Downloaded 398 times
Uploaded bySamten Dorji
clinical case presentation on anterior uveitis
This clinical case presentation summarizes a 38-year-old male gardener who presented with right eye pain and redness for 5 days. On examination, his right eye showed circumcorneal congestion, grade +4 cells and grade +3 flare in the anterior chamber with posterior synechiae and miosis. He was diagnosed with acute anterior uveitis based on the unilateral eye symptoms and anterior chamber inflammation seen on examination. He was prescribed cycloplegic, antibiotic, and steroid eye drops as well as oral steroids to treat the condition.
In this document
Powered by AI
Presentation of a clinical case by Dr. Samten Dorji.
38-year-old male presenting with right eye pain, redness, and systemic review without significant findings.
Ocular examination reveals decreased visual acuity in right eye with anterior chamber abnormalities.
Diagnosis of acute anterior uveitis supported by symptoms and examination findings, with differential diagnoses noted.
Chest X-ray shows no abnormal findings.
Management includes cycloplegic drops, antibiotics, and systemic steroids for acute anterior uveitis.
Introduction to uveitis, discussing clinical features and types of inflammatory conditions in uveal tract.
Differences in clinical course and histology regarding acute, chronic, recurrent anterior and posterior uveitis.
Community study indicates 71% of uveitis cases are anterior, with various common causes outlined.
Typical presentation includes unilateral pain, photophobia, redness, and associated examination findings.
Definition and grading of anterior chamber cells and flare relevant to uveitis assessment.
Indications for various investigations including biopsies, serological tests, and imaging for uveitis diagnosis.
Management options for uveitis including medications, steroids, complications, and monitoring.
Summary of key points regarding clinical features, investigations, and treatment strategies for uveitis.
Concludes the case presentation with a thank you.
More Related Content
Similar to clinical case presentation on anterior uveitis
clinical case presentation on anterior uveitis
- 1. CLINICAL CASE PRESENTATION Dr.Samten Dorji Your Logo Here
- 2. • 38 yearold male complained of right eye pain and redness for 5 days duration. CHIEF COMPLAINT Personal information He is from Zhemgang, married with two children and is gardener by profession
- 3. • He developedslow onset of pain in his right eye and increase progression of pain. He had associated redness, photophobia, excessive tearing and reduced vision. HISTORY OF CHIEF COMPLAINT
- 4. • No jointpain • No history of asthma or symptoms suggestive of chest infection • No gastro intestinal symptoms • No history of haematuria or urethral discharge • No skin conditions SYSTEMIC REVIEW
- 5. • Past ocularhistory/ocular medications/systemic medications/comorbidities/allergies/family history/social history • No pets in house HISTORY CONT.
- 6. Examination Right eye Lefteye Visual acuity 6/60 6/6 With pinhole 6/12 6/6 Color vision Normal Normal Extraocular movements Normal Normal Lids and adnexa Normal Normal Conjunctiva and sclera Circumcorneal congestion Normal Cornea Clear Clear Anterior chamber Cells grade +4 and flare grade +3 Normal Iris and lens Posterior synechia Normal Pupil Round regular and miotic Round regular and reactive IOP by Icare 13 mmhg 11 mmhg Dilated Funduscopy NAD NAD
- 7. • 38 yearold male presented to eye OPD with right eye pain with redness for 5 days duration with associated photophobia, excessive tearing and reduced vision. On examination there was no significant findings in his left eye. On his right eye his visual acuity was 6/12 with pin hole. He had circumcorneal congestion and had grade +4 cells and grade +3 flare in anterior chamber with posterior synechia and miosis. He doesn’t have any clinical features suggestive of systemic disorder. CASE SUMMARY
- 8. DIAGNOSIS Acute anterior uveitis Supportingpoints • Unilateral eye pain with photophobia and redness with excessive tearing for duration of 5 days. • Circumcorneal congestion with anterior chamber cells and flare with posterior synechia and miosis. • Fundus appeared normal Non-Supporting points • Slow onset Aetiology • Idiopathic • HLA-B27 associated uveitis • Behcet disease • Lyme disease
- 9. Differential diagnosis • Posterioruveitis with spill over into the anterior chamber • Traumatic iritis • Infectious keratouveitis
- 11. Chest X rayPA= NAD
- 12. • Cycloplegic drops •Antibiotic drops • Prednisolone drops • Oral prednisolone MANAGEMENT
- 13.
- 14. • Introduction • Clinicalfeatures • Investigation • Treatment OUTLINE
- 15. • Uveitis isthe inflammation of the uveal tract INTRODUCTION
- 16. Clinical course Acute ChronicRecurrent Aetiology Infectious Noninfectious
- 17. Histology Granulomatous Nongranulomatous Anatomy Anterior uveitisIntermediate uveitis Posterior uveitis Panuveitis
- 21. • In alarge community-based study, the vast majority of uveitis cases were anterior (71%), followed by posterior uveitis (5%) and intermediate and panuveitis (1% each). • The most common causes of anterior uveitis are idiopathic (38−56%), the seronegative spondyloarthropathies (21−23%), juvenile idiopathic arthritis (JIA; 9−11%), and herpetic keratouveitis (6−10%).
- 22. • Presentation: suddenonset of unilateral pain, photophobia and redness, which maybe associated with lacrimation. • Visual acuity is usually good at presentation except in eyes with severe hypopyon CLINICAL FEATURES
- 23. External examination Miosis Endothelialdusting Aqueous flare and cells
- 24. Cells in fieldGrade (anterior chamber cells) <1 0 1-5 +- 6-15 +1 16-25 +2 26-50 +3 >50 +4 Description Grade (aqueous flare) Nil 0 Just detectable +1 Moderate (iris and lens details clear) +2 Marked (iris and lens detail hazy) +3 Intense(fibrinous exudate) +4
- 25. Fibrinous exudate Hypopyon Posteriorsynechiae Low IOP
- 26. Investigation INDICATIONS NOT INDICATED Granulomatousinflammation Single attack of mild unilateral AAU Recurrent uveitis Sympathetic ophthalmitis and Fuchs cyclitis Bilateral disease When systemic disease is already apparent Systemic manifestation Confirmation
- 28. Skin test Tuberculin testPathergy test Lepromin test
- 29. 1. Non-treponemal test=rapid plasma reagin 2. Treponemal antibody test= fluorescent treponemal antibody absorption test and microhaemagglutination treponema pallidum test 3. Dark ground microscopy Serology Syphilis Toxoplasmosis 1. Dye test(Sabin-Feldman)= gold standard 2. Immunofluorescent antibody test 3. Haemagglutination tests 4. Enzyme linked immunosorbent assay (ELISA)
- 30. Enzyme assay Sarcoidosis Tuberculosis Leprosy Serum angiotensin convertingenzyme Lysozyme assay HLA tissue typing HLA type Associated disease B27 spondyloarthropathies A29 Birdshot chorioretinopathy B51 Behcet syndrome
- 31.
- 32. Radiology Chest X raySacro iliac joint X ray CT and MR
- 33. 1. Conjunctival andlacrimal gland biopsy BIOPSY
- 34. Treatment Mydriatics Short acting Longacting Tropicamide (6 hours) Homatropine (2 days) Cyclopentolate(24 hours) Atropine(2 weeks) Phenylephrine(3 hours) Promote comfort Break down recently formed posterior synechiae Prevent formation of posterior synechiae
- 35. Topical steroids AAU CAU •Frequent instillation of drops at first • The frequency is tapered off once the inflammation gets controlled • Exacerbations treated as AAU • The intensity of flare can also indicate an active process • Follow up of patient regularly
- 36.
- 37. Periocular steroid injection Advantages •Therapeutic concentrations behind the lens may be achieved • Trans-sclerally entrance • Prolonged effect Indications • First line therapy in unilateral intermediate or posterior uveitis • Supplement systemic therapy or when systemic steroids are contraindicated • Poor compliance • At time of surgery
- 38. Complication Globe penetration Increased IOP Ptosis Subdermal fat atrophy Extraocular muscle paresis Optic nerve injury Retinal and choroidal vascular occlusion Cutaneous hypopigmentation
- 39. Systemic steroids • Oralprednisolone and intravenous infusion of methylprednisolone Indications • Intermediate uveitis unresponsive to posterior sub tenon injection • Posterior or panuveitis, particularly with bilateral involvement • Prior to intraocular surgery • Anterior uveitis resistant to topical. Contraindications • Poorly controlled diabetes • Peptic ulceration • Osteoporosis • Active systemic infection • Psychosis on previous exposure to steroids Short term side effects Long term side effects • Dyspepsia • Mental changes • Electrolyte imbalance • Aseptic necrosis of the head of the femur • Cushingoid state • Osteoporosis • Limitation of growth • TB reactivation • Cataract • Diabetes and myopathy
- 40. Antimetabolites Azathioprine Methotrexate Mycophenolatemofetil Indications Behcet syndrome Vogt-Koyanagi-Harada syndrome Uveitis associated with sarcoidosis and Juvenile idiopathic arthritis Alternative to azathioprine Dose and route Starting dose=1-3mg/kg After 1-2 weeks dose is doubled Stopped only after disease has been inactive for over 1 year and the daily steroid dose is under 7.5mg Adult:10-25mg weekly Children:30mg Folic acid 2.5-5mg/ day 1-2 g daily orally Side effects Bone marrow suppression, hepatotoxicity and nausea + acute pneumonitis Gastrointestinal disturbance and bone marrow supression Monitoring CBC and LFT CBC and LFT CBC
- 41. Calcineurin inhibitors Ciclosporin Tacrolimus IndicationsBehcet syndrome, intermediate uveitis, birdshot choroidopathy, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmitis and idiopathic retinal vasculitis Alternative to Ciclosporin Dose and route 2.5-7.5mg/kg daily orally 1-0.25mg/kg daily orally Side effects Nephrotoxicity, hyperlipidaemia, hepatotoxicity, hypertension, hirsutism and gingival hyperplasia Hyperglycaemia, neurotoxicity and nephrotoxicity monitoring Blood pressure, RFT and LFT + blood glucose
- 42. Biological blockers Interleukin receptorantagonists Tumour necrosis factor alpha antagonist Daclizumab and anakinra Infliximab and adalimumab
- 43. • Introduction • Clinicalfeatures • Investigation • Treatment SUMMARY
- 44.