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x Patologie Uvee

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    UVEITELE ANTERIOARE

    Inflamatia irisului=IRITA iar inflamatia

    corpului ciliar = CICLITA. De obicei lele

    evolueaza concomitentIRIDOCICLITE.

    Simptome subiective:

    1. DURERI OCULARE2.FOTOFOBIE, LACRIMARE,

    BLEFAROSPASM

    3.VEDERE INCETOSATA

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    SEMNE OBIECTIVE

    1.CONGESTIE CONJUNCTIVALAPERIKERATICA

    2.EDEM CORNEEAN ENDOTELIAL

    3.MIOZA sau IREGULARITATE

    PUPILARA

    4.PRECIPITATELE RETROCORNEENE-celule inflamatorii localizate pe fata

    posterioara a corneei.

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    5.EXUDATE IN CAMERA ANT cu

    aspect de fulgi de nea.

    PurulenteHemoragice

    Fibrinoase

    6.TULBURAREA UMORII

    APOASE

    in functie de tipul exudatelorprezente.

    7.ALTERAREA RELIEFULUI SI

    CULORII IRIENE

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    DIAGNOSTIC DIFERENTIAL

    -CONJUNCTIVITE

    -GLAUCOM ACUT

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    ETIOPATOGENIE

    Uveitele anterioare endogene apar

    in cadrul unei boli manifeste sau latentece afecteaza organismul respectiv

    1. Boli infectioase cronice (tbc.lues)

    2. Infectii de focar

    3. Boli de colagen (les,pr)

    4. Boli SN5. Boli de piele (acnee rozacee,eritem

    nodos)

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    6. Boli reumatismale degenerative

    7. Sarcoidoza

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    FORME CLINICE

    -d.p.d.v evolutiv *acute

    *subacute

    *cronice-d.p.d.v anatomo-patolgic:

    *difuze-negranulomatoase

    *nodulare-granulomatoase

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    COMPLICATII-propagarea lor in intreaga uvee

    -panuveite/ panoftalmie

    -sinechiile iriene

    -glaucomul secundar

    - cataracta complicata-atrofia progresiva a G.O.

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    TRATAMENT

    Local- midriatice

    - antibioticeinstilatii sau inj.subconjunctivale sau parabulbare

    - cortizoninstilatii sau inj.subconjunctivale sau parabulbare

    General - Antiinflamator

    - Antibiotic

    - Acetazolamida in

    uveitele hipertensive

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    Iridociclita acuta

    http://images.google.ro/imgres?imgurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/toxoplasma_chorioretinitis.jpg&imgrefurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/clinical_symptoms.htm&h=158&w=193&sz=7&hl=ro&start=10&tbnid=cDl8wCIr-XnWqM:&tbnh=84&tbnw=103&prev=
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    Uveita anterioara cu sinechii

    cronice posterioare

    http://images.google.ro/imgres?imgurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/Chorioretinitis.jpg&imgrefurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/uveitis.htm&h=178&w=248&sz=62&hl=ro&start=4&tbnid=WMibR3O7B-e20M:&tbnh=80&tbnw=111&prev=
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    Precipitate

    http://images.google.ro/imgres?imgurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/toxobilat.jpg&imgrefurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/uveitis.htm&h=198&w=482&sz=130&hl=ro&start=34&tbnid=HgDSgVcPWXjD9M:&tbnh=53&tbnw=129&prev=
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    UVEITELE POSTERIOAREcand procesul inflamator afecteaza

    coroida vorbim despre uveita posterioara

    sau coroidita.

    COROIDITELE EXOGENEse datoreaza patrunderii agentului

    patogen in interiorul ochiului printr-o

    plaga perforanta accidentala sauchirurgicala.

    - stafilococ, streptococ,

    pseudomonas, pneumococ, escherichia

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    Tablou clinic

    SEMNE SUBIECTIVE

    - durere ocularaaccentuata la palpare sila miscarile globului ocular

    SEMNE FUNCTIONALE

    - scaderea acuitatii vizualeSEMNE OBIECTIVE

    - edem si spasm palpebral

    -congestie ciliara accentuata-plaga (daca exista) cu buze infiltrate

    -hipopion

    -sinechii posterioare, exudat pupilar

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    Evolutie:

    a) spre vindecare sub tratament

    b) subacut complicandu-se cu secluzie- ocluzie

    pupilara

    c) spre panoftalmie dureri vii

    chemozis ce herniaza

    printre pleoapecornee tulbure

    hipopion abundent

    exudat galbui in pupilavitros cu reflex galbui, nu

    se vizualizeaza fundul de ochi

    glob ocular dur, exoftalm

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    Tratament:

    Local: -antibioatice cu spectru larg-midriatice

    General: -antibiotice in doze mari

    -antalgice, sedative, AINS

    Chirurgical in cazul panoftalmiei in care

    ochiul e pierdut functional si dezorganizat

    anatomic. Se recomanda evisceratia.

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    COROIDITELE ENDOGENE

    I. COROIDITE EXOGENE

    NESUPURATIVE

    Etiopatogenia:

    apar prin mecanism autoimun, alergic.

    Cea mai frecventa cauza-TOXOPLASMOZA

    Tablou clinic:

    - senzatia de muste zburatoare

    - metamorfopsii

    - scaderea AV

    - scotoame

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    - Ochiul este alb fara congestie

    conjunctivala- flocoane in vitros = exudate inflamatorii

    FO: noduli albi galbui cu contur sterszone alb galbui marginite sau

    presarate cu pigment negru peste care

    vasele retiniene trec nemodificate. Acestaspect indica o leziune cicatricealasi se

    datoreaza atrofiei coroidiene

    http://images.google.ro/imgres?imgurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/toxoplasma_chorioretinitis.jpg&imgrefurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/clinical_symptoms.htm&h=158&w=193&sz=7&hl=ro&start=10&tbnid=cDl8wCIr-XnWqM:&tbnh=84&tbnw=103&prev=http://images.google.ro/imgres?imgurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/Chorioretinitis.jpg&imgrefurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/uveitis.htm&h=178&w=248&sz=62&hl=ro&start=4&tbnid=WMibR3O7B-e20M:&tbnh=80&tbnw=111&prev=
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    http://images.google.ro/imgres?imgurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/toxobilat.jpg&imgrefurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/uveitis.htm&h=198&w=482&sz=130&hl=ro&start=34&tbnid=HgDSgVcPWXjD9M:&tbnh=53&tbnw=129&prev=http://images.google.ro/imgres?imgurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/toxoplasma_chorioretinitis.jpg&imgrefurl=http://www.foodsafety.no/Skjerve/Platform_Toxoplasma_Risk_Assessment/clinical_symptoms.htm&h=158&w=193&sz=7&hl=ro&start=10&tbnid=cDl8wCIr-XnWqM:&tbnh=84&tbnw=103&prev=http://images.google.ro/imgres?imgurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/Chorioretinitis.jpg&imgrefurl=http://medweb.bham.ac.uk/easdec/eyetextbook/Uveitis/uveitis.htm&h=178&w=248&sz=62&hl=ro&start=4&tbnid=WMibR3O7B-e20M:&tbnh=80&tbnw=111&prev=
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    Tratament:

    - antiinfectios local si general- antiiflamator

    - antialergic

    Complicatii:

    - cataracta complicata subcapsulara

    posterioara- pierderea nervului optic realizan o

    neurocorioretinita

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