Download Free Medical Ocular manifestations of sarcoidosis PowerPoint Presentation

Ocular manifestations of sarcoidosis PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : This medical presentation titled "Ocular manifestations of sarcoidosis" gives definition, epidemiology, theories of pathogenesis, clinical manifestations, symptoms, complications, pathology, differential diagnosis, investigations, treatment, and prognosis of ocular sarcoidosis.

Tags : Ocular manifestations, sarcoidosis, definition, epidemiology, theories of pathogenesis, clinical manifestations, symptoms, complications, pathology, differential diagnosis, investigations, treatment, prognosis, ocular sarcoidosis, allergy, chronic multisystemic granulomatous disorder, noncaseating granuloma, acute, insidious respiratory problems

Published on : Apr 25, 2021 | Views : 3085 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

OCULAR MANIFESTATIONS OF SARCOIDOSIS Dr.Rajesh Babu B MS, FMRF, MSc (CEH) , DLSHTM, UK Consultant Uveitis & Ocular Immunology Ocular Epidemiology & Community Eye Health Narayana Nethralaya , Bangalore
Slide 2-

Ocular Sarcoidosis Definition Epidemiology Theories of pathogenesis Clinical manifestations Symptoms Complications Pathology Differential diagnosis Investigations Treatment Prognosis
Slide 3-

Definition Sarcoidosis is a chronic multisystemic granulomatous disorder of unknown etiology thought to result from an exaggerated cellular immune response to a variety of self antigens or non-self antigens that is characterized by its pathological hallmark, the noncaseating granuloma.
Slide 4-

The illness can be self-limited or chronic Episodic recrudescence and remissions. Because the lungs and thoracic lymph nodes are almost always involved, most patients report acute or insidious respiratory problems, variably accompanied by symptoms affecting the skin, eyes, or other organs.
Slide 5-

Epidemiology Sarcoidosis occurs worldwide. Affecting persons of all races, both sexes, and all ages. It has a particular proclivity for adults < age of 40 and for certain ethnic and racial groups (US blacks, Scandinavian and Irish white people). The lifetime risk of sarcoidosis for U.S. blacks is 2.4 percent, and that for U.S. whites 0.85 percent.
Slide 6-

Epidemiology The frequency of sarcoidosis is reported to be low in various parts of the world. It is not known whether this low frequency of sarcoidosis is genuine or whether it represents an underdiagnosis owing to the frequent occurrence of subclinical course, similarity with other diseases, or absence of firm diagnostic criteria.
Slide 7-

Etiopathogenesis The cause of sarcoidosis remains obscure for a number of reasons The heterogeneity of the manifestations of the disease The lack of a precise definition Clinical overlap with other disorders and insensitive and nonspecific diagnostic tests that lead to misclassification of the disease . Mycobacterium remain leading suspects. Transmission after cardiac /bone-marrow transplant has been reported Almenoff PL, Johnson A, Lesser M, Mattman LH. Growth of acid fast L forms from the blood of patients with sarcoidosis. Thorax 1996;51:530-533. Burke WMJ, Keogh A, Maloney PJ, Delprado W, Bryant DH, Spratt P. Transmission of sarcoidosis via cardiac transplantation. Lancet 1990;336:1579-1579. Heyll A, Meckenstock G, Aul C, et al. Possible transmission of sarcoidosis via allogeneic bone marrow transplantation. Bone Marrow Transplant 1994;14:161-164.
Slide 8-

Theories of pathogenesis The diverse manifestations of this disorder help fuel the prevailing hypothesis that sarcoidosis has more than one cause, each of which may promote a different pattern of illness.
Slide 9-

Theories of pathogenesis Conceptually, it appears likely that Genetically predisposed hosts are exposed to antigens that trigger an exaggerated cellular immune response and the formation of granulomas.
Slide 10-

PATHOLOGICAL AND IMMUNOLOGIC FEATURES Non-caseating granuloma holds the key to the diagnosis of sarcoidosis and provides clues to the immunopathogenesis of the disease.
Slide 11-

Clinical Manifestations Can be widespread or may involve only one organ system at a time. Two peaks of incidence - the first at ages 20–30 years and the second at ages 50–60 years. Ocular involvement manifests in 25%–60% of patients with systemic sarcoidosis. Albert DM, Jakobiec FAHunter DG, Foster CS(1994) Ocular manifestations of sarcoidosis. in Principles and practice of ophthalmology . eds Albert DM, Jakobiec FA(WB Saunders, Philadelphia), pp 443–450.
Slide 12-

Symptoms The majority of patients, however, present with systemic symptoms such as fatigue, anorexia, weight loss, and fever . Many report dyspnea on exertion, retrosternal chest pain, and cough . This may precede of come many months and years later. Ocular symptoms related to chronic granulomatous uveitis Lid nodules, conjunctival injection and nodules, rarely proptosis
Slide 13-

Symptoms In 20 to 50 percent of the patients with more acute presentations, one sees the constellation of Erythema Nodosum Bilateral hilar lymphadenopathy Polyarthralgias, known as Löfgren's syndrome. Parotid involvement with uveitis is called Herfordt syndrome.
Slide 14-

Examination findings Ophthalmic lesions develop in approximately 25 percent of patients. The classic symptom of anterior uveitis has a rapid onset, with blurred vision, photophobia, and excessive lacrimation; it usually clears spontaneously within a year. Conjunctival involvement with small, pale, yellow nodules is common.
Slide 15-

The most common ocular manifestations are uveitis (30%–70%) and conjunctival nodules (40%) More than 80% of uveitis cases manifested before or within 1 year after the onset of systemic disease.
Slide 16-

RIGHT EYE DIFFUSE MUTTON FAT KERATIC PRECIPITATES AQUEOUS FLARE ++ AQUEOUS CELLS ++ FIBRIN PRESENT IRIS NODULES LENS CLEAR NO VITREOUS REACTION
Slide 17-

Multiple koeppe’s and bussaca nodules
Slide 18-

CONJUNCTIVAL NODULES Conjunctival involvement has been reported in 6.9 - 70% of patients with ocular sarcoidosis Sarcoidosis granulomas are described as solitary, yellow "millet-seed" nodules.
Slide 19-

Posterior segment manifestations Intermediate Uveitis
Slide 20-

Posterior segment manifestations Active sarcoid granulomas Disc edema
Slide 21-

Complications The clinical impact of sarcoidosis is directly related to the extent of granulomatous inflammation and its effect on the function of vital organs. Specimens should be obtained from the most readily accessible organ with the least invasive method.
Slide 22-

Complications The clinical impact of sarcoidosis is directly related to the extent of granulomatous inflammation and its effect on the function of vital organs. Specimens should be obtained from the most readily accessible organ with the least invasive method.
Slide 23-

Pathology Small focus of necrosis. The most common appearance of necrosis in sarcoidosis
Slide 24-

Rather like a rugby scrum with all the players grouped around the ball; only with sarcoidosis the ball is invisible.
Slide 25-

Small focus of necrosis
Slide 26-

Granulomas involving a bronchiole
Slide 27-

Angiotensin converting enzyme (ACE) ACE is normally present in the vascular endothelium of many organs (lung, kidney, small intestine, uterus, prostate, thyroid, testes, adrenals) and in macrophages. The macrophages accounts for elevated ACE levels in patients with sarcoidosis. ACE is elevated in 60-90% of patients with active sarcoidosis. A normal serum ACE does not exclude the diagnosis, especially if the disease is in its early stages, localized to a small area (e.g. the eye), and therefore with a small epithelioid cell "burden".
Slide 28-

False low values of ACE Patients taking ACE inhibitors Endothelial abnormalities, such as deep vein thrombosis Patients who have had chemotherapy or radiation. Treatment with systemic steroids or other immunosupressive agents can also affect ACE levels with values normalizing with adequate control of intraocular inflammation.
Slide 29-

Elevated serum ACE Gaucher's disease Leprosy Chronic pulmonary disease Rheumatoid arthritis Spondylitis Primary biliary cirrhosis Tuberculosis Histoplasmosis Histiocytic medullary fibrosis Hyperthyroidism Diabetes mellitus.
Slide 30-

Differential diagnosis Any cause of chronic granulomatous diseases Tuberculosis Syphillis Herpetic uveitis Lymphoma Metastases
Slide 31-

Investigations In the absence of a known causative agent, sarcoidosis remains a diagnosis of exclusion. There are no definitive diagnostic blood, skin, or radiologic imaging tests specific for the disorder. Even serum ACE and galluium 67 Scan s are not specific to Sarcoidosis Gold standard is demonstration of non caseating granulomas from tissue .
Slide 32-

Investigations CBC, ESR Mantoux test Chest X Ray Serum ACE levels Lymph Node Biopsy Broncheo Alveolar Lavage Trans Bronchial Lung Biopsy Other tests TPHA Sputum for AFB Gallium 67 Scan
Slide 33-

Gold standard In most centers, skin and transbronchial lung biopsies have supplanted biopsy of mediastinal lymph nodes and the liver because of their high yield, greater specificity, and low morbidity.
Slide 34-

Radiographic Staging of Pulmonary Sarcoidosis Using Conventional Chest Radiography Lungs and thoracic lymph nodes are affected in 90% of patients with sarcoidosis Clinical staging is based on the pattern of chest radiographic findings:
Slide 35-

Stage 0--No abnormality is defined.
Slide 36-

Bilateral hilar lymphadenopathy (BHL),stage 1
Slide 37-

Stage 1- Hilar and paratracheal adenopathy without parenchymal involvement. Bilateral hilar adenopathy is most common, followed by adenopathy in the right paratracheal area or aortopulmonary window area on the left.
Slide 38-

BHL with parenchymal infiltrates, stage II
Slide 39-

Bilateral hilar adenopathy with Mild interstitial disease in upper lobes.
Slide 40-

Stage 2-Adenopathy with parenchymal involvement. The parenchymal involvement includes a diffuse accentuation of interstitial markings resulting in a reticular pattern.
Slide 41-

Sarcoidosis (with progression from stage II to stage III)
Slide 42-

Parenchymal infiltrates, stage III
Slide 43-

Signs of fibrosis with shrinkage, stage IV.
Slide 44-

CT showing bilateral nodular infiltrates along bronchovascular bundles and enlarged mediastinal lymph nodes
Slide 45-

Treatment The optimal therapy for sarcoidosis is not well defined; therapeutic decisions are dictated by the localisation of the disease and severity of organ involvement. The mainstay of treatment is corticosteroid therapy, which exhibits especially short term beneficial effects.
Slide 46-

Treatment Steroid sparing drugs for longer term treatment Methotrexate 10-22.5mg/week Cyclosporin B 3-5 mg/kgBW/day Azathioprine 1-3mg/kgBW BID/TID
Slide 47-

Local Treatment Topical Prednisolone acetate eye drops Peri-ocular Posterior subtenons triamcinolone acetonide Dexamethasone implant in very severe recurrent cases
Slide 48-

Prognosis The poor visual prognosis was associated with the advanced age of the patients, black race, female sex, chronic systemic disease, and also with posterior segment involvement, peripheral punched out lesions, and the presence of cystoid macular oedema and glaucoma. CME is leading cause of visual loss in sarcoid patients
Slide 49-

Thank You drrajeshbabu@yahoo.com