Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 3rd Year (Third Year) Ophthal Management of Uveitis Topic Handwritten Notes
ANATOMICAL CLINICAL
PATHOLOGICAL ETIOLOGICAL
Anterior
Acute
Suppurative
Infective
Intermediate
Chronic
Non-suppurative
Immune related
Posterior
Toxic
Panuveitis
Traumatic
Systemic disorders
Idiopathic
MANAGEMENT OF
ANTERIOR UVEITIS
INVESTIGATIONS
1.Haematological investigations
2.Urine tests
3.Stool examination
4.Radiological investigations
5.Skin tests
1. Haematologial investigations
?TLCand DLC
?ESR
?Blood sugar
?Serological tests
?Tests for antinuclear
antibodies,Rh factor,LE cel a,C-
reactive
proteins,antistreptolysin-0,ACE
2.Urine examination:
For WBCs,pus cel s,RBCs and culture
3.Stool examination:
For cyst and ova of parasites
4.Radiological:
? X-ray:chest,paranasal sinuses,sacroiliac
joints and lumbar spine.
? HRCT of thorax
? MRI of head
5.Skin tests:tuberculin tests,Kveim's
tests'toxoplasamin,lepromin testand
pathergy test for Behcet's d/s
TREATMENT
1.Non-specific teatment:
?Local therapy
?Systemic therapy
?Physical measures
2.Specific treatment for the cause
3.Treatment of complications.
?Nonspecific-Local therapy
1.Cycloplegic drugs-
1% atropine sulphate
2%homatropine
1%cyclopentolate
Inj.0.25ml mydriacin
MOA:? gives rest and comfort to eyes by
relieving spasm of iris sphincter and
ciliary muscle
? Prevants synechiae
? Reduces exudation by decreasing
hyperemia and vascular permeability
? Increases blood supply to anterior
uvea
2.Corticosteriods
Anti-inflammatory,anti-allergic,anti-
fibrotic
Eg:dexamethasone,betamethasone,hy
drocortisone,prednisolone
? Non-specific:systemic therapy
1.corticosteriods:anti-inflammatory,anti-fibrotic
effects
Dosage:prednisolone/dexamethasone/betamet
hasone(60-100mg)
Dose should be decreased by a week's interval
and stopped in 6-8 weeks.
2.NSAIDS:when steriods are contraindicated.
Aspirin ,Phenylbutazone ,oxyphenbutazone
3.Immunosuppresive drugs:
In serious cases only.
Only under supervision of haematologist and
oncologist.
Used in severe cases of Behcet's
syn,sympathetic ophthalmia,pars planitis and
VKH syn
Eg:cyclophosphamide,chlorambucil,azathioprine
and methotrexate.
cyclosporin effective in cytotoxic
immunosuppresive resistant cases but
nephrotoxic.
4.Azithromycin or tetracycline or
erythromycin:
In chlamydial infections to patients and
partners with Reiter's syn having
urethritis and iritis.
? Non-specific:physical measures
1.Hot fomentation
2.Dark goggles
? Specific treatment:
If no cause found ?broad spectrum antibiotics
? Treatment of complications :
1.Inflammatory glaucoma(hypertensive
uveitis):0.5%timolol maleate drops
BD+tab acetazolamide 250mg TD
C/I-Pilocarpine and latanoprost.
2.Postinflammatory glaucoma:
Laser iridotomy/surgical iridectomy.
3.Cataract:Surgery C/I -KPs
4.Retinal detachment:Exudative type
settles itself with treatment of
uveitis.Tractional detachment needs
Vitrectomy
5.Phthisis bulbi:when painful needs
enucleation
MANAGEMENT OF
INTERMEDIATE UVEITIS
Inflammation of pars plana ciliaris ,peripheral
retina, choroid and vitreous base.
MANAGEMENT
Modified 4 step protocol of Kaplan:
Step 1:Periocular and systemic steriods
? Posterior subtenon inj.of triamcinolone
40mg/3 weeks by 3 inj.
? Systemic steriods in unresponsive cases.
Step 2:Immunosuppresive drugs
Cyclosporine,azathioprine,methotrexate,
cyclophosphamide
Step 3: Cryotherapy/indirect laser
photocoagulation
Step 4:pars-plana virectomy: in severe
cases.
Remove inflammatory debris,antigenic
load and possible traction on macula.
MANAGEMENT OF
POSTERIOR UVEITIS
Inflammation of choroid and retina
TREATMENT
1.Periocular and systemic corticosteriods
2.Immunosuppresive agents
3.Specific treatment for the cause.
As in cases of toxoplasmosis,Tb etc...
This post was last modified on 11 August 2021