Inflammation
- Function of immune system for defence and repair
- Inflammatory response to injury, irritation, infection
- Timeline: brief vasoconstriction, vasodilation, tissue repair and scarring
- Inappropriate inflammatory responses are hypersensitivity and inflammatory disease
Vasodilation
- Increased blood flow to the affected tissue
- Redness due to the increased blood flow
- Increase in temperature
How does inflammation occur and its affect
- Fluid escapes from the blood vessels
- Accumulates around the tissue= swelling
- Swelling stimulates sensory nerves= pain
- Oedema = swelling
Episcleritis
- Effects the outermost layer of the sclera
- Inflammation of the episcleral tissue
- Symptoms are acute onset, mostly unilateral, redness, mild discomfort, no pain, unaffected vision
- Signs are hyperima, vasodilation, increased blood flow, can be sectoral in a defined area
- Nodular episcleraitis: raised lumps at the area of hyperemia, conjunctiva buldges forward, displaces slit lamp beam
Scleritis
- Severe inflammatory disease of the sclera
- Stronger systemic association than episclertitis
- May be first sign of scleritis
Symptoms of scleritis
- 50% unilateral 50% bilateral
- Redness
- Pain: moderate to severe, interferes with sleep, worse on the eye movement and touch
- Effects vision
Watery eyes
Categories of scleristis
Anterior scleritis
- Necrotising
- Non-necrotising
Posterior scleritis
Non necrotising scleritis
Diffuse - without nodule, inflammation causing hyperaemia
Nodular - Characterised with the presence of a fixed nodule within the sclera
Necrotising scleritis
With inflammation - presence of hyperaemia and patches of avascular tissue indicating scleral necrosis
With inflammation - characterised by the presence of grey/purple plaque without hyperaemia, raising risk of globe perforation
Posterior scleritis
- 10% of the sclertis cases thorough management and evaluation required
- No redness
- Behind the orra seratta
- vision loss and disorientation
Diagnosis of scleritis
To distinguish between episcleritis and scleritis phenylephrine is used
- After using phenylephrine if the hyperaemia resolves its episcleritis
- If hyperaemia is consistent it is scleritis
- Also check VA as it effects scleritis
Management of episcleritis and scleritis
Episcleritis
- Reassure not sight threatening and will resolve in 1-2 weeks
- Caution recurrent disease
- Cold compressions to promote vasoconstriction
-Flannel soaked in cold water hold over closed eyes for 5 min 2 times min a day
- Artificial tears
- Routine referral on third episode
Scleritis
- Urgent referral to the ophthalmologist
- IP prescribes NSAID flurbiprofen 100mg
Uveitis components
- Uvea includes iris, ciliary body and choroid
- Anterior uvea: Iris and ciliary body
- Intermediate uvea: Cilliary body, anterior vitreous and peripheral retina
- Posterior uvea: Peripheral retina and retinal choroid
Anteiror uveitis
- Most cases are idopathic -no known cause
- Systemic association witch erthymatosis and inflammatory diseases
- Associated with ankylosing spobdylitis a disease which causes the inflammation of the spine, px experience back pain
Symptoms of anterior uveitis
- Generally unilateral
- Aching/ dull ache
- Sudden onset
- Recurrent disease
- Iris and cilliary body packed with photo receptors
- Pain and odema
- Pain amplified by eye movement near work and light
- Redness - vasodilation
- Reduced vision
- Lacrimation
Signs of anterior uveitis
- Hyperaemia
- Circulimbal flush
- Meiosis
- Aquesous cell- white blood cells deposited in the anterior chamber
- Aqueous flare - anterior chamber appears hazy, smokey glow
- Hypopyon - anterior chamber cells accumulate inferiporly at the inferior chamber
- Keratic percipitates - inflammatory cells adhere to the anterior chamber
Complications of anterior uveitis
- Posterior synechiae - abnormal attachment between the posterior iris and anterior lens, disrupts the flow of aqueous humour pupil block and raised iop
- Examine pupil margin carefully
- Measure IOP
Anterior uveitis and glaucoma
Secondary galucoma
Secondary angle closure glaucoma
- Posterior synache
- raised IOP
Secondary open angle glaucoma
- Reduced aqueous humour outflow
- Raised IOP
Intermediate uveitis
Inflammation of ciliary body, anterior vitreous and peripheral retinal choroid
Intermediate uveitis symptoms
- Reduced vision, gradual over a few days
- Floaters, sharp increase in the numbers of floaters
- Vitreous inflammation
Signsof intermediate uveitis
- Reduced vision, inflammatory debris
- Vitritis, accumulation of inflammatory cells in vitreous humour. Accumalation of flare protein
- Snowball, yellow fluffy collections of accumulation of inflammatory diseases
- Snow banking, white grey plaques
Posterior uveitis
Inflammation of peripheral choroid, retina and vitreous
Signs of posterior uveitis
- Reduced vision, inflammatory debris
- Vitritis, inflammatory cells in vitrous humour
- Chorotidis, multiple yellow fluffy patches
- Retnitis, indistinct fluffy patches
- Vasculitis- Inflammation around the retinal blood vesses
- Cystoid macular odema, accumulation of fluid in the retina, retinal oedema/ swelling
Management of uveitis
Uveitis, regardless of its type is a sight threatening conditon and should be treated promptly to prevent vision loss and complications
