Uveitis

8 Uveitis






Anterior uveitis


Inflammation of iris (iritis) and ciliary body (cyclitis)


Most common cause of anterior uveitis in adults is idiopathic (followed by HLA-B27 associated)


Most common cause of acute, noninfectious, hypopyon iritis is HLA-B27-associated iritis








Findings


conjunctival and episcleral injection, ciliary injection (circumcorneal flush from branches of anterior ciliary arteries), miosis (iris sphincter spasm), AC reaction; may have hypopyon, keratic precipitates, iris nodules, dilated iris vessels (occasionally, rubeosis), synechiae (posterior [iris adhesions to lens; seclusio pupillae is a complete adhesion that can result in iris bombe] or anterior [iris adhesions to cornea and angle]) (Figure 8-1)












Diagnosis




















Intermediate uveitis





Pars Planitis


Most common cause of intermediate uveitis (85–90%)


Usually young adults; females > males; 75% bilateral


Accounts for 25% of uveitis in children


Associated with HLA-DR15 and MS











Posterior uveitis


Most common cause of posterior uveitis in adults is toxoplasmosis (followed by retinal vasculitis)




Infections






Cytomegalovirus (CMV)


Progressive hemorrhagic necrotizing retinitis involving all retinal layers


Occurs in 15–46% of AIDS patients; usually when CD4 count <50 cells/mm3


40% bilateral at presentation


Rare syndrome of neonatal cytomegalic inclusion disease






Treatment


antiviral therapy (induction during first 2 weeks)










Acute Retinal Necrosis (ARN)


Acute self-limited confluent peripheral necrotizing retinitis due to infection with VZV, HSV, or rarely CMV


Usually occurs in immunocompetent individuals; 33% bilateral (BARN), commonly in immunosuppressed


Association with HLA-DQw7 (50%)









Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Uveitis
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