Keratic precipitate

Figure 9.7 Mild anterior uveitis. Collections of macrophages (keratic precipitates) can be seen on the endothelial surface of the cornea (arrowheads).

Epithelial bullae can be found in some cases of disciform keratitis, as can a Wessley ring, which is composed of immune cells surrounding the discoid edema.A mild to moderate uveitis with keratic precipitates is usually present, although it may not be visible due to corneal edema. Secondary glaucoma can also develop, primarily the result of intraocular inflammation (trabeculitis). 

Deep corneal edema with folds in Descemet s membrane, in the presence of an intact epithelium, can develop from 3 to 4 months after acute HZO. This disciform keratitis may involve the full thickness of the cornea and may be surrounded by a ring-like cellular infiltrate called a Wessley ring. It is considered to be an immune response to viral antigens and responds quickly to topical steroids, especially when initiated early. Unfortunately, it is common to have recurrences when steroids are tapered or discontinued and can lead to corneal scarring or, more seriously, corneal melt.There is often an associated anterior uveitis with keratic precipitates as well as diffuse corneal edema, endothelial cell loss, and increased lOP secondary to trabeculitis. 

Clinical features of ARN must include (1) focal well-demarcated areas of retinal necrosis located in the retinal periphery, (2) rapid circumferential progression of necrosis, (3) evidence of occlusive vasculitis, and (4) moderate to severe anterior chamber and vitreal inflammation. Mild presentations may manifest low-grade anterior chamber inflammation with or without blurred vision, whereas severe cases may include episcleritis, scleritis, and pain on eye movement. Early clinical findings include anterior and posterior uveitis, keratic precipitates, and presence of vitreous cells. Within several days to weeks, the patient develops dramatic progressive retinal whitening in multifocal and confluent patches, vasculitis of both retinal arteries and veins, and possible optic nerve head... 

Rapid loss of temporal eyebrow and eyelashes, and ocular puffiness have been recognized as early clinical signs of hypothyroidism since the nineteenth century. Eyelid puffiness may be related to deposition of myxedematous tissue in the eyefid. Cataracts, corneal changes (edema, keratic precipitates, opacities) and iritis have also been described (see Mahto, 1972 for actual case descriptions). 

Uveitis is the most common ocular manifestation of sarcoidosis in most series (4,5). Anterior uveitis occurs in 20% to 70% of patients with ocular sarcoidosis (4—6) and typically presents as an iritis or iridocyclitis (1,7). Symptoms include blurred vision, red eyes, painful eyes, and photophobia. However in one-third of patients, the patient may present without ocular symptoms. Therefore, all sarcoidosis patients require a slit-lamp and fundoscopic examination regardless of the presence of ocular symptoms. The slit-lamp examination may reveal mutton-fat keratic precipitates (Fig. 1), which are aggregates of inflammatory cells in the comeal epithelium (1,7). Other lesions of anterior sarcoid uveitis that may be seen with a slit lamp include Busacca nodules on the iris (Fig. 2) and Koeppe nodules on the papillary margin (8). Both these nodules are almost exclusively found when anterior sarcoid uveitis is a chronic condition (8). Chronic anterior sarcoid uveitis may cause cataracts and glaucoma. Since corticosteroid use can also lead to cataract formation and... 

Figure 1 See color insert.) Keratic precipitates seen as small white dots on slit-lamp examination of a patient with anterior uveitis from sarcoidosis.

Ciprofloxacin White crystalline precipitates lid margin crusting crystals/scales foreign body sensation itching conjunctival hyperemia bad taste in mouth corneal staining keratopathy/keratitis allergic reactions lid edema tearing photophobia corneal infiltrates nausea decreased vision. 

In its mild form ocular surfece disease (OSD) may cause intermittent patient discomfort with symptoms of burning, itching, and blurring of vision. At its most severe the condition may precipitate secondary keratitis and conjunctivitis, corneal ulceration and scarring, and permanent vision loss. Up to one-fourth of all adults in the United States are affected by OSD. Fortunately, in most the condition is mild to moderate, and with proper diagnosis and treatment these patients can maintain comfortable clear vision and good ocular health. 

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