Uveitis: A Practical Guide to the Diagnosis and Treatment of Intraocular Inflammation PDF ebook Free
Uveitis: A Practical Guide to the Diagnosis and Treatment of Intraocular Inflammation PDF Download
By George N. Papaliodis (Editor)
- Paperback:371 pages
- Publisher:Springer; 1st ed. 2017 edition (February 4, 2017)
The term uveitis is broadly defined as inflam- mation of the uveal tract comprised by the iris, ciliary body, and choroid. In practice, this term has been more broadly applied to any inflam- matory state involving the interior of the eye including iritis, intermediate uveitis, pars planitis, vitritis, retinal vasculitis (phlebitis and arteritis), choroiditis, and papillitis. This area of ophthal- mology encompasses multiple pathologic pro- cesses that can induce aberrant or exuberant inflammation within the eye such as infections of the eye, autoimmune disorders, trauma to the eye, certain medications which can incite ocular inflammation, and rarely malignancies.
The practitioner in this realm must
- perform a careful history with review of systems as this can often lead to a differential diagnosis and direct subsequent investiga- tions. The adage that “if you listen to the patient, they will very likely give you their diagnosis” is more pertinent in this realm than practically any other in ophthalmology.
- examine the patients’ eyes CAREFULLY documenting: visual acuity, pupillary responses, extraocular muscle movements, confrontational or automated visual field testing, the areas of the eye with inflammation (anterior, intermediate, posterior), presence of cells and/or flare (quantified and characterized as granulomatous or non-granulomatous), iris pathology (transillumination defects, nodules, peripheral anterior synechiae, posterior syne- chiae), lens changes, intraocular pressure, clarity of the vitreous, appearance of the optic nerve and retinal vasculature, and choroidal pathology.
- examine other areas of the patient’s body for pertinent findings (joint swelling, rashes, heart murmur, etc.).
- evaluate the information obtained by history, review of systems, and physical exam to parsimoniously order supportive laboratory and radiographic studies. Every patient with uveitis does NOT require complete serologic testing and MRI of the brain/orbit.
- prescribe the most effective and least toxic medication to treat the ocular pathology. This may merely require the use of topical steroids for an episode of iritis or could necessitate intravenous Infliximab or cyclophosphamide for Adamantiades-Behçet’s associated retinal vasculitis. The decision of which medication to use should be evidenced based. Are there double-blinded, placebo controlled trials demonstrating safety and efficacy for this indication? If not, are there large cohort series or published reports in this realm? Addition- ally, the physician must be cognizant of the overall health of the patient and especially comorbidities when prescribing systemic medications