Uveitis and Glaucoma Overview

Uveitis

Pathophysiology

• Inflammation of the uveal tract (iris, ciliary body, choroid), causing pain, photophobia, and possible visual disturbance.

• Can be anterior (iritis), intermediate, or posterior; severity varies.

Management

1. Cycloplegic Drops:

   • Atropine: Relieves pain by preventing ciliary spasm, also prevents synechiae formation.

   • Phenylephrine: Mydriatic only, less common alone.

2. Topical Steroids:

   • Prednisolone 1% eye drops after infection is excluded.

   • Reduces inflammation; risk of raised IOP with prolonged use.

3. Referral:

   • Urgent ophthalmology if suspect uveitis → need slit-lamp exam, possible systemic workup (autoimmune/infectious causes).

Glaucoma

Risk Factors

• Age >60, family history, increased IOP, diabetes, hypertension, high myopia, trauma, African/Asian ancestry.

Acute Angle-Closure Glaucoma Management

Position

• Lay the patient flat (improves optic nerve perfusion, though some sources advise head slightly elevated; this can vary).

Symptom Control

• Morphine for severe pain

• Ondansetron for nausea

IOP Reduction

1. Beta-Blocker: Timolol 0.5% → ↓ aqueous humour production (contraindicated in asthma, heart block).

2. Alpha-2 Agonist: Apraclonidine 1% → ↓ production, ↑ outflow of aqueous humour.

3. Cholinergic (Miotic): Pilocarpine 2% → pulls iris away from trabecular meshwork, ↑ outflow (works better after initial IOP reduction).

4. Carbonic Anhydrase Inhibitor: Acetazolamide 500 mg IV or oral → ↓ aqueous humour production.

Referral

• Urgent ophthalmology for possible laser iridotomy or surgical intervention to definitively open drainage angle.

Key Notes

• Uveitis: Must exclude infection (herpetic, etc.) before using topical steroids; rapid referral to ophthalmologist crucial to prevent complications (e.g., synechiae, vision loss).

• Glaucoma: Timely IOP reduction is critical to preserve optic nerve function. Delay can cause irreversible vision loss.