2. RED EYE- UVEITIS Brig Mazhar Ishaq Advisor in Ophthalmology,
Comdt Armed Forces Institute Of Ophthalmology,
Rwp

3. ANATOMICAL CLASSIFICATION
ANTERIOR UVEITIS
IRITIS
IRIDOCYCLITIS
INTERMEDIATE UVEITIS
POSTERIOR UVEITIS
PANUVEITIS

4. POSTERIOR UVEITIS Involves the fundus posterior to the vitreous base
- Retinitis Choroiditis Vasculitis

5. SARCOIDOSIS Presentation - Acute - Insidious Ocular features
- AAU CAU
- Intermediate
- Candlewax drippings’
- Multifocal choroiditis
- Retinal granulomas

6. TUBERCULOSIS Anterior segment involvement Tuberculous uveitis
- Anterior uveitis, - Choroiditis
- Periphlebitis

7. TOXOPLASMOSIS Presentation - Unilateral sudden onset of floaters Signs
- Spill-over’ anterior uveitis Satellite lesion Multiple foci are uncommon Severe vitritis (‘headlight in the fog’)

8. TOXOPLASMOSIS

9. BEHCET SYNDROME Recurrent oro-genital ulceration Ocular features
AAU - cold abscess
Retinitis
Retinal vasculitis
Vitritis,

10. BEHCET SYNDROME

11. FUNGAL UVIETIS

12. INVESTIGATIONS Recurrent granulomatous anterior uveitis
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

13. 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

14. INVESTIGATIONS Obtain a history, attempting to define the etiology.
Complete ocular examination, including an IOP check and a dilated fundus examination.

15. SKIN TESTS Tuberculin skin test (montoux & Heaf) Positive Negative
Intradermal inj of purified protein
Positive
Induration of 5-14 mm with in 48 hours
Negative
Excludes TB
May occure in advanced disease

16. PATHERGY TEST Increased dermal sensitivity to needle trauma
Behcet syndrome
Rarely positive in absence of systemic activity
Pustule formation

17. SEROLOGY SYPHILIS Non-treponemal tests RPR or VDRL Primary infection
Monitor disease activity
Response to therapy

18. Immunofluorescent antibody test
Haemagglutination test

19. 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

20. ENZYME ASSAY Angiotensin converting enzyme (ACE) Lysozyme
Nonspecific test
Granulomatous disease like
- Sarcoidosis (elevated in 80% & in acute)
- TB
- Leprosy
Lysozyme
Good sensitivity but less speceficity for sarcoidosis

21. HLA TISSUE TYPING HLA type Associated disease
B27 Spondyloarthropathies
A29 Birdshot chorioretinopathy
B51 Behcet syndrome
HLA-B7 & POHS & APMPPE
HLA-DR2

22. IMAGING Fluorescein angiography (FA) Retinal vasculitis CMO
Indocyanine angiography (ICG)
Better for choroidal disease

23. Optical coherence tomography(OCT)
Ultrasonography (US)
It is useful in opaque media especially in excluding a RD or intraocular mass
Optical coherence tomography(OCT)
Detecting CMO
Identify vitreoretinal traction as a mechanism of CMO

24. BIOPSY Histopathology still remains the gold-standard
conjunctiva And Lacrimal gland
- Sarcoidosis
Aqueous samples
- For (polymerase chain reaction) PCR
- Viral retinitis (occasionally)
Vitreous biopsy
- Infectious endophthalmitis

25. RADIOLOGY Chest X-rays Sacro-illiac joint X-Rays CT & MRI
- To exclude TB and Sarcoidosis
Sacro-illiac joint X-Rays
- Diagnosis of spondyloarthropathy
CT & MRI
- Sarcoidosis
- Multiple sclerosis
- Primary intraocular lymphoma

26. TREATMENT AIM FOUR GROUP OF DRUGS
Prevent vision threatening complications
Relieve patients discomfort
Treat the underlying cause
FOUR GROUP OF DRUGS
Mydriatics
Steroids
Cyclosporine
Cytotoxic agents

27. TREATMENT Mydriatics To give comfort
To prevent formation of posterior synechia
To break down synechia
Drugs (atropine, homatropine, scopolamine, tropicamide)

28. 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

29. TREATMENT Systemic therapy Preparations Indications Rules
Prednisolone 5mg
Indications
Rules
Start with large dose then reduce
Initial dose mg/kg BW
Before breakfast
Taper off
Less than 2 weeks abrupt stop

30. TREATMENT
Side effects
Short term
Long term

31. TREATMENT Cyclosporin Steroid sparing agent
Complications are hypertension and nephrotoxicity
Cytotoxic drugs
Potentially blinding bilateral reversible uveitis
Intolerable side effects from systemic steroids therapy.

32. THANK YOU