ADENOVIRAL KERATOCONJUNCTIVITIS
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Transcript ADENOVIRAL KERATOCONJUNCTIVITIS
RED EYE- UVEITIS
Brig Mazhar Ishaq
Advisor in Ophthalmology,
Comdt Armed Forces Institute Of Ophthalmology,
Rwp
ANATOMICAL
CLASSIFICATION
ANTERIOR UVEITIS
IRITIS
IRIDOCYCLITIS
INTERMEDIATE
UVEITIS
POSTERIOR
UVEITIS
PANUVEITIS
POSTERIOR UVEITIS
Involves the fundus posterior to the
vitreous base
- Retinitis
- Choroiditis
- Vasculitis
SARCOIDOSIS
Presentation
- Acute
- Insidious
Ocular features
- AAU
- CAU
- Intermediate
- Candlewax drippings’
- Multifocal choroiditis
- Retinal granulomas
TUBERCULOSIS
Anterior segment involvement
Tuberculous uveitis
- Anterior uveitis,
- Choroiditis
- Periphlebitis
TOXOPLASMOSIS
Presentation
- Unilateral sudden onset of floaters
Signs
- Spill-over’ anterior uveitis
- Satellite lesion
- Multiple foci are uncommon
- Severe vitritis (‘headlight in the fog’)
TOXOPLASMOSIS
BEHCET SYNDROME
Recurrent oro-genital ulceration
Ocular features
AAU - cold abscess
Retinitis
Retinal vasculitis
Vitritis,
BEHCET SYNDROME
FUNGAL UVIETIS
INVESTIGATIONS
Indications
Recurrent granulomatous anterior uveitis
Bilateral disease
Systemic manifestations with out a specific
diagnosis
Confirmation of suspective ocular picture
such as HLA-A29 testing in birdshort
chorioretinopathy
NOT NECESSARY
Single attack of mild unilateral acute
anterior uveitis
A specific uveitis entity
When a systemic diagnosis compatible
with the uveitis is already apparent
INVESTIGATIONS
Obtain a history, attempting to define the
etiology.
Complete ocular examination, including an
IOP check and a dilated fundus
examination.
SKIN TESTS
1.
Tuberculin skin test (montoux & Heaf)
Intradermal inj of purified protein
Positive
Induration of 5-14 mm with in 48 hours
Negative
Excludes TB
May occure in advanced disease
PATHERGY TEST
Increased dermal sensitivity to needle trauma
Behcet syndrome
Rarely positive in absence of systemic activity
Pustule formation
SEROLOGY
SYPHILIS
1.
Non-treponemal tests
RPR or VDRL
Primary infection
Monitor disease activity
Response to therapy
2.
Immunofluorescent antibody test
3.
Haemagglutination test
Enzyme-linked Immunosorbent Assay
(ELISA)
Antibodies in aqueous (more specific)
Other conditions (cat-scratch fever & toxocariasis
Antinuclear Antibody (ANA)
In children with JIA who are at high risk of
developing ant uveitis
ENZYME ASSAY
1.
Angiotensin converting enzyme (ACE)
Nonspecific test
Granulomatous disease like
- Sarcoidosis (elevated in 80% & in acute)
- TB
- Leprosy
2.
Lysozyme
Good sensitivity but less speceficity for
sarcoidosis
HLA TISSUE TYPING
HLA type
Associated disease
B27
Spondyloarthropathies
A29
Birdshot chorioretinopathy
B51
Behcet syndrome
HLA-B7 &
POHS & APMPPE
HLA-DR2
IMAGING
1.
Fluorescein angiography (FA)
Retinal vasculitis
CMO
2.
Indocyanine angiography (ICG)
Better for choroidal disease
3.
Ultrasonography (US)
It is useful in opaque media especially in
excluding a RD or intraocular mass
4.
Optical coherence tomography(OCT)
Detecting CMO
Identify vitreoretinal traction as a mechanism
of CMO
BIOPSY
Histopathology still remains the gold-standard
1. conjunctiva And Lacrimal gland
- Sarcoidosis
2.
Aqueous samples
- For (polymerase chain reaction) PCR
- Viral retinitis (occasionally)
3.
Vitreous biopsy
- Infectious endophthalmitis
RADIOLOGY
1.
Chest X-rays
- To exclude TB and Sarcoidosis
2.
Sacro-illiac joint X-Rays
- Diagnosis of spondyloarthropathy
3.
CT & MRI
- Sarcoidosis
- Multiple sclerosis
- Primary intraocular lymphoma
TREATMENT
AIM
Prevent vision threatening complications
Relieve patients discomfort
Treat the underlying cause
FOUR GROUP OF DRUGS
Mydriatics
Steroids
Cyclosporine
Cytotoxic agents
TREATMENT
Mydriatics
To give comfort
To prevent formation of posterior synechia
To break down synechia
Drugs (atropine, homatropine, scopolamine,
tropicamide)
TREATMENT
Steroids (mainstay of treatment)
Topical administration
Complications (glaucoma, posterior sub capsular
cataract, corneal complications, systemic side
effects)
Periocular injections
Severe acute anterior uveitis
Adjuvant to topical/systemic
Poor compliance
Pre op
TREATMENT
Systemic therapy
Preparations
Prednisolone 5mg
Indications
Rules
Start with large dose then reduce
Initial dose 1-1.5 mg/kg BW
Before breakfast
Taper off
Less than 2 weeks abrupt stop
TREATMENT
Side effects
Short term
Long term
TREATMENT
Cyclosporin
Steroid sparing agent
Complications are hypertension and nephrotoxicity
Cytotoxic drugs
Potentially blinding bilateral reversible uveitis
Intolerable side effects from systemic steroids
therapy.
THANK YOU