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uveitis

uveitis

acute anterior uveitis (AAU)

  • classic triad of eye pain, redness and photophobia
  • up to 50-60% patients in western countries may have HLA-B27 and these patients tend to have 1st presentation at age 20-40yrs, whereas B27 negative patients tend to have 1st presentation 30-50yrs.
  • may occur in patients with seronegative spondyloarthopathies
  • usually unilateral and resolves within 4-12 weeks

aetiology

clinical features

  • corneal manifestations may include:
    • fine keratitic precipitates
    • fibrin on the endothelium.
    • corneal edema may develop due to endothelial decompensation
    • band keratopathy may be seen in chronic uveitis
  • anterior chamber shows:
    • cells and flare
    • in severe inflammation, fibrinous exudate in the anterior chamber may occlude the pupil, causing iris bombe.
      • this fibrin may be mistaken for endogenous endophthalmitis, cataract, or hypopyon.
    • a hypopyon may be seen, and, rarely, even a spontaneous hyphema occurs as a result of severely dilated iris vessels.
  • iris:
    • pigment dispersion, pupillary miosis, and iris nodules may be noted
    • synechiae, both anterior and posterior, can occur.
  • posterior segment involvement is relatively rare, but cystoid macular edema, disc edema, pars plana exudates, or choroiditis may be seen.
  • intraocular pressure often is low, secondary to decreased aqueous production with inflammation of the ciliary body and trabecular meshwork.
    • intraocular pressure also may be high if inflammatory cells and debris clog the trabecular meshwork

prognosis

  • generally runs a short course of 4-12 weeks, with a tendency to recur in the same eye, especially in individuals who are HLA-B27 positive.
  • prognosis of anterior uveitis associated with HLA-B27, either with or without systemic disease, is less favorable when compared with patients who are HLA-B27 negative with idiopathic anterior uveitis. Despite the potential for sequelae, the overall prognosis is good.
  • classic AAU resolves completely when promptly and aggressively treated.
  • undertreated or misdiagnosed cases may progress to chronic iridocyclitis due to permanent damage of the blood-aqueous barrier.

complications of AAU

  • cataract
  • glaucoma
  • hypotony
  • cystoid macular oedema
  • synechiae formation.

medical Mx

uveitis.txt · Last modified: 2013/10/10 14:52 (external edit)