CLASSIFICATION
| 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
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INVESTIGATIONS
- Haematological investigations
- Urine tests
- Stool examination
- Radiological investigations
- Skin tests
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- Haematological investigations
- TLC and DLC
- ESR
- Blood sugar
- Serological tests
- Tests for antinuclear antibodies, Rh factor, LE cella, C-reactive proteins, antistreptolysin-O, ACE
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- Urine examination: For WBCs, pus cells, RBCs and culture
- Stool examination: For cyst and ova of parasites
- Radiological:
- X-ray: chest, paranasal sinuses, sacroiliac joints and lumbar spine.
- HRCT of thorax
- MRI of head
- Skin tests: tuberculin tests, Kveim's tests, toxoplasamin, lepromin test and pathergy test for Behcet's d/s
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TREATMENT
- Non-specific treatment:
- Local therapy
- Systemic therapy
- Physical measures
- Specific treatment for the cause
- Treatment of complications.
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? Non-specific-Local therapy
- Cycloplegic drugs-
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1% atropine sulphate
2% homatropine
1% cyclopentolate
Inj. 0.25ml mydriacin
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MOA:
- gives rest and comfort to eyes by relieving spasm of iris sphincter and ciliary muscle
- Prevents synechiae
- Reduces exudation by decreasing hyperemia and vascular permeability
- Increases blood supply to anterior uvea
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- Corticosteroids
Anti-inflammatory, anti-allergic, anti-fibrotic
Eg: dexamethasone, betamethasone, hydrocortisone, prednisolone
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- Non-specific: systemic therapy
- corticosteroids: anti-inflammatory, anti-fibrotic effects
Dosage: prednisolone/dexamethasone/betamethasone (60-100mg)
Dose should be decreased by a week's interval and stopped in 6-8 weeks. - NSAIDS: when steroids are contraindicated.
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Aspirin, Phenylbutazone, oxyphenbutazone
- Immunosuppressive drugs:
In serious cases only.
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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 immunosuppressive resistant cases but nephrotoxic.
Azithromycin or tetracycline or erythromycin:
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In chlamydial infections to patients and partners with Reiter's syn having urethritis and iritis.
- Non-specific: physical measures
- Hot fomentation
- Dark goggles
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- Specific treatment:
If no cause found - broad spectrum antibiotics - Treatment of complications:
- Inflammatory glaucoma (hypertensive uveitis): 0.5% timolol maleate drops BD+tab acetazolamide 250mg TD C/I-Pilocarpine and latanoprost.
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- Post-inflammatory glaucoma:
Laser iridotomy/surgical iridectomy. - Cataract: Surgery C/I - KPs
- Retinal detachment: Exudative type settles itself with treatment of uveitis. Tractional detachment needs Vitrectomy
- Phthisis bulbi: when painful needs enucleation
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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 steroids
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- Posterior subtenon inj. of triamcinolone 40mg/3 weeks by 3 inj.
- Systemic steroids in unresponsive cases.
Immunosuppressive drugs
Cyclosporine, azathioprine, methotrexate, cyclophosphamide
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Step 3: Cryotherapy/indirect laser photocoagulation
Step 4: pars-plana vitrectomy: in severe cases.
Remove inflammatory debris, antigenic load and possible traction on macula.
MANAGEMENT OF POSTERIOR UVEITIS
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Inflammation of choroid and retina
TREATMENT
- Periocular and systemic corticosteroids
- Immunosuppressive agents
- Specific treatment for the cause.
As in cases of toxoplasmosis, Tb etc...
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities
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