Intermeddiate & posterior uveitis dr.k.srikanth, 23.03.2016 revised

1. UVEA -2
Dr. K. Srikanth
Dept.Ophthal
MGMCRI

2. Intermediate Uveitis
• Pars planitis ( Pars plana & periphery of choroid)
• Children, young adults
• Bilateral in 80%
• Cause unknown-non specific inflammation
• Insidious onset
• Resolve spontaneously/prolonged course

3. Intermediate Uveitis
Symptoms:
Deterioration of vision
Floaters
Signs:
Spill over anterior uveitis(min. flare,occ.KPs)
Anterior vitritis
White snow-ball exudates near ora
Snow banking
Peripheral Periphlebitis

4. Intermediate Uveitis
• Complications:
Macular edema
Disc edema
Papillitis
Cyclitic membrane
Vitreous hemorrhage
TRD
• D/D:
Toxoplasmosis/peripheral Toxocariasis/Syphilis/MS/Sarcoidosis

5. Posterior Uveitis
• Isolated/Diffuse involvement
• Involves retina secondarily
Symptoms:
• Floater
• Diminished vision
• Metamorphopsia
• Photopsia
• Scotoma

6. Posterior Uveitis
Signs:
• Vitritis (Cells, exudates)
• Infiltration/Exudation of retina, choroid
• Edema of retina, choroid
• Sheathing of vessels
• Spill over anterior uveitis
• Disc edema
• Retinal hemorrhages

7. Complications:
• Complicated cataract,
• Glaucoma,
• RD,
• CNVM

8. • Retinitis:
– Fluffy white retina with diffuse borders and lots of vitritis.
• Choroiditis:
– Yellow or grey retinal elevation with demarcated borders and no
vitritis.
• Chorioretinitis:
– Choroiditis with a little vitritis.
• Old Choroiditis:
– Punched Out Scars, may vary in size & shape

9. • Focal:
– Single lesion, may be localized like in Toxoplasma
or spread like CMV retinitis.
• Multifocal:
– Multiple lesions, I.e: MEWDS.
• Diffuse:
– Sympathetic Ophthalmia

10. Choroiditis
Active Healed

11. Retinitis

12. Investigations
• Single
• Unilateral NO INVESTIGATIONS
• Anterior
• Non Granulomatous
• Posterior
• Bilateral CBC,ESR,HLA-B27
• Recurrent ACE,ANA,RPR,VDRL
• Granulomatous CXR, Lyme titre

13. Treatment Goals
Symptom Relief
– Pain, photophobia, blurred vision
Prevent Visual Loss
Prevent Complications

14. Treatment
1. Cycloplegia – giving rest to ciliary body,
prevents + breaks Synechiae,
decreases hyperemia
Atropine, Homatropine, cyclopentolate,
Mydricaine – SC inj.of 0.3 ml Atr,Procaine,Adr
2. Cortico steroids-
topical, subconj, subtenon’s, systemic
3. Immunosuppressants
4. Specific Rx- TB, Syphilis, leprosy, etc.

15. Treatment of complications
• Secondary glaucoma:
Intensify uveitis trt
Anti glaucoma medications
Laser iridotomy(Ring synechiae)
• Complicated cataract:
Surgery after 3 months
• Band Keratopathy:
PTK, Chelation with EDTA
• CME:
Oral steroids, Diamox

16. • Intermediate uveitis:
Steroids
Immunosuppressants
• Posterior Uveitis:
Steroids
Immunosuppressants
Specific treatment of cause

17. Approach to Treatment
Anterior Uveitis
 Topical:
 Steroid drops
 Cycloplegics
 Systemic:
Corticosteroids
Steroid sparing agents
Posterior Uveitis
 Local:
Periocular steroid
injections
 Systemic:
Corticosteroids
Steroid sparing agents

18. Possible Questions
• How would you
investigate a case of
intermediate uveitis
• List the pathological
features of Sympathetic
ophthalmia & its
prevention