مختصر للـ uveal tract
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مختصر للـ uveal tract
من طرف 7oda السبت أغسطس 28, 2010 5:07 pm
اليكم افضل مختصر للuveal tract
Uveitis
Clinically
Acute uveitis less than 8 weeks
Chronic uveitis more than 3months
Subacute uveitis 8 till 3 months
anatomically
Anterior = ( iris and ciliary body ) irisdocyclitis
Posterior = ( choroid ) choroiditis
Aetiology
Infective = exogenous - endogenous
Non infective = traumatic - allergic
Unknown syndormes = Vogt koyanagi harada syndrome - behcet's disease
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Irido cyclitis
1- Vascular phenomenon
vessels of the iris and ciliary body become dilated to increase the
blood flow ( pupil decrease in size - dilatation of blood vessels )
happens due to increase histamine release
2- Exudative phenomenon
Exudation
of plasma proteins and inflammatory cells - aqueous become turbid and
thick filled with inflammatory cells - polymorphs and Macrophaes starts
to appear
Clinical picture
symptoms
1- severe neuralgic ache ( nerves in the iris and ciliary body becomes
irritated by inflammation and metabolites ) causes lacrimation and
photophobia
2- Defective vision due to
a- turbidity of aqueous
b- sphincter pupillae spasm - ciliary muscles spasm in a phenomenon called artificial ,yopia
c- corneal oedema
d- vitreous turbidity
e- Toxic maculopathy or neuritis
Signs
1- circum corneal ciliary injection ---> Due to hyperemia and engorgement of prelimbic bvs deep to cponjunctiva
2- keratic percipetates --> inflammatory cells on the back of cornea
3- aqueous flare --> seen by slit lamp - rays of light appear due to
presence of proteins and cells .. normally it is optically empty
4- The pupil ---> miotic - sluggish reaction because of sphincter
spasm and sticking of iris to anterior surface of lens by the exudates -
early can be dialted using atropine , sites of adhesions will show "
festoons "called posterior synechciae
5- Iris pattern is lost due to oedema bacomes sponge like or muddy iris
6- Intra Ocular Pressure may increase
7- vitreous turbidity
Management
Acute Attack
1-
Topical atropine ( essential ) ---> release sphincter spasm -
prevent posterior synechiae and relief ciliary ms spasm --> improve
blood supply
2- Topical cortico steroids to decrease the inflammation --> in autoimmune or allergic causes
3- Non steroidal anti-inflammatory drugs --> when steroids is contraindicated
Treatement of the cause
N.B .. Atropine eyedrops is contraindicated in children
Complications
after negligance
Pupil
1-
seculsio-pupillae --> If pupile delayed in dilatation -->
permanent post synechiae - affix pupil to anterior lens capsule
2- occlusiopupillae --> maybe pupil covered with opaque membrane from exudates causing pupillary block --> 2ry glaucoma
Angel of anterior chamber
1- PAS --> Iris root adhere to endothelium
2- 2ry Glaucoma --> Thick aqueous clogs the meshwork or with pupillary block ( 1 and 2 ) in pupil comlications
The lens
1- complicated cataract --> defective nutrition of lens
2- Cyclitic membrane --> exudates in posterior chamber encircling the lens forming membrane
Choroid and Retina
1- chorido retinitis --> severe cases = endophthalmitis
2- Retinal detachment --> Subretinal exudation - maybe tractional from organized exudates
Phthisis Bulbi
Final stage ..
Damage of C.B. - Hypotony - Globe shrinkage - Defective formation of aqueous
Diagnosis
History
Investegation
Complete blood picture
skin test to check hypersensitvity
Tissue typing
ELISA
Chest x-ray for ankylosing spondylitis and sarcoidosi
--------
Choroiditis
Supporative
Endophtalmitis
Panophthalmitis
Non supporative
Granulomatous
Non Gran.
Endophthalmitis
Inflamation of the uveal tract with adjacent tissues
maybe exogenous from a perforation
Or endogenous from Pyemia
Clinical picture
Symptoms
Pain - lacrimation - drop of vision
Signs
Injcected
eye - conjunctival chemosis - KPS ( keratic percipitates) - hypopyon -
turbid aqueous - yellow reflex - hazy vitreous and Cornea
Management
Intensive broadspectrum antibiotics
Viterectomy if early case
enucleation if late case
Panophthalmitis
All coats of the eye are inflammed
Clinical picture
Symptoms
Severe pain - Headache - loss of vision
Signs
Lid
oedema - conjun. chemosis - corn. oedema - hypopyon - light perception
is lost - eyeball may perforates and pus gets out called self
evascerated
Management
Intensive broadspectrum antibiotics 48 hours
If no response ?
Evasceration, enucleatuion is contra indicated because infection may spread to meninges causing meningitis
منقووووول لامانه
7oda- Admin
- عدد المشاركات : 7833
البلد : بص جنبك كدا ..
تاريخ التسجيل : 01/07/2010
المود :
طب عين شمس- الإدارة
- عدد المشاركات : 1480
تاريخ التسجيل : 24/08/2010
المود :
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