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Ophthalmology Case: Uveitis Analysis

A 43-year-old male presented with redness and pain in both eyes for 3 months and diminishing vision in both eyes for 1 month. On examination, he was found to have multiple mutton fat keratic precipitates in both eyes with mild haze and absent foveal reflex. He was diagnosed with recurrent bilateral granulomatous anterior uveitis. Differential diagnoses included tuberculosis, sarcoidosis, leprosy, syphilis, VKH, and toxoplasmosis. He was started on topical and oral steroids along with antibiotics and further investigations were advised.

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Sadyaja Smita
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121 views14 pages

Ophthalmology Case: Uveitis Analysis

A 43-year-old male presented with redness and pain in both eyes for 3 months and diminishing vision in both eyes for 1 month. On examination, he was found to have multiple mutton fat keratic precipitates in both eyes with mild haze and absent foveal reflex. He was diagnosed with recurrent bilateral granulomatous anterior uveitis. Differential diagnoses included tuberculosis, sarcoidosis, leprosy, syphilis, VKH, and toxoplasmosis. He was started on topical and oral steroids along with antibiotics and further investigations were advised.

Uploaded by

Sadyaja Smita
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

CASE

PRESENTATION
PRESENTER- Dr SADYAJA SMITA
UNDER GUIDANCE OF- DR. ABHA SHUKLA
PATIENT DETAILS

• Name: Ramwaran s/o Roopkishor

• Age/Sex: 43 years/Male

• Address: BHIND,Gwalior

• Occupation: Shopkeeper
PRESENTING COMPLAINTS

• C/o redness and pain in both eye 3 months back

• C/o Dimunition of vision in both eyes since 1 month


HISTORY OF PRESENTING ILLNESS

• The patient presented in our opd with redness in both eye 3 months back
which was acute in onset and gradually progressive in nature associated
with watering in both eye which was relieved on medication.

• The patient developed diminution of vision in both eyes since 1 month


which is insidious in onset, gradually progressive and not associated with
floaters, micropsia, macropsia, metamorphopsia, photopsia,
dyschromatopsia, or nyctalopia.
PAST HISTORY

•h/o rta 6 yrs back when he underwent surgery for right tibia fracture

•c/o back stiffness since 4 years

•No c/o flu like illness, chronic cough, shortness of breath, oral or genital
ulceration, burning micturition, skin lesions, significant weight loss,
chronic diarrhea, tinnitus, or vertigo.

•The patient did not give any history of previous ocular trauma, ocular
surgery, or any history of intake of immunosuppressants, or i/v drug
abuse.
MEDICAL HISTORY

• Not a k/c/o hypertension, diabetes mellitus, tuberculosis, bronchial asthma,


epilepsy.
PERSONAL HISTORY

• The patient denied any history of close contact with animals, bathing in the river,
or consuming uncooked meat.

FAMILY HISTORY

• No history of similar illness in the family.


On Examination

• The patient was well oriented to time, place and

person; had average built and stature with normal

appearance.

• All the vitals of the patient were within normal

limits.

• No signs of pallor, icterus, cyanosis, clubbing,

lymphadenopathy, pedal edema


RIGHT EYE LEFT EYE
VA 6/36 PH 6/12 6/24 PH 6/12
Orbit Normal Normal
Lids Normal Normal
Position Primary Primary
Movements of the globe Full Range Full range
Conjunctiva Normal NASAL PTERYGIUM GRADE 2
Sclera White White
Cornea MILD HAZY, sensations normal MILD HAZY, sensations normal
AC NID NID,
Pupil CCRL+ CCRL+
Lens Opacity 1+ Opacity1+
IOP BE 16 mm Hg with GAT (10/07/20 at 10 AM)
SLIT LAMP EXAMINATION
• BE- MULTIPLE MUTTON FAT KPs in arlt’s
triangle
• AC cells grade 2
• Aqueous flare grade 1
• Koeppes nodule on pupillary border
OD OS
FUNDUS EXAMINATION
BOTH EYE- Red glow seen. Media mild hazy(vitreous haze
grade 2), Disc- size, shape, colour - normal, margins normal,
general fundus –mild tessalation, vessels in general fundus-
normal Foveal reflex absent.
Probable Diagnosis- RECURRENT BILATERAL
GRANULAMATOUS ANTERIOR UVEITIS

DIFFERENTIAL DIAGONOSIS
TUBERCULOSIS
SARCOIDOSIS
LEPROSY
SYPHILLIS
VKH
TOXOPLASMOSIS
TREATMENT GIVEN
• E/D MOXIFLOXACIN+DEXAMETHASONE 6 TIMES A DAY
• E/D HOMATROPINE TWO TIMES A DAY
• E/D CMC 4 TIMES A DAY
• TAB prednisolone 40mg tapered in 5 days
• TAB MVBC ONCE A DAY
Investigations

• Blood investigations- CBC, ESR, CRP,RA FACTOR

• SEROLGY- VDRL, SEUM ANCA, SEUM ACE

• MONTOUX TEST, CBNAAT , INTERFERON GAMMA ESSAY

• Radiological investigations-CHEST XRAY, SACRO-ILIAC JOINT XRAY

• Immunoassay/HLA- HLA-B27 TYPING

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