#28. Anterior uveitis / iridocyclitis / - clinical features, complications, differential diagnosis, treatment.

Question 1

What is UVEITIS?

Answer 1

• INFLAMMATION of the UVEAL TISSUE / TRACT
• Associated with INFLAMMATION of ADJACENT STRUCTURES
  a. Retina
  b. Vitreous
  c. Sclera
  d. Cornea

Question 2

What are the 5 TYPES of UVEITIS?

Answer 2

1) ANTERIOR Uveitis = Inflammation of the IRIS + PARS PLICATA of the Ciliary Body

2) INTERMEDIATE Uveitis= Inflammation of the PARS PLICATA of the Ciliary Body

3) POSTERIOR Uveitis = Inflammation of the CHOROID

4) ENDOPHTHALMITIS = Inflammation of INTERNAL STRUCTURES of the eye

5) PANOPHTHALMITIS = PURULENT Inflammation of ALL STRUCTURES of the eye

Question 3

What is the CAUSE of ANTERIOR UVEITIS?

Answer 3

• Idiopathic
• Other Causes are IMMUNOLOGIC
  a. Allergic
  b. Hyperergic Reaction to Bacterial Toxins
• In RHEUMATIC DISORDERS, it’s associated with LEUKOCYTE ANTIGENS, HLAB27
• Secondary Condition to SYSTEMIC DISEASES like:
  a. Ankylosing Spondylitis
  b. Reiter’s Syndrome
  c. Sarcoidosis

Question 4

What are the SYMPTOMS of ANTERIOR UVEITIS?

Answer 4

• DULL Pain in Eye / Forehead
• Accompanied by IMPAIRED / BLURRED Vision
• Photophobia
• EXCESSIVE Tearing = EPIPHORA

** EXCEPT FOR Juvenile Idiopathic Arthropathy (PAINLESS)

Question 5

What are the SIGNS of ANTERIOR UVEITIS?

Answer 5

• Redness of Eye WITH Conjunctival Circumciliary Injection, AROUND THE LIMBUS
• Ciliary Injection = Episcleral / Perilimbal Vessels appear BLUE / RED
• HYPERAEMIC Iris
• REACTIVE MITOSIS is present
• There are KERATIC PPT = WBC on Corneal EPITHELIUM
• POSTERIOR SYNECHIAE = Inflammatory Cells CAUSING ADHESIONS BTW Lens + Iris

Question 6

What INVESTIGATIONS are Conducted for ANTERIOR UVEITIS?

Answer 6

• ESR
• Full Blood Count
• Serum ACE Levels
• Syphilis Serology
• HLA Typing
• Chest AND Sacroiliac Joint X-Rays

Question 7

What are the COMPLICATIONS resulted DUE to ANTERIOR UVEITIS?

Answer 7

• Secondary OPEN ANGLE Glaucoma, WITH INCREASED INTRAOCULAR Pa
• ADHESIONS BTW Iris + POSTERIOR Surface of Cornea = ANTERIOR SYNECHIAE
• ADHESIONS BTW Iris + Lens = POSTERIOR SYNECHIAE

Question 8

What is the TREATMENT for ANTERIOR UVEITIS?

Answer 8

• TOPICAL
• SYSTEMIC Antibiotic / Antiviral Therapy
• Eye Rest VIA DILATION with = ATROPINE
• HEAT APPLICATION to improve blood circulation + relieve pain
• CONTROL Acute Phase of inflammation with = CORTICOSTEROIDS
• RELIEVE Pain / Discomfort = ANALGESICS + ANTI-INFLAMMATORY
• MODERN BROAD-SPRECTRUM Antibiotics = CROSS the Blood-Aqueous Barrier