dr hab.n. med. Lidia Puchalska-Niedbał anterior uveitis

The four main classifications are: 1. anatomical 2. clinical 3. aetiological 4. 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 uveitis cause 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 procedures serologic toxoplasma dye test free 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 pathogenesis Mycobacterium tuberculosis diagnostic procedures of tuberculosis the 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 glaucoma Pathogenesis unknow diagnostic procedures is a clinical one Noninfectious Entites

Rheumatoid Artritis clinical characteristics anterior 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 precipitates complication cataract, seclusion of the pupil, iris bombe, secondary glaucoma and rarely, macular edema pathogenesis: 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 times daily Systemic  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 mg daily 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) mg followed by mg daily for 10 days

Fungal infection Topical mydriatic drops, Natamycin drops Systemic Nystatin Viral infection Topical mydriatic drops, antiviral ointment - Zovirax Systemic acyclovir 800 mg tablets administered five times daily for 7 days Treatment

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