Presentation
To describe the clinical presentation and course of Whipple disease in an adult. A 34-year-old man with phthisis bulbi in the right eye secondary to uveitis-induced neovascular glaucoma presented with severe acute posterior uveitis in the left eye. [ncbi.nlm.nih.gov]
The presenting symptoms are often floaters or blurred vision but since these are present in all forms of posterior uveitis, they have little value in differential diagnosis. [gpnotebook.com]
Entire Body System
- Inflammation
It suggests intraocular inflammation in BD affects the choroid as well as the retina. KEYWORDS: Behçet’s disease; EDI-OCT; choroidal thickness; intraocular inflammation; posterior uveitis [ncbi.nlm.nih.gov]
- Pain
Clinical Presentation The hallmark presenting symptom of posterior scleritis is moderate to severe pain. Patients will often describe a deep, dull, boring pain that, classically, wakes them from sleep. [reviewofophthalmology.com]
When to get medical advice Contact a GP as soon as possible if you have persistent eye pain or an unusual change in your vision, particularly if you've had previous episodes of uveitis. [nhs.uk]
A 34-year-old woman with multiple sexual partners over the past few years presented with painful and progressively worsening unilateral vision loss for 2 weeks. [ncbi.nlm.nih.gov]
In acute glaucoma, the patient has severe pain, the cornea of the eye is cloudy, and the pressure level of the fluid inside the eye is abnormally high; whereas in uveitis the pain is moderate, the cornea is clear, and the fluid pressure is normal or possibly [medical-dictionary.thefreedictionary.com]
Uveitis symptoms Uveitis may develop suddenly with eye redness and pain, or with a painless blurring of your vision. [klinikamaja.rs]
- Surgical Procedure
Surgical procedures may be needed to replace the vitreous (or gel-like area) or to implant a device in the eye for slow-release of corticosteroid medication Some medications can have serious side effects. [bausch.com]
Two or more surgical procedures may be associated with the onset of surgically induced scleritis. General Pathology Histologically, the appearance of episcleritis and scleritis differs in that the sclera is not involved in the former. [eyewiki.aao.org]
Cardiovascular
- Thrombosis
MPV seems to relate to neither thrombosis nor posterior uveitis in BD patients. [ncbi.nlm.nih.gov]
Minor complications such as sinusitis, nasal morbidity, and deep venous thrombosis were not included in the study. [richtlijnendatabase.nl]
Skin
- Ulcer
A much more serious form of the inflammation is ulcerative keratitis, in which an ulcer forms in the clear tissue of the cornea. [drscottsylvia.com]
Behcet’s disease Presumed autoimmune multisystem disease Rare in Ireland Commonest along silk route from Mediterranean to Far East Main clinical features Oral ulcers Genital ulcers Panuveitis and retinal vasculitis Acute anterior uveitis [slideshare.net]
The most common causes: INFECTIONS: toxoplasmosis, tuberculosis, citerpesa simplex, syphilis SYSTEMIC CONNECTIVE TISSUE DISEASES: sarcoidosis, ulcerative colitis, pauciarticular rheumatoid arthritis, ankylosing spondylitis, Behcet’s disease, Reiter’s [optometry-today.com]
Before giving corticosteroids, it is important rule out corneal ulcers by using a florescence dye test. [medicalnewstoday.com]
- Photosensitivity
Systemic lupus erythematous may present with a malar rash, photosensitivity, pleuritis, pericarditis and seizures. In addition to scleritis, myalgias, weight loss, fever, purpura, nephropathy and hypertension may be signs of polyarteritis nodosa. [eyewiki.aao.org]
Eyes
- Anterior Uveitis
OBJECTIVES: To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic arthritis, and macular edema. METHODS: Systematic review. [ncbi.nlm.nih.gov]
Back to top Anterior uveitis (iritis) The most common type of uveitis is anterior uveitis. What are the symptoms of anterior uveitis? The symptoms of anterior uveitis usually start over hours or days and usually only affect one eye at a time. [rnib.org.uk]
Anterior uveitis is the most common type of uveitis, affecting the iris and/or ciliary body. [oculispharma.com]
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. [pt.slideshare.net]
- Eye Pain
Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision. Most cases get better with treatment – usually steroid medicine. [nhs.uk]
Overview Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea). Uveitis (u-vee-I-tis) warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. [mayoclinic.org]
Mydriatic eye drops, such as atropine or cyclopentolate, dilate the pupil and help the eye to heal. It also helps with eye pain and stops the pupil from sticking to the lens. [medicalnewstoday.com]
- Visual Impairment
INTRODUCTION: Noninfectious posterior uveitis is a leading cause of visual impairment. Although conventional immunosuppressive agents have been successfully used, these are nonspecific and their long-term use may induce significant adverse effects. [ncbi.nlm.nih.gov]
At one year follow up, we found 9% of patients with visual loss, and 2 third of patients who had a follow-up of more than 10 years were visually impaired. In the group of eyes with AU, 15.4% developed visual loss. [iovs.arvojournals.org]
Overall, 55.3% of eyes had a good visual outcome at final follow-up, while 24.9% had moderate visual impairment and 19.8% had severe visual impairment at final follow-up. [dovepress.com]
Despite being an uncommon eye condition, uveitis is a leading cause of visual impairment in the UK. It's estimated that the more serious types of uveitis are responsible for one in every 10 cases of visual impairment in the UK. [moorfields.nhs.uk]
Visual impairment depends on the size and site of a scar – the nearer the scar to macula, the greater the damage. The disease lasts from several days to several weeks. The period between relapses lasts from several weeks to several years. [optometry-today.com]
- Conjunctival Injection
[…] may be required Possible sub-conjunctival injection of mydriatic Possible systemic immunosuppression Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org) Sources of evidence Huang JJ, Elia [college-optometrists.org]
Anterior segment examination of the left eye showed conjunctival injection and 2+ cells in the anterior chamber and minimal cells in the vitreous. Fundus examination did not demonstrate any changes from her previous exam. [springerplus.springeropen.com]
Recurrent uveitis is defined as repeat episodes occurring after three months of disease inactivity without treatment. 1 Most eyes with anterior uveitis display conjunctival injection, often associated with a blush of limbal vessels. [aafp.org]
Perilimbal vessel engorgement of the conjunctival and episcleral vasculature (ciliary flush) is a characteristic finding of anterior uveitis. Diffuse injection can also be seen. • Anterior chamber. [reviewofoptometry.com]
- Visual Acuity Decreased
However, thereafter the visual acuity decreases again. Cataract and elevated IOP are common side effects. [ncbi.nlm.nih.gov]
Visual acuity may be decreased. Extraocular movement: generally normal. [patient.info]
Neurologic
- Headache
Several months prior, she had reported non-specific symptoms of headache and diffuse skin rash. [ncbi.nlm.nih.gov]
The main symptoms are fever with biphasic temperature curve, headache, arthralgia, myalgia, and gastrointestinal disturbances [1,2,3]. [karger.com]
Initially, I was suffering with persistent headaches, which then became pain in my right eye. The next morning I awoke with a cloudy and slightly red eye. [iritis.org]
Signs & Symptoms Uveitis may present with one or more of the following symptoms: Headaches Reddening in the eye Pain in the eye – the eye may feel sore or tender, with the pain ranging from mild to severe. [essilor.ie]
- Confusion
Although this may sound confusing, the purpose of pointing this out is to explain that the term, Posterior uveitis is just one way of describing some forms of uveitis. Posterior uveitis, affects the back of the eye. [uveitis.net]
Much less commonly, retinitis pigmentosa can manifest with mild inflammation, which may be confused with uveitis. [msdmanuals.com]
Conversely, the outer retinal form of toxoplasmosis has minimal vitritis because it involves the deeper retinal layers with less spillover of inflammatory cells into the vitreous cavity. 10 Do not confuse these lesions with choroidal tubercles (small, [ophthalmologymanagement.com]
Workup
Workup ultimately revealed ocular syphilis, and neurosyphilis was additionally confirmed with cerebrospinal fluid studies. Treatment with intravenous penicillin was promptly initiated with complete visual recovery. [ncbi.nlm.nih.gov]
Designed for quick point-of-care reference, the book features numerous full-color photographs and bulleted how-to instructions for workup and treatment of each disorder. [books.google.com]
[…] of any suspected underlying systemic condition Ophthalmoscopic examination Leukocytes in the vitreous humor and vitreous opacity Foci of inflammation of the choroid and/or retina Further workup of any suspected underlying systemic condition Complications [amboss.com]
(eg, HIV, toxoplasmosis), depending on the presentation See Workup for more detail. [emedicine.medscape.com]
Colonoscopy
- Colitis
The most common causes: INFECTIONS: toxoplasmosis, tuberculosis, citerpesa simplex, syphilis SYSTEMIC CONNECTIVE TISSUE DISEASES: sarcoidosis, ulcerative colitis, pauciarticular rheumatoid arthritis, ankylosing spondylitis, Behcet’s disease, Reiter’s [optometry-today.com]
If a cause can be determined, it may be one of the following: Eye injury or surgery An autoimmune disorder, such as sarcoidosis or ankylosing spondylitis An inflammatory disorder, such as Crohn's disease or ulcerative colitis An infection, such as cat-scratch [mayoclinic.org]
[…] including: AIDS Ankylosing spondylitis Behcet’s disease CMV retinitis Herpes zoster infection Histoplasmosis Kawasaki disease Multiple sclerosis Psoriasis Reactive arthritis Rheumatoid arthritis Sarcoidosis Syphilis Toxoplasmosis Tuberculosis Ulcerative colitis [webmd.com]
Complications Cataract Secondary glaucoma Posterior synechia Anterior synechia Visual field loss due to scarring Major loss of visual acuity, if macula is affected Uveitis is often associated with HLA-B27 syndromes, such as Crohn disease, ulcerative colitis [amboss.com]
Treatment
One patient developed ocular and systemic tuberculosis, which responded to antituberculous treatment. Infliximab is effective in the treatment of sight-threatening refractory posterior uveitis. [ncbi.nlm.nih.gov]
Prognosis
With appropriate treatment, the prognosis is generally good. However, the condition can lead to permanent blindness if left undiagnosed or untreated Complications, such as glaucoma and cataract, can also worsen the prognosis. [dovemed.com]
In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. [ncbi.nlm.nih.gov]
The clinical characteristics and visual prognosis did not reveal statistically significant difference compared to the patients with anterior uveitis. [iovs.arvojournals.org]
Etiology
Introduction Uveitis represents a heterogeneous group of intraocular inflammatory diseases with a diverse set of infectious and noninfectious etiologies. [dovepress.com]
The diagnosis and treatment of the underlying systemic disease may be useful at the management of the visual and systemic complications Key Words: Pediatric üveitis, etiology, complication, treatment Keywords: pediatric üveitis, etiology, complication [journalagent.com]
Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. [ncbi.nlm.nih.gov]
Other causes for a focal retinitis include infectious etiologies such as toxoplasmosis, acute retinal necrosis, cysticercosis or onchocerciasis.[82–85] A history of immunosuppression should suggest unusual etiologies such as CMV, retinitis, or progressive [medscape.com]
Posterior Uveitis: Advances in Imaging and Treatment focuses on the ocular imaging modalities used in the diagnosis of various uveitis and intraocular inflammation entities resulting from infectious and non-infectious etiologies. [amazon.com]
Epidemiology
Nakae K, Masaki F, Hashimoto T, et al (1992) A nation-wide epidemiological survey on Behçet’s disease, report 2: association of HLA-B51 with clinico-epidemiological features. Report of Behçet’s Disease Research Committee. [link.springer.com]
From the *Department of Ophthalmology and the †Department of Medicine, The Johns Hopkins University School of Medicine, and the ‡Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. [journals.lww.com]
Uveitis epidemiology varies widely with geographic location; however, it remains a significant cause of vision loss throughout the world. [dovepress.com]
Epidemiology: This clinical syndrome is encountered frequently. Pathogenesis: The pathogen,Toxoplasma gondii, is transmittedby ingestionof tissue cysts in raw or undercooked meat or by oocysts from cat feces. [brainkart.com]
Vadot E (1992) Epidemiology of intermediate uveitis: a prospective study in Savoy. Dev Ophthalmol 23:33–34 PubMed 7. Tran VT et al (1994) Epidemiological characteristics of uveitis in Switzerland. Int Ophthalmol 18(5):293–298 PubMed CrossRef 8. [springermedizin.de]
Pathophysiology
[…] iris Etiology Vascular hypoxia (e.g., central retinal vein occlusion, central retinal artery occlusion, temporal arteritis) Neural diseases (e.g., diabetic retinopathy) Inflammatory (e.g., chronic uveitis) Neoplasms of the eye (e.g., uveal melanoma) Pathophysiology [amboss.com]
Pathophysiology As there are different forms of scleritis, the pathophysiology is also varied. Scleritis associated with autoimmune disease is characterized by zonal necrosis of the sclera surrounded by granulomatous inflammation and vasculitis. [eyewiki.aao.org]
Non-neoplastic: retinitis pigmentosa intraocular foreign body juvenile xanthogranuloma retinal detachment Neoplastic: retinoblastoma lymphoma malignant melanoma leukemia reticulum cell sarcoma Pathophysiology[edit] Immunologic factors[edit] Onset of uveitis [en.wikipedia.org]
Pathophysiology Autoimmune reaction (similar to Episcleritis and Scleritis ) Uveitis may occur in isolation or as part of a systemic inflammatory condition (see causes below) Diagnosis is as a result of spillover inflammation into the aqueous and vitreous [fpnotebook.com]
Prevention
There are no current guidelines to prevent posterior uveitis. [lahey.org]
Treatment Goals Symptom Relief – Pain, photophobia, blurred vision Prevent Visual Loss Prevent Complications 14. Treatment 1. [pt.slideshare.net]