Clinical features of uveitis Dr. Anupama Karanth www.ophthalclass.blogspot.com

Symptoms: Classical triad of acute onset Pain Redness Photophobia With or without diminished vision Anterior uveitis: PRESENTATION Chronic iridocyclitis – variable presentation

Anterior uveitis: PRESENTATION

Redness can result from any inflammation in anterior segment Conjunctivitis Keratitis / Episcleritis / Anterior scleritis Iritis / Iridocyclitis / Cyclitis Angle closure glaucoma All red eyes are not conjunctivitis Clues: type of congestion and associated features

Anterior uveitis - Signs Signs seen by slit lamp

Anterior uveitis - Signs

Keratic precipitates

Keratic precipitates (KPs) vary in size, shape, number Base down triangle inferiorly – Arlt’s Granulomatous / non granulomatous Proteinaceous influx gives rise to aqueous flare (Tyndall effect) Aqueous cells are always a sign of activity Anterior uveitis - Signs

Aqueous cells and flare cells flare

Anterior uveitis - Signs

Posterior synechiae Festooned pupil – multiple posterior synechiae seen on pupillary dilatation

Posterior synechiae Posterior synechiae with cataract in a child with blunt injury

Pupillary constriction is an important sign in D/D of red eye Risk of pupil block glaucoma exists with extensive posterior synechiae Iris nodules are characteristic of granulomatous uveitis Iris nodules

Symptoms Insiduous onset Floaters Opacities in the anterior vitreous Diminished vision Intermediate uveitis: PRESENTATION

Intermediate uveitis - Signs Signs seen by slit lamp & indirect ophthalmoscopy

Symptoms Painless Visual disturbances Floaters Metamorphopsia Macropsia / Micropsia Photopsia Blurring of vision Posterior uveitis: PRESENTATION

Posterior uveitis - Signs Signs seen by slit lamp & indirect ophthalmoscopy

Posterior uveitis - Signs

Vitritis Cells and exudates seen in the anterior vitreous

Diseases of the uveal tract. In: Parsons’ Diseases of the eye. 20th ed. Sihota R, Tandon R eds. Elsevier; 2007 Basic and Clinical Science Course. Intraocular inflammation and uveitis. American Academy of Ophthalmology. 2006-2007 Nussenblatt RB, Whilcup SM, Palestine AG. Uveitis: Fundamentals and Clinical Practice. 2nd ed. St. Louis: Mosby; 1996 Duane’s Ophthalmology 1997. CD-ROM Edition. References