Anterior Chamber granuloma
By Dr.Gehad Elnahri
AC granuloma on topical steroids/cycloplegics for 3 weeks in an unusual 30yrs old
Today we gave our recommended therapy rimactazide/flagyl for 3 weeks
Lets wait and see.
Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.
Anterior uveitis is the commonest form of intraocular inflammation with a varying incidence in the general population of various countries around the world. The potential severe consequences of recurrent or untreated anterior uveitis are probably underestimated. Anatomically, anterior uveitis involves inflammation of the iris alone (iritis), anterior part of ciliary body (anterior cyclitis) or both structures (iridocyclitis). It is commoner than posterior segment inflammation and is generally less sight-threatening and less serious, especially if treated early. Anterior uveitis normally causes reduction in the vision during the acute stage but it is the sequelae of anterior uveitis which can have long-lasting impact. The purpose of the present article is to highlight the diagnosis of anterior uveitis and its various subtypes and to outline management strategies for each. Detailed medlars search was carried out to review the articles and case reports on anterior uveitis. The methods used to collect/select evidence were hand-searches of published literature (primary sources) and searches of electronic databases. The current guidelines for diagnosis and management of anterior uveitis are based on the literature search using the National Library of Medicine’s Medline database and the Vision Net database.
The uveitis was classified in different ways. Classification based on the duration of uveitis was based on Standardization of Uveitis Nomenclature (SUN) criteria in which anterior uveitis was classified as limited (less than or equal to three months duration) and persistent (more than three months). Based on the course of uveitis, anterior uveitis was classified as acute anterior uveitis with episodes of sudden onset and limited duration, recurrent anterior uveitis with repeated episodes separated by periods of inactivity without treatment ≥ three months in duration, and chronic uveitis which persists and relapses in less than three months after discontinuing treatment. Based on etiology anterior uveitis was classified as infectious (such as viral, bacterial, fungal or protozoal), autoimmune with only ocular involvement or with systemic disease association or presenting as masquerade syndrome. Anterior uveitis with other etiologies can be post-traumatic, post-surgical, lens-induced and drug-induced. Pathologically anterior uveitis was classified as granulomatous or non-granulomatous based on the nature of keratic precipitates.