Management of Traumatic Uveitis The frequency of uveitis in the United States matches international numbers at approximately 15 cases per , persons. Hyphema, if present, is a serious condition requiring close monitoring. Patients should avoid aspirin, but can take acetaminophen for pain as needed. Atropine 1. Oral aminocaproic acid, an antifibrinolytic, also should be administered, depending on the size of the hyphema.
Laboratory studies also should be considered for hyphema cases. Typical labs ordered include complete blood count CBC with differential, prothrombin time PT , partial thromboplastin time PTT , blood urea nitrogen BUN , creatinine, electrolytes, sickle prep and hemoglobin studies. IOP medications i.
Prostaglandins and miotics should be avoided, because they can add to the inflammatory effect. Angle recession is noted if there is an uneven iris insertion posteriorly, allowing a larger-than-normal band of ciliary body to be seen.
Angle recession does not always occur with blunt trauma, and——if present——does not always produce an elevated IOP at onset. However, microscopic damage to the trabecular meshwork endothelial cells is possible, with resultant IOP increase years after the initial trauma. Uveitis may present concurrently with other morbidities. Therefore, it is prudent to be thorough when examining a patient with anterior segment inflammation.
A methodical case history often can pinpoint the cause of the inflammation. Additionally, knowing what to look for during the slit lamp evaluation is imperative, so proper management and further diagnostic testing, if needed, can be instituted in an expedited manner. Iritis can range from mild to severe, with vision loss and even blindness occurring if left untreated. Most cases of iritis that present to the primary eye doctor are localized anteriorly, mild to moderate in severity and relatively simple to manage.
The prognosis generally is favorable with appropriate treatment and follow-up regimens; the pillars for proper management remain corticosteroids and cycloplegics. Bilateral and recurrent cases may need further investigation into the etiology. Overall, it is vital to educate patients about symptoms and the importance of future periodic eye examinations to monitor for complications.
He has no direct financial interests in any of the products mentioned. Yanoff M, Duker JS eds. Ophthalmology, 2nd ed. Louis: Mosby; Uveitis Classification. Accessed November 8, Harkins TJ. Personal communication. Aug-Dec Gold DH. Clinical Eye Atlas. Chicago: AMA Press; Iritis and Uveitis. Accessed November 10, Uveitis evaluation and treatment. Kunimoto DY. Kanski JJ. Clinical Ophthalmology: A Systematic Approach. London: Butterworth Heinemann; Eye Trauma.
Keil J, Chen S. Contusion injuries and their ocular effects. Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in your care. People with suspected COAG 1. People with COAG 1.
Discharge back to primary care 1. Treatment for people with suspected COAG 1. Treatment for people with COAG 1. Goldmann applanation tonometry slit lamp mounted standard automated perimetry central thresholding test central supra-threshold perimetry this visual field strategy may be used for monitoring OHT or suspected COAG when the visual field is normal stereoscopic slit lamp biomicroscopic examination of the anterior segment van Herick peripheral anterior chamber depth assessment examination of the posterior segment using slit lamp binocular indirect ophthalmoscopy.
Enhanced case-finding Enhanced community case-finding services use slit lamp mounted Goldmann-type applanation tonometry, dilated slit lamp indirect biomicroscopy and other tests deemed necessary by the healthcare professional. Hospital-based triage A hospital-based risk assessment shortly after referral.
Primary eye care professionals These include optometrists, GPs with a special interest in ophthalmology and community orthoptists. Referral filtering A general term for any type of accuracy checking before referral to hospital eye services.
Code Red: The Key Features of Hyperemia
Referral refinement A 2-tier assessment in which initial evidence of abnormality found during case-finding or screening is validated by an enhanced assessment, which adds value beyond that achieved through a simple 'repeat measures' scheme. Repeat measures The repeated measurement of parameters related to the diagnosis of glaucoma. Sight loss Sight loss in glaucoma is visual damage that manifests as blind spots in the field of vision. Sight test A sight test determines whether or not a person has a sight defect, and if so what is needed to correct, remedy or relieve it. Visual impairment A severe reduction in vision, which cannot be corrected with standard glasses or contact lenses and reduces a person's ability to function in a visual environment.
Control of IOP.
Acute anterior uveitis in primary care
Not detected or uncertain conversion 2. Conversion to COAG. Progression of COAG. Uncertain progression 2 or progression. No progression detected and low clinical risk. Comparative histopathologic presentation of the posterior section of the eyes at the end of study Day A Control untreated eye : The inflammation is severe and the photoreceptor layer is completely damaged.
More studies e.
Practical Pearls for Managing Anterior Uveitis
Considering a qualitative DEX vs. DSP and indirect comparison nonhuman primate vs. In summary, the ophthalmoscopic observations and histopathological examinations strongly indicate that the DSP-Visulex treatment was safe and well tolerated in the rabbit uveitis model. DSP-Visulex treatment regimens two applications on the first week and then weekly after were evaluated for safety and efficacy against daily prednisolone acetate eye drop PA for noninfectious anterior uveitis[ 54 ].
Patients self-administered the study eye drops 6 times daily through Visit 4, then tapered off.
Both safety and efficacy assessments were made at all visits. The safety parameters assessed were the incidence of treatment-emergent adverse events AEs , best-corrected visual acuity BCVA , intraocular pressure IOP , slit lamp biomicroscopy assessments, ophthalmoscopy assessments, and ocular pain. The patient characteristics regarding age, gender, and race were comparable among the three groups [ 54 ]. Moreover, the baseline characteristics were also comparable to larger phase III studies [ 54 , 56 ].
Code Red: The Key Features of Hyperemia
The percentages of patients with zero ACC count were comparable among all three treatment groups at the end of the study Figure 6A. The profiles of ACC clearing over the course of the study are similar among the three treatment groups Figure 6B.
The same trends were also observed with respect to ACF. Based on the criteria of the SUN working group on the short-term evaluation of a new therapy i. Majority of patients in all groups showed similar improvement in visual acuity i.