Please do not prescribe emprical treatment for uveitits patient, this will mask the symptoms
كل تفكيري مع المريض ده في التشخيص الصح مش العلاج
Optic nerve may not be involoved in MS
Toxoplasmosis is a cause of retinal vasculitits
Affect retinal artery and veins
Vasculitis is a pathology of the wall
occlusion is a pathology of the lumen
ممكن يحصلوا مع بعض وممكن لا
Occulsion without inflammation may be BRVO
rare to see CRVO dt toxoplasmosis
Do not vitritis dt uninvolvement of the vitrous
Intermediate uveitis only can cause vitritis
You can say vitrous infiltration if it is not intermediate uveitis
Sarcoidosis is one of the causes of exudative vasculitits but not the only cause, TB is one of the causes
Sarcoidosis causes candle wax drippings
متحفظش أي حاجة في ال uveitis
المعلومة الرمادي اللي مش فاهمها فيها متشتغلهاش
Recurrent BRVO is Behcet disease till proved otherwise
Lecture 2
it is so hard to see normal choroid in a normal patient
Factors affecting the choroid:
Long term or short term
Long term: Myopic patient - thinning of the choroid due to overstretching of the layer to cope with the axial length
Short term:
Drinking water: increase the thickness
Drinking coffee: decrease the thickness
Smoking: Decrease the thickness
بلاش الحجات دي من 3 الي 4 ساعات قبل الفحص
We should exclude that before attributing any change in the thickness to the pathology Difference between Choroiditis and Retinitis: Choroiditis: Lesions are more yellowish Retinal vessels are uninterrupted lesions are well defined Retinitis: Lesions are more whitish Retinal vessels are interrupted Lesions are ill defined There is overlap sometimes: in deep retinitis, the retinal vessels are uninterrupted Choroiditis Lesions: one lesion - small: Focal Choroiditis 2 lesions or more- small : Multifocal Choroiditis 1 lesion - large : Geographic 2 lesions or more - large: Disseminated (TB- AIDS) Multifocal serbiginous Choroiditis : TB vitrous cells is not an indication of activity and absence of vitrous cells is not an indication of inactivity Birdshot Retinochoroidopathy usually misdiagnoesd with Harada 1 single pigmented lesion in the fundus exclude Birdshot Birdshot is lesions of the inferior and nasal quadrant Cream colored lesions not chalky white Lesions are oval, elongated, fusiform , ms form مهم جدا أوسع عين المريض للتشخيص
Laser - initial if poor compliance to medications, significat posterior TM pigmentations
Surgery - Initial if advanced
Other surgeries if the above ttt is not working:
medications:
Start with one type of drop in one eye
(Monocular therputic trail)
- Prostaglandin agonists
- beta blockers
- Selective alpha2 receptor agonists
- Topical CAI
-Miotics
- Sympathomimetics
-Systemic CAI
To reduce Systemic absorption;
Close the punctum
cloas the eyelid for a couple of minutes without blinking
Follow up:
-Reexamination: 4-6 weeks after medications and laser
- Close monitoring 1-3 days if damage is severe and IOP is high
- Once IOP is reduced - reevaluate 3-6 month for IOP and Optic n
-Gonioscopy yearly
-Dilated retinal exam - yearly
- VF and optic nerve imaging from -6 month
Trabeculectomy - Filtration surgery animation
SLT
Low pressure POAG (Normal pressure glaucoma) Normal IOP Greater liklihood of optic disc hge VF defects are denser, mora localized and closer to fixation dense nasal paracentral defect is typical Average CCT 510-50 microns IOP plays an important role in normal pressure glaucoma vascular dysregulation Work up: - History: vasospasm, hypotensive crisis, anemia, HD, corticosteroids use, trauma, uveitits, GCA, cardiovascular RF - Color plates -Gonioscopy - Obtain diurnal curve of IOP - Carotid dopplers to evaluate ocular blood flow - CT or MRI Treatment - lowering IOP - 30% lower than the level of the progressive damage.( the same therpies of POAG) - Managment of cardiovascular RF is benifical for general hralth but not for glaucoma. ( Avoid use of antihypertensive drugs at bedtime and use it in the morning) -Systemic CAI may improve the capillary perfusion for the optic nerve. Ocular HTN IOP >3 mmhg above the average (15 mmHg) normal apperaing AC angle normal gonioscopy normal optic nerve and VF
