveitis.
Cytomegalovirrus (CMV ) may cause uveits ( es. In patient with AIDS
Fungulinfections and metastatic infections may cause uveitis ( usyally in immunocompromised patient )
On examination :
1- Decrease visual acuity .
2- Eye will be inflammed in acute anterior disease .
3- Inflamatory cells may be visible clumped together on endothelium of cornea ( es. Inferiorly )( Keratitic pps ).
4- Slight lamp examination : reveal aqueouscells and flare.
If inflammation sever , White cells collect as a mass inferiorly ( hypopyon )
5- Dilatation of vessels on the iris .
6- Iris may adhere to lens ( posterior synechiae or PS ).
7- IOP may be elevated.
8- cells may be present in the vitreous.
9- retinal or choroidal foci of inflammation may be present .
10- Macular odema may be present .
Aimed at determining a systemic association and are directed in part by the type of uveitis.
A. Anterior Uveitis :
B. Posterior Uveitis :
- May have an infectious or systemic inflammatory cause
- Disease such as CMV in HIV- positive patients have characteristc appearance with appropriate history ( no need for further diagnostic test )
- Associated symptomns may help toward systemic disease ( e.g. fever, diarrhoea, weight loss )
Not all case of anterior uveitis requir investigations at first presentation unless systemic symptoms are present .
There are a large number of systemic disease associated with Uveitis :
Definition: Seronegative ( RF – ve ) inflamatory arthritis of the spine .
Signs : Typical of anterior uveitis.
Treatment : Ocular treatment + intermittent anti-inflammatory + Physiotherapy.
Prognosis : Recurrent attack . The out look for vision is good ( if acute attack treated early & vigorously ).
Juvenile chronic arthrits
Definition : A seronegative arthritis which present in children , either systemic disease with fever and lymphadenopathy, particular or polyparticular arthritis.
Signs : white eye + signs of an anterior uveitis + cataract + glucoma ( due to uveitis or steroid drops .
Treatment : Ocular treatment + systemic treatment for joint disease + glucoma difficult to be treated ( if medication fail , syrgery may be required ).
The infection may be congenital or aquired ( 50-75 % congenital )
- Reactivated lesions will subsidebut treatment is required if macula or optic nerve is threatened or if the inflammatory response is very severe.
+ systemic steroids are adminstered with antiproto zoal e.g. clidamycin
( care for pseudomembranous colitis from clindamycin )
( patient should be warned that if diarrhoea dvelops they should seek medical help immediately )
1. Methicillin :
- Sensetive to moisture --- Loss ½ of its activity after 5 days at RT .
- Solution for parental ad. May kept for 24 hr ----- [ at 5oC ] .
2. Nafcillin , Oxacillin :
Parentral sol. Stable for 3 days at RT. ( 96 hr if ref. ) .
3. Dicloxcillin :
Parentral sol. Stable for 7 days at RT ( 14 day if ref. ).
4. Cloxacillin :
Parentral sol. Stable for 14 days ( ref. ) .
5- Flucloxacillin :
Parentral sol. Stable for 7 days ( ref. )
Store between 15 – 30oC