Eye: Uveitis

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Disorders of uveal tract
Uvea: Part of the eye, consisting collectively of the iris, the choroid of the eye, and the ciliary body
Uveitis
Uveitis is an inflammation of the intraocular structures.
Causes
  • Infections - toxoplasmosis, herpes zoster virus, ocular candidiasis, histoplasmosis, herpes simplex virus, tuberculosis, and syphilis.
  • Immune-mediated disorders: such as ankylosing spondylitis, Crohn's disease, Reiter's  syndrome, SLE, sarcoidosis, psoriasis  
  • Trauma
  • Idiopathic

Classification
Based on involved structures  
(1)Anterior uveitis: inflammation of  iris (iritis) or iris and ciliary body (iridocyclitis)
  • Most common type 75%
  • Only one eye is usually affected
  • Symptoms- eye pain ranging from mild aching to intense discomfort, redness, blurred or cloudy vision, small pupil, photophobia, headache.
(2) Intermediate uveitis: structures posterior to the lens (pars plantis or peripheral uveitis )
  • Second most common type
  • Both eyes tend to be affected and usually painless.
  • Symptoms- mild redness, blurred vision
(3)Posterior uveitis: choroid (choroiditis), retina (retinitis), or vitreous near the optic nerve and macula.
  • Symptoms- decreased vision, and sometimes retinal detachment. Can be more dangerous leading to visual loss
  • Symptoms are slower to develop and often lasts longer.
Nongranulomatous and granulomatous
  1. Non granulomatous-
  • Most common type, which manifests as an acute condition with pain, photophobia, and a pattern of conjunctival injection, especially around the cornea. The pupil is small or irregular, and vision is blurred.
  • There may be small, fine precipitates on the posterior corneal surface and cells in the aqueous humor (ie, cell and flare).
  1. Granulomatous:
  • Granulomatous uveitis can have a more insidious onset and can involve any portion of the uveal tract. It tends to be chronic.
  • Symptoms such as photophobia and pain may be minimal.
  • The keratic precipitate may be large and grayish. Vision is markedly and adversely affected.

Diagnosis
  • Physical examination
  • Complete systems review
Diagnostic tests-
  • Complete blood cell count
  • Erythrocyte Sedimentation Rate
  • Antinuclear antibodies (ANA)
  • VDRL
Management
  • Wear dark glasses outdoors for photophobia   
  • Mydriasis - to avoid Ciliary spasm and synechia
  • E.g., cylopentolate (Cyclogyl) and atropine
  • Local corticosteroid drops, such as Pred Forte 1% and Flarex 0.1%, instilled four to six times a day are used to decrease inflammation.
  • In very severe cases, systemic corticosteroids, as well as intravitreal corticosteroids, may be used
  • Teach patient how to instill medications and adhere to dosing schedule to prevent permanent eye damage.
  • Encourage follow-up for intraocular pressure (IOP) masurements because corticosteroids can increase IOP.



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notes.nursium.com: Eye: Uveitis
Eye: Uveitis
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