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1、Uveitis,Burning of the eye Redness of the eye Blurred vision Photophobia or sensitivity to light Keratic precipitates,CASE 1,Episodes are considered to be short if they last for less than 3 monthsLong or chronic if they last longer,acute or chronic,Severevisual loss is 50% or more of prediseased vis
2、ion or if there is 50% or more loss of the electroretinogram amplitudes from normal Mildvisual acuity is less than 50% decreased from baseline or the electroretinogram amplitudes are decreased by less than 50%.,severe or mild,anterior uveitis includes iritis and iridocyclitisintermediate uveitis inc
3、ludes cyclitis, vitritis, and parsplanitisposterior uveitis includes retinitis and choroiditis.panuveitis -inflammation of all parts of the uvea,anterior、intermediate or posterior,unilateral toxocariasis and Fuchs iridocyclitisunilateralbilateral HLA-B27-associated iridocyclitisbilateral Vogt-Koyana
4、gi-Harada (VKH) syndrome,unilateral or bilateral,Uveitis is considered granulomatous if there are Busacca nodules in the iris stroma, large greasy “mutton-fat” keratic precipitates, large vitreous snowballs, or choroidal granulomas,granulomatous or nongranulomatous,ciliary spasm. radiate to the peri
5、orbital region and to the eye. axon reflex. cycloplegia,PAIN,distinguished from the photodysphoria or photoaversion prominent symptom cycloplegia may lessen photophobia and pain,PHOTOPHOBIA,floaters macular edema micropsia, and metamorphopsia.,BLURRED VISION,radiating from the limbus. distinguished
6、from the deeper and more peripheral injection of scleritis and from the sectoral or diffuse injection of episcleritis. overlying conjunctival injection neosynephrine,CILIARY INJECTION,Clusters of inflammatory cells deposited on the endothelial surface of the cornea,KERATIC PRECIPITATES,slit-lamp bea
7、m is seen in the anterior chamber “flare”represents breakdown of the blood-aqueous barrier with exudation of protein. Flare Description 0 Complete absence 1+ Faint flare (barely detectable) 2+ Moderate flare (iris and lens details clear) 3+ Marked flare (iris and lens details hazy),ANTERIOR CHAMBER
8、FLARE,active inflammation of the iris and ciliary bodylarger cells macrophages or lymphocytessmaller cells may be individual lymphocytes,ANTERIOR CHAMBER CELLS,Grade Cells per Field 0 No cells Rare 12 Occasional 37 1+ 710 2+ 1020 3+ 2050 4+ 50 or more,Patients with acute anterior uveitis usually pre
9、sent with low IOPPatients with chronic iridocyclitis frequently develop elevated IOP,INTRAOCULAR PRESSURE,Grade Description 0 No haze Trace Slight blurring of optic disc margin 1+ Slightly blurred optic nerve and vessels 2+ Moderately blurred optic nerve and vessels 3+ Optic nerve head border blurry
10、 but visible 4+ Optic nerve head obscured,VITREOUS OPACITIES AND HAZE,VogtKoyanagiHarada disease,bilateral diffuse uveitis pain redness blurring of vision.,auditory (tinnitus,vertigo, and hypoacusis)neurological (meningismus, with malaise, fever, headache, nausea, abdominal pain, stiffness of the ne
11、ck and back, or a combination of these factors;meningitis, CSF pleocytosis, cranial nerve palsies, hemiparesis, transverse myelitis and ciliary ganglionitis)cutaneous manifestations, including poliosis, vitiligo, and alopecia. The vitiligo often is found at the sacral region.,may have no symptoms ma
12、y be fever, headache, nausea, meningismus, tinnitus, and/or vertigo. orbital pain, photophobia and tearing. skin and hair may be sensitive to touch.cranial nerve palsies and optic neuritis are uncommon.,prodromal phase,bilateral panuveitis causing blurring of vision if initially unilateral The proce
13、ss can include bilateral granulomatous anterior uveitis, variable degree of vitritis, thickening of the posterior choroid with elevation of the peripapillary retinal choroidal layer, optic nerve hyperemia and papillitis, and multiple exudative bullous serous retinal detachments.,acute uveitic phase,
14、gradual tissue depigmentation of skin with vitiligo and poliosisnummular depigmented scarsalopecia diffuse fundus depigmentation resulting in a classic orange-red discoloration (“sunset glow fundus“)retinal pigment epithelium clumping and/or migration.,convalescent phase,repeated bouts of uveitisgra
15、nulomatous anterior inflammationcataractsglaucomaocular hypertensiondysacusia,chronic recurrent phase,If tested in the prodromal phase, CSF pleocytosis is found in more than 80%, mainly lymphocytes. This pleocytosis resolves in about 8 weeks even if chronic uveitis persists.,diagnosis,electroretinog
16、ram visual field testing retinography fluorescein indocyanine green angiography optical coherence tomography ultrasound ocular MRI audiologic testing histopathology,diagnosis,the acute uveitis phase of VKH is usually responsive to high-dose oral corticosteroids; parenteral administration is usually
17、not required. ocular complications may require an subtenon or intravitreous injection of corticosteroids or bevacizumab. in refractory situations, other immunosuppressives such as cyclosporine, or tacrolimus, antimetabolites (azathioprine, mycophenolate mofetil or methotrexate), or biological agents such as intravenous immunoglobulins (IVIG) or infliximab may be needed. cycloplegic agents,
