PART III. CLASSIFICATION OF UVEITIS
PRACTICE CASES
Case 1. 50 y.o./F presents with a history of two-month duration of blurring of vision and redness in the left ye. She denies any other associated symptoms nor any history of a similar episode in the past.
Ophthalmologic examination revealed the f
unduscopy OD – essentially normal funduscopic Findings
rn of the iris, (+) lens opacity
ne non-pigmented keratic precipitates, (+) ells in the retrolental area, (+) vitreous condensation
asis of disease opic findings in the left eye, what is the anatomic classification of this patient’s uveitis?
n?
Cas complaint of bilateral blurring of vision. History reveals that the i
with nd blurring of vision. Consult was done at that time and symptoms allegedly resolved with unrecalled topical medication. About 1 month prior to consultation, however, the patient noted
ft Eye e
ollowing findings:
Best corrected vision OD = 6/21 OS = CF at 1 meter Intraocular Pressures OD – soft OS – hypotonic
EOM’s OU – full
F
OS – no ROR noted due to a very hazy media Slit Lamp Findings:
OD – clear co ea, no cells or flare, no KP’s, normal appearance OS – clear cornea, (+) perilimbal flush, (+) cells/ (+) flare, (+) fi c
1. Based on the given information, how would you classify the patient’s condition on the b activity?
2. Assuming that this patient has normal fundusc
3. What ancillary procedure may be useful in determining the presence or absence of posterior segment inflammatio
e 2. 24 y.o./M presents with a chief
pat ent first experienced eye redness in the left eye about one year prior to consultation that was associated photophobia a
recurrence of symptoms in the left eye and a week later, experienced similar symptoms in his right eye. He also noted the presence of oral ulcers. The rest of the history was unremarkable.
Ophthalmologic Examination at time of consultation revealed the following findings:
Right Eye Le
Visual Acuity 6/21 6/30
IOP Soft Soft
EOM”S Full Full
Fundusc py (+)ROR, sligh ia, distinct disc borders, CD 0.3, AV 2:3, no hemorrhages, no exudates, (+) note of perivascular sheat slightly dull
(+)ROR, slight dia, distinct disc borders, CD 0.3, AV 2:3, no hemorrhages, no exudates, (+) note of perivascular sheat slightly dull
Findings Clear cornea, formed anterior chamber, (+) small pigmented KP’s, (+)cells,(+) flare (-) iris nodules, moth eaten iris
Clear cornea, (+) small pigmented KP’s, (-)cells, (+)flare (-) iris nodules, moth eaten iris
1. ts of the y you
he patien 2. Is the disease con
. Based on the above findings, is the disease condition granulomatous or non-granulomatous in nature?
What par
classify t uveal tract is involved in the inflammator t’s condition?
dition chronic, recurrent, or acute?
process? Based on this, how would
3
4. What ancillary procedure may be requested in this patient to determine the extent of inflammation?
Case 3. A 43 y.o female presents with a 6-month history of red, painful left eye. She previously had an episode of corneal ulcer in the same eye. Her past medical history was positive for sinusitis, rosacea, photosensitivity and pneumonia. She also had a hysterectomy about 2 years ago. Her family history was
tory
20/20, OD – 20/25
ross Exam: Rosacea facies; normal pupillary reflexes; normal eyelids
S – localized redness temporally with note of corneal edema and infiltration (pls. refer to picture below)
1. Given the pati ur differential diagnoses for this case?
2. How would you differe r?
was the primary objective of this self-instructional material to provide the reader with a guide on how to eitis and scleritis. The importance of a comprehensive clinical history can not be veremphasized since the etiologic diagnosis of most of these ocular inflammatory conditions relies on the positive for glaucoma (grandfather), diabetes mellitus and tuberculosis (grandmother). The rest of her his was unremarkable.
Ophtha Exam revealed the following findings:
Visual acuity: OD – G
EOMs: full on all directions of gaze IOPs: OD- 15 mm Hg, OS – 12 mm Hg Fundus Exam: Normal in both eyes Slit lamp Examination
OD – essentially normal findings O
ent’s history and eye findings, what are yo ntiate one condition from anothe PART V. SUMMARY
It
diagnose patients with uv o
history. Secondly, one should be able to recognize the various ocular signs associated with these inflammatory conditions.
RECOMMENDED FOLLOW-UP
It is recommended that the students be given demonstration sessions on how to properly conduct
history-taking and ophthalmologic examin e, it is further recommended that
e students be provided clinical sessions to allow them to see actual cases of patients with uveitis and ation of patients. Following this exercis th
scleritis.
CONCLUSION
As medical practitioners, you may, in the future encounter patients who will seek consultation for eye problems. One should bear in mind that not h present with a red eye is “sore eyes” and a
atient may actually be suffering from another, more vision-threatening condition like uveitis or scleritis. It is all conditions whic ptherefore your role to be able to properly recognize these patients so that immediate referral to an ophthalmologist for further evaluation and management can be done. By doing so, early intervention can be
1. Berson, Frank G. (ed) Basic Ophthalmology for Medical Students and Primary Care Residents. 6th edition. American Academy of Ophthalmology.
. Kanski, Jack J. Clinical Ophthalmology A Systematic Approach
2 . 4th edition. Butterworth Heinemann.
3. Oxford, 1999.
Newell, Frank, Textbook of Ophthalmology. latest edition.
. Nussenblatt, R.B., Whitcup, S.M. and Palestine, A.G. Uveitis: Fundamentals and Clinical Practice.
4 2nd ed.
5. Mosby, Baltimore, 1996. ster CS: Severity of scleritis and episcleritis. Ophthalmology 1994 Feb;
Sainz de la Maza M, Jabbur NS, Fo 101(2): 389-96
6. Smith, Ronald E., and Nozik, Robert A. Uveitis: A Clinical Approach to Diagnosis and Management.
Williams and Wilkins, Baltimore, 1983.
8. bury, T. and Riordan-Eva, P. General Ophthalmology.
7. Watson PG, Hayreh SS: Scleritis and episcleritis. Br J Ophthalmol 1976; 60: 163-192
Vaughn, D., As 15th ed. Appleton and Lange,
ANSWERS TO QUESTIONS FOR CAS S Case 1.
. anterior uveitis, specifically iritis
sound, since there is no view through the pupil
d/or choroid) – based on anterior and posterior segment findings
rrent uveitis – assuming that the patient was inflammation free during the one year period . non-granulomatous type of uveitis
itis
tors and if blanches Æ episcleritis;
if it does not blanch Æ scleritis
so check for tenderness since tenderness would support
tis
1. iris, ciliary body and the posterior segment (retina an 2. recu
34. fluorescein angiography
Case 3.
1. nodular episcleritis vs. nodular scler 2. > may instill vasoconstric
> al
diagnosis of scleritis
> check if nodule present is movable; if nodule is movable, would support diagnosis of episcleri
TEARING