Iritis, iridocyclitis, anterior uveitis, and panuveitis PDF

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Summary

Iritis, iridocyclitis, anterior uveitis, and panuveitis: what they are, how they present, risk factors, investigations and management ...

Description

Topic Introduction

The red eye: Iritis, iridocyclitis, anterior uveitis, and panuveitis The iris, ciliary body and choroid are similar embryologically and are known as the uveal tract. Inflammation of the iris= iritis Inflammation of the ciliary body= cyclitis If inflammation of the ciliary body and iris comes together= iridocyclitis (aka anterior uveitis) Inflammation of all layers of the uveal tract (iris, ciliary body, and choroid) >> both anterior and posterior segments of the eye are inflamed and patients may have evidence of an associated systemic disease (ex: sarcoidosis, Bechet’s syndrome (blood vessel inflammation throughout the body+ positive pathergy test ), SLE, polyarteritis nodosa (is a systemic necrotizing inflammation of blood vessels (vasculitis) affecting medium-sized muscular arteries, typically involving the arteries of the kidneys and other internal organs), Wegner’s granulomatosis (is a rare multisystem autoimmune disease), or toxoplasmosis

Risk factors

History

O/E

Managemen t

Several patients are at risk of developing anterior uveitis: - History of past attacks of iritis (particularly if they are positive for HLA B27> ankylosing spondylitis) - Uveitis in children with juvenile chronic arthritis/seronegative arthritis - Patients with sarcoidosis - Herpes zoster opthalmicus infection - Syphilis - TB  Patient with previous attacks can often feel an upcoming attack even before any physical signs  Photophobia (due to inflammation & ciliary spasm)  Pain (worse when patient is reading as they are contracting ciliary muscles to focus on words) On examination:  Initially vision may be normal but may be impaired later  Accommodation/reading vision is affected  Cataract may form  Adhesions can develop between iris and lens  The affected eye is red with injections over the area covered by the ciliary body (near the lens) > aka ciliary flush  Pupil small due to spasm of the sphincter  An abnormal pupil in a red eye usually means serious ocular disease. If there is an underlying cause> that should be investigated and managed accordingly After making sure there are no other issues with the eye (for example posterior inflammation, retinal detachment, or an intraocular tumour.

IRITIS

MEDICAL TREATMENT - Topical steroids (to reduce inflammation) - Antiglaucoma treatment could be given if there is a rise in intraocular pressure ** patients with panuveitis will need systemic investigation and possible immunosuppression. What is it: inflammation of the iris (it’s the most common ophthalmic presentation) Aetiology: most cases (95%) are idiopathic, 5% is associated with systemic conditions such as (HLA-B27/ankylosing spondylitis, sarcoid, TB) or intrinsic eye problems (corneal ulcer, retinal detachment) Symptoms: pain, photophobia, blurred vision Signs: redness around the cornea (injection), pupil stuck to lens, clumps of cells stuck together to inner surface of cornea, increased or decreased intraocular pressure Investigations: screening tests for systemic conditions if the iritis is recurrent, severe or bilateral Treatment: topical steroids, cycloplegic/mydriatic drops (atropine, cyclopentolate)...