![Page 1: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/1.jpg)
Shibu lijack
![Page 2: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/2.jpg)
Shibu lijack Speaker: Kumar Saurabh
![Page 3: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/3.jpg)
Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal tract which extend occasionally to the contiguous structures like vitreous, optic nerve head, cornea and sclera.*
* International Uveitis Study Group Definition
Uveitis: Definition
![Page 4: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/4.jpg)
Prevalence: 0.73% worldwide Age group: 20-50 years Five to 20% of legal blindness Tedious diagnostic workup Elusive aetiologies Permanent structural damage Low therapeutic index of medications
Problem Statement
![Page 5: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/5.jpg)
Aetiology of Uveitis
Idiopathic Uveitis: 35.7% Uveitis Secondary to Systemic Disease Infectious Uveitis Lens Induced Uveitis Masquerade Syndrome
![Page 6: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/6.jpg)
Goals of Uveitis Management
Reduction of visual morbidity Proper identification of the specific
disease Cost effective utilization of resources
![Page 7: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/7.jpg)
Approach: Ways to achieve that
History Clinical Assessment: Site, stage and vision Differential Diagnosis Tailored Laboratory Tests Correlation with Ancillary Tests Definitive Treatment Control of Adverse Effects
![Page 8: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/8.jpg)
History: Salient Points
Detailed and Suggestive Geographic History Family History Demography: Age, gender, race Personal History: Pets, diet, drugs, sexual Systemic Diseases Ocular History
![Page 9: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/9.jpg)
Ocular History
Onset: Insidious or Sudden Laterality: Unilateral or Bilateral Severity: Mild or Severe Pattern: Single or Multiple Episodes Duration: Acute or Chronic Treatment
![Page 10: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/10.jpg)
Clinical Assessment: Ocular Visual Acuity External : Lids, lacrimal glands
Conjunctiva & Sclera: Congestion, nodules
Cornea: Keratitis, ulceration, keratopathy
Keratic precipitates Anterior chamber: Flare and cells
Iris: Surface, nodules, new vessels
Vitreous: Haze, detachment, hemorrhage
Retina: Retinitis, new vessels, oedema
Choroid: Choroiditis, neovascularization
![Page 11: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/11.jpg)
Keratic Precipitates
Mutton fat keratic precipitates in a case of granulomatous uveitis
![Page 12: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/12.jpg)
Keratic Precipitates
Fine keratic precipitates in a case of non-granulomatous uveitis
![Page 13: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/13.jpg)
Keratic Precipitates
Old keratic precipitates seen in the Arlt’s triangle of corneal endothelium
![Page 14: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/14.jpg)
Keratic Precipitates
Large keratic precipitates seen in case of granulomatous uveitis
![Page 15: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/15.jpg)
Anterior Chamber Reaction
Flare *
0 : Absence + : Barely detectable ++ : Moderate, iris details visible+++ : Marked, iris
details not visible
++++: Intense, fixed fribrinous aqueous
Cell *
0 : Nil 0.5 + : 1-5 cells
+ : 6-15 cells ++ : 16-25 cells +++ : 26-50 cells
++++ : >50 cells
*Standardization of Uveitis Nomenclature (SUN). AJO 2005;140: 509-16
![Page 16: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/16.jpg)
Anterior Chamber Reaction
Cells and flare in uveitic eyes
![Page 17: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/17.jpg)
Iris Nodules
![Page 18: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/18.jpg)
Vitreous HazeDirect Ophthalmoscope
0 : Clear vitreous
+ : Few, normal view ++ : Moderate scattered opacities, obscured view +++ : Many opacities, blurring of view ++++ : Dense opacities, no view
![Page 19: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/19.jpg)
Vitreous HazeIndirect Ophthalmoscope
++++ : Optic nerve head obscured+++ : Optic nerve head visible, blurred border++ : Better view of retinal blood vessels+ : Better view of retinal blood vessels & ONH+ : Blurring of nerve fiber layer striations0 : Nerve fiber layer well defined
![Page 20: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/20.jpg)
Retinal Features
Retinitis
Primary vasculitis
Secondary vasculitis Retinal detachment
Macular oedema
Neovascularization
![Page 21: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/21.jpg)
Active choroiditis
Inactive choroiditis
Choroidal granulomas
Choroidal neovascularization
Choroidal vasculitis
Choroidal Features
![Page 22: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/22.jpg)
Site of Uveitis
Anterior Uveitis: Iritis, iridocyclitis, Anterior cyclitis
Intermediate Uveitis: Posterior cyclitis, Hyalites, Basal Retinochoroiditis
Posterior Uveitis: Chorioretinitis, Retinochoroiditis, Neuroretinitis, Choroiditis
![Page 23: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/23.jpg)
Systemic Examination
Mucocutaneous system
Erythema nodosum Oral ulcerations Kaposi sarcoma Kearatoderama Circinate balanitis Vitiligo Sarcoid granulomas
Musculoskeletal system
Ankylosing spondylitis Rheumatoid arthritis Psoriasis Behcet’s disease Reiter’s syndrome
![Page 24: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/24.jpg)
Differential Diagnosis
Working diagnosis Basis for laboratory investigation Basis for treatment
![Page 25: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/25.jpg)
Laboratory Investigations
To rule out infective etiology To alleviate risks of treatment To find out systemic disease To find out etiology of
masquerade syndrome To come to specific diagnosis Academic purposes
Aims
![Page 26: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/26.jpg)
Laboratory Investigations
Granulomatous uveitis Recurrent uveitis (>3
attacks) Uveitis in a child Positive leads on examination Posterior uveitis Retinal vasculitis Worsening on steroids
Indications
![Page 27: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/27.jpg)
Laboratory Investigations
Complete Blood Count Rheumatoid factor (RA) Antinuclear Antibody (ANA) Anti ds-DNA Antibody Anti Neutrophil Cytoplasmic Antibody (ANCA) Angiotensin Converting Enzyme C- reactive Protein X-ray Chest and Spine Toxoplasma, Rubella, Cytomegalovirus, Herpes
simplex (TORCH) Test Mantoux Test HLA Typing
![Page 28: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/28.jpg)
Ancillary Investigations
Ultrasonography: Media opacity
Fluorescein Angiography: Macular oedema, Chorioretinitis, Disc leakage,
Response
Vitreous Biopsy: Lymphoma, Endophthalmitis
Chorioretinal Biopsy:
![Page 29: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/29.jpg)
Treatment Strategy
![Page 30: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/30.jpg)
Specific Therapy
Ocular Toxoplasmosis
Regimen 1.Pyrimethamine: 75mg, D125mg/day, 4-6 weeks PLUSSulphadiazine: 2 gm, D11 gm four times daily, 4-6wksPLUSPrednisolone: 40-60 mg/ dayFrom D3-D7, taperedPLUSFolinic Acid: 5mg twice weekly
Regimen 2.Clindamycin 300mg, 4 times Daily, 4-6 weeksPLUSSulphadiazine: 2 gm, D11 gm four times daily, 4-6wksPLUSPrednisolone: 40-60 mg/ dayFrom D3-D7, tapered
![Page 31: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/31.jpg)
Specific Therapy
Peripheral Lesion: Follow up
Posterior Pole Involvement:Prednisolone 40mg/day and
Thiobendazole 20mg/day. 5-7 daysVitrectomy
Ocular Toxocariasis
![Page 32: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/32.jpg)
Nonspecific Therapy: Medical
Steroids: Topical, periocular, systemic
Indications: Active Inflammation Prevention and treatment of
complications Infiltration of retina, choroid and optic
nerve
![Page 33: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/33.jpg)
Nonspecific Therapy: Medical
Nonsteroidal Antinflammatory Drugs
Indication: To maintain lower dose of topical steroids
![Page 34: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/34.jpg)
Nonspecific Therapy: Medical
Immunosuppressive Therapy
Vision threatening intraocular inflammation Inadequate response to steroids
Serious steroid induced side effectsContraindication of steroid therapy
![Page 35: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/35.jpg)
Immunosuppressive Therapy
Absolute Indications: Behcet’s diseaseSympathetic Ophthalmia
Vogt-Koyanagi-Harada Syndrome
Wegener’s Granulomatosis Polyarteritis Nodosa
Nonspecific Therapy: Medical
![Page 36: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/36.jpg)
Nonspecific Therapy: Medical
LASER and Cryotherapy
Indications: LASER for choroidal neovascularization
Cryotherapy for refractory pars planitis
![Page 37: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/37.jpg)
Nonspecific Therapy: Surgical
Pars plana Vitrectomy
Indications: Pars planitis Subretinal neovscular membrane
![Page 38: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/38.jpg)
Treatment Response*
Inactive Uveitis : Rare cell in anterior chamber
Improvement : Two step decrease in cells
Reduction in cell count to Grade 0
Worsening : Two step increase in cells
Increase in cell count from 3+ to 4+
Steroid resistance : Two weeks
Immunosuppressive resistance: Three months
*Standardization of Uveitis Nomenclature (SUN). AJO 2005;140: 509-16
![Page 39: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/39.jpg)
Treatment of Complications
Management of cataract Management of glaucoma Management of band shaped keratopathy
and other corneal complications
![Page 40: Shibu lijack. Speaker: Kumar Saurabh Group of diseases characterized by severe sight threatening intraocular inflammation primarily involving the uveal](https://reader036.vdocument.in/reader036/viewer/2022062322/56649cb15503460f94976407/html5/thumbnails/40.jpg)
Shibu lijack