Corneal, uveal tract, endophthalmitis and glaucoma. Pay attention!!

Keratitis inflamed usually due to infection. Pathogens: amoebic, bacterial, fungal and viral. Commonest = viral (HSV type 1) Herpes Simplex Keratitis

May triggered by stress, fever, sun exposure, immunosuppression. Features: Pain, tearing, foreign body sensation, redness. May have reduce vision and eyelid edema. Dendritic lesion in epithelium stains with fluorescein. Complications: Corneal scarring, chronic interstitial keratitis due to penetration of virus into stroma and secondary iritis. Treatment: topical antiviral = trifluridine. Systemic = acyclovir Dendritic debridement. Initially, no steroids!! may exacerbate condition.

Uveitis may involve all, or one part. Assoc. with autoimmune, infectious, granulomatous, malignant. Anterior uveitis inflammation of iris (iritis), usually accompanied by cyclitis (ciliary body inflamed) iridocyclitis. Usually, unilateral. Posterior uveitis choroiditis.

Aetiology: usually idiopathic. CT diseases (Reiters syndrome, AS, IBD, psoriasis and JRA). Infectious: syphilis, lyme disease, TB. Other: sarcoidosis, trauma, post ocular surgery. Features: photophobia, ocular pain, tenderness, brow ache, reduced acuity, ciliary flush, miosis. Occasionally, keratitic precipitates (clumps of cells on corneal epithelium) Iritis reduces IOP because ciliary body inflammation causes decreased aqueous production.

Complications: inflammatory glaucoma, posterior synechiae, cataracts, peripheral anterior synechiae (PAS) If chronic band keratopathy (corneal calcified) and macular edema. Treatment: mydriatics dilate pupil to prevent formation of posterior synechiae and ciliary spasm Steroids (topical/systemic), systemic analgesia and Ix to determine aetio.

Aetiology: bacterial, viral, fungal, parasitic (toxoplasmosis; the most common), autoimmune, immunosuppression, malignant. Features: painless (choroid has no sensory), reduce acuity, floaters, opacities and hypopyon formation Treatment: steroids retrobulbar or systemic if indicated (threat of vision loss)

Inflammation of the intraocular cavities (aqueous/vitreous)

Aetiology: Infectious is the most common (fungal and bacteria). Other: penetrating trauma, retained intraocular foreign body and post operative.
Features: very painful, red eye, photophobia, discharge, severely reduce visual acuity, lid edema, proptosis, corneal edema, hypopyon, reduce red reflex. Treatment: Ocular emergency immediate vitrectomy and intravitreal AB to prevent loss of vision. For ALL vitreous tap, culture and respective AB.

Progressive optic neuropathy (damage to optic nerve head) Associated with HIGH IOP.

Primary open and close angle glaucoma Secondary trauma, surgery, diseases (cataract, uveitis), steroids. Congenital iridocorneal angle developmental abnormality, maternal rubella. Special Normal tension glaucoma (normal IOP) and ocular hypertension (high IOP but no glaucomatous field/cupping of optic disc)

Aqueous produced by ciliary body from post. Chamber ant. Chamber through pupil via trabecular meshwork and Schlemm canal. High IOP = ocular hypertension. Average is 15 3 mmHg. Risk 10% if 20-30 mmHg, 40% if 30-40 mmHg. Normal C:D ratio <0.4, suspicious if > 0.6 Hence, start with increase IOP increase C:D ratio visual field loss.

Obstruction aqueous drainage within trabecular meshwork and its drainage into the schlemm canal. Asymptomatic Features: initially asymptomatic, painless, rise IOP, optic disc changes (CD ratio), flame shape disc hemorrhage, peripheral follow by central (late and untreated).

Treatment: decrease IOP to decrease IOP/increase outflow. Mx: prostaglandin analogue (latanoprost), beta blocker (timolol), parasympathomimetic (pilocarpine) and carbonic anhydrase inhibitor (acetazolamide). Laser trabeculoplasty or trabeculectomy.

Iris bunch up (response to pupil dilatation) and block the meshwork. Can be acute and chronic. Features: Painful red watery eye, loss of vision, headache, nausea and vomitting, hazy cornea, halo around lights, fix dilated pupil. Treatment: Mx: acetazolamide, pilocarpine and timolol. Sx: laser iridotomy/iridectomy by YAG laser. IMMEDIATE treatment important to preserve vision and prevent adhesion of peripheral iris to trabecular meshwork.