Uveitis

Published on 10/03/2015 by admin

Filed under Opthalmology

Last modified 10/03/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 5 (1 votes)

This article have been viewed 4118 times

8 Uveitis

Anterior uveitis

Inflammation of iris (iritis) and ciliary body (cyclitis)

Most common cause of anterior uveitis in adults is idiopathic (followed by HLA-B27 associated)

Most common cause of acute, noninfectious, hypopyon iritis is HLA-B27-associated iritis

Findings

conjunctival and episcleral injection, ciliary injection (circumcorneal flush from branches of anterior ciliary arteries), miosis (iris sphincter spasm), AC reaction; may have hypopyon, keratic precipitates, iris nodules, dilated iris vessels (occasionally, rubeosis), synechiae (posterior [iris adhesions to lens; seclusio pupillae is a complete adhesion that can result in iris bombe] or anterior [iris adhesions to cornea and angle]) (Figure 8-1)

image

Figure 8-1 Severe idiopathic anterior uveitis with fibrinoid reaction.

(From Hooper PL: Idiopathic and other anterior uveitis. In Yanoff M, Duker JS [eds]: Ophthalmology, London, Mosby, 1999.)

image

Figure 8-2 Keratic precipitates in anterior uveitis.

(From Forster DJ: General approach to the uveitis patient and treatment strategies. In Yanoff M, Duker JS [eds]: Ophthalmology, London, Mosby, 1999.)

image

Figure 8-3 Chronic granulomatous uveitis demonstrating Busacca nodules.

(From Forster DJ: General approach to the uveitis patient and treatment strategies. In Yanoff M, Duker JS [eds]: Ophthalmology, London, Mosby, 1999.)

Diagnosis

Intermediate uveitis

Pars Planitis

Most common cause of intermediate uveitis (85–90%)

Usually young adults; females > males; 75% bilateral

Accounts for 25% of uveitis in children

Associated with HLA-DR15 and MS

Posterior uveitis

Most common cause of posterior uveitis in adults is toxoplasmosis (followed by retinal vasculitis)

Infections

Cytomegalovirus (CMV)

Progressive hemorrhagic necrotizing retinitis involving all retinal layers

Occurs in 15–46% of AIDS patients; usually when CD4 count <50 cells/mm3

40% bilateral at presentation

Rare syndrome of neonatal cytomegalic inclusion disease

Treatment

antiviral therapy (induction during first 2 weeks)

Acute Retinal Necrosis (ARN)

Acute self-limited confluent peripheral necrotizing retinitis due to infection with VZV, HSV, or rarely CMV

Usually occurs in immunocompetent individuals; 33% bilateral (BARN), commonly in immunosuppressed

Association with HLA-DQw7 (50%)