Inflammation of uveal tract (iris, ciliary body, choroid)
What are the different types of uveitis?
Anterior
Intermediate
Posterior
Panuveitis
What is anterior uveitis?
Inflammation of anterior part of uveal tract (iritis, iridocyclitis (iris & ciliary body))
Most common type of uveitis
What is intermediate uveitis?
Inflammation of middle part of uveal tract
-> mainly vitreous
What is posterior uveitis?
Inflammation of posterior part of uvealtract
What is panuveitis?
Inflammation of whole of uveal tract
What are the common symptoms of uveitis?
Blurred vision
Pain
Redness
Photophobia
Floaters (commonly seen in posterior uveitis)
What is shown in the image?
Anterior uveitis
What are the symptoms of anterior uveitis?
Redness
Pain
Photophobia
Intraocular pressure may be raised
What is the treatment of anterior uveitis?
Topical steroids
Dilating pupil (cyclopentolate) -> prevents formation of posterior synechiae
If intraocular pressure is raised
topical beta blockers
prostaglandin analogues
referral to ophthalmology
What are the signs & symptoms of intermediate uveitis?
Painless
Blurred vision
Floaters
Commonly affects both eyes
What is the treatment for intermediate uveitis?
Combination of anterior & posterior treatments
What are the signs & symptoms of posterior uveitis?
Painless
Blurred vision
Can progress to severe visual loss
Floaters
Scotomata
Blind spots
Often found with systemic autoimmune diseases
What are the treatments of posterior uveitis?
Steroids
In need long-term steroids, give second-lineimmunosuppressant
Biological agents can be used in severe cases (e.g. adalimumab)
What is cataracts?
Clouding of the eye's lens
What is shown in the image?
Cataracts
What are the signs & symptoms of cataracts?
Gradual, painlessdeterioration of vision
Glare (esp at night)
What are the risk factors of cataracts?
> 65 years old
Female
Smoking
Long term UV exposure
Diabetes
Eye trauma
Long term corticosteroid use
FH of congenital catarct
Uveitis
Myopia
How is being over 65 a risk factor for cataracts?
Change in lens proteinsincreases with age & reducetransparency
How is being female a risk factor for cataracts?
May be due to reduction if protective effect of oestrogen during menopause
How is smoking a risk factor for cataracts?
Oxidative stress is linked to changes in crystalline lens proteins -> cataracts
How is long-term UV exposure a risk factor for cataracts?
Lens is susceptible to UV damage
How is diabetes a risk factor for cataracts?
High glucose levels -> retention of glucose in the lens & conversion to sorbitol
How is uveitis a risk factor for cataracts?
Due to prolonged ocular inflammation & use of corticosteroids
What is the treatment of cataracts?
Early changes in lens
-> correctable with glasses
But, eventually opacification needs surgical intervention
Cataract extraction (incision into eye & removal of opacified crystalline lens) with insertion of an intraocular lens
What is retinal detachment?
Separation of the retina from the underlying tissue.
What is the process of retinal detachment?
Tear in retina -> fluid collects in potential space between sensory retina & pigment epithelium -> fluid continues to leak behind retina & with gravity -> retinal detachment
What are the signs & symptoms of retinal detachment?
Sudden onset of floaters
Photopsia (flashes of light) -> prior to detachement
Painless, progressive visual field loss
What are the risk factors of retinal detachment?
Posterior vitreous detachment
Age
Myopia
Trauma
Previous ophthalmic surgery
Previous cataract surgery
Intraocular tumour
Vitreous haemorrhage
Diabetes
Why is age a risk factor of retinal detachment?
Due to structural changes in vitreous gel -> promotes retinal breaks
Why is myopia a risk factor for retinal detachment?
High myopia may accelerate the breakdown of normal vitreous gel & weaken retina
What is the treatment for retinal detachment?
Referral to ophthalmologist for detailed fundal examination
Surgery to re-attach retina or fix retinal tear
What is glaucoma?
A group of eye diseases that cause damage to the optic nerve.
What is glaucoma due to?
Increased pressure inside the eye -> optic nerve damage -> visual field defects (loss of vision)
2nd most common cause of blindness worldwide
What are the 2 main types of glaucoma?
Primary open-angle glaucoma
Acute angle-closure glaucoma
What is shown in the image?
Primary open-angle glaucoma
What is primary open-angle glaucoma?
Most common form of glaucoma
Due to reduced outflow of aqueous humour through trabecular meshwork -> high intraocular pressure
What are the risk factors of primary open-angle glaucoma?
Older age
Race (black Africans have a 5x greater risk than white)
Positive FH
Myopia
What are the signs & symptoms of primary open-angle glaucoma?
Gradual, painless loss of peripheral visual fields