uveitis associated with multiple sclerosis
Introduction
Introduction to uveitis associated with multiple sclerosis Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system characterized by recurrent dysfunction and multi-regional involvement, which can cause optic neuritis, uveitis, extraocular muscle lesions, etc. The eye is abnormal. basic knowledge The proportion of illness: 0.0002% Susceptible people: no specific people Mode of infection: non-infectious Complications: optic atrophy cataracts cystoid edema
Cause
Causes of uveitis associated with multiple sclerosis
(1) Causes of the disease
It is not completely clear at this time.
(two) pathogenesis
The pathogenesis of this disease is not fully understood. Some people believe that the neuropathic pathogens include rabies virus, measles virus, rubella virus, mumps virus, coronavirus, herpes simplex virus, herpes zoster virus, EB virus, etc. More people think it is an autoimmune disease, and its own autoantigens may be myelin basic protein and lipid protein. Immunizing animals with Freund's complete adjuvant can induce experimental allergies. Inflammatory encephalomyelitis, the inflammation and multiple sclerosis of this animal model are very similar in clinical and pathological aspects. In addition, it is also found to be associated with HLA-DR15-(DRB1*1501) and HLA-DQ6. Immune genetic factors may play a role in the occurrence of this disease.
Prevention
Uveitis prevention associated with multiple sclerosis
1. If you find redness, pain, photophobia, tearing, decreased vision or no redness or pain, but there are black shadows floating in front of you, blurred vision or visual distortion, people with flashing sensation and decreased vision may have uveitis. Go to the relevant specialist for a detailed examination to confirm the diagnosis.
2, once the diagnosis of uveitis, should be actively treated, dilated sputum is a necessary measure to treat anterior uveitis, can prevent pupillary adhesions, to avoid the production of secondary glaucoma and complicated cataract; hormone is the treatment of uveitis Commonly used drugs, but with side effects, whether systemic or topical, must be used under the guidance of a doctor, should not be abused.
Complication
Uveitis complications associated with multiple sclerosis Complications optic atrophy cataract macular cystic edema
This disease can cause a variety of ocular complications, such as optic atrophy, atrophy of the inner layer of the retinal nerve fiber, complicated cataract, cystoid macular edema, retinal anterior membrane, secondary glaucoma, retinal detachment, retinal neovascularization Formation, retinal hemorrhage, vitreous hemorrhage, etc.
Symptom
Symptoms of uveitis associated with multiple sclerosis Common symptoms Neuropathic nystagmus diovititis Uveitis dysphagia Macular cystic edema Fatigue Visual field defect Color vision abnormality
1. Ocular manifestations of this disease can cause a variety of eye lesions, the most common is optic neuritis, followed by uveitis, can also cause diplopia, nystagmus and so on.
(1) optic neuritis: optic neuritis is the most common eye lesion of this disease, the incidence rate is as high as 40% to 73%, with optic neuritis as the initial manifestation of this disease accounted for 15% to 25%, patients often showed a sudden drop in vision Or loss, central dark spots or other multiple visual field defects, visual and contrast sensitivity abnormalities, some patients may have eye pain or post-ball pain, pain occurs mostly at rest, when the eye movement or when the eyeball is oppressed, after the ball There may be no abnormal changes in the fundus of the neuritis. Some patients may have optic discitis, and there may be a fissure-like loss of the nerve fiber layer along the optic disc. Occasionally, the retinal vascular sheath may appear. After 2 weeks of onset, the patient's visual acuity usually improves gradually. After a few months, the visual acuity can be restored. However, in many patients, blurred vision, abnormal color vision and pale color of the optic disc can be left.
(2) uveitis: 2.4% to 44% of patients with multiple sclerosis have uveitis, more common in women, male to female ratio of about 1:1.2, can cause anterior uveitis, intermediate uveitis, posterior uveitis ( Includes retinal vasculitis and retinitis).
1 anterior uveitis (Figure 1, 2): It is generally believed that anterior uveitis is rare, clinically mainly bilateral granulomatous iridocyclitis, patients with sheep fat KP, iris nodules, after iris Adhesive, a small number of patients may occasionally have bilateral acute anterior uveitis, but there may still be iris nodules and a large amount of sheep fat KP.
2 middle uveitis: the most common type of uveitis combined with this disease, but it is also reported that the middle uveitis is only 25% of the uveitis associated with this disease, and the patients are mostly mild. Vitreous inflammatory response can also cause severe ciliary flatulitis, bilateral flat ciliary body and vitreous basal lesions, which are not significantly different from idiopathic uvitis in clinical manifestations. Uveitis associated with multiple sclerosis is more likely to have obvious granulomatous anterior uveitis and post-iris adhesion, more likely to appear posterior retinal vascular sheath, but not easy to cause cystoid macular edema And neovascularization of the peripheral retina.
3 posterior uveitis: this type is more common, mainly manifested as retinal vein inflammation, most of which occurs in the posterior pole retina, can also occur in the peripheral retina, this lesion and optic neuritis, systemic disease deterioration and disease There is no obvious relationship between the severity, usually manifested as mild retinal vein inflammation, retinal vascular sheath, vitreitis, generally short duration, not easy to cause cystoid edema of the macula, retinal vascular occlusion and retinal neovascularization, other types Post- uveitis, such as retinitis, has been reported, but it is quite rare.
(3) Other eye manifestations: Some patients may have double vision due to cranial nerve involvement, and some patients may still have nystagmus and Horner syndrome.
2. Systemic manifestations The most common systemic manifestations of this disease are fatigue and weakness. Symptoms are also quite common. They can be expressed as tingling, acupuncture, numbness, coldness, etc. Symptoms usually start in the hands or feet. It can progress to the entire limb within a few days and resolve within a few weeks; there can be a variety of pains, such as trigeminal neuralgia, headache, radiculopathy, musculoskeletal pain, convulsions, clonic, touching pain, etc.; Cognitive impairment, memory loss, speech and dysphagia, depression, mental euphoria, bladder, intestinal and sexual dysfunction can occur.
Examine
Examination of uveitis associated with multiple sclerosis
Cerebrospinal fluid examination can increase the protein concentration, increase leukocytosis, increase IgG level, and the presence of some viral antibodies (such as anti-Rubella virus antibody, anti-herpes virus antibody) to support the diagnosis of this disease.
1. Magnetic resonance imaging examination revealed that there are scattered demyelinating plaques in the white matter area of the brain and spinal cord. Three lesions (at least one lesion around the ventricle) or more than three lesions are of great value for diagnosis. The lesion is usually larger than 6 mm, and the lesions originating from the corpus callosum and the cerebellum are highly suggestive of the diagnosis of multiple sclerosis.
2. Electrophysiological examination In patients with optic neuritis, visual evoked potentials usually appear abnormal, but about 35% of patients with visual evoked potentials return to normal within 2 years of onset.
3. Fluorescein fundus angiography fluorescein fundus angiography is of great value in determining retinal vasculitis in patients. Active vasculitis may have vascular dye leakage and staining of blood vessel walls, venous sclerosis without vasculitis, although Vascular sheath can occur, but no abnormal changes in angiography, angiography can also find changes in retinal neovascular membrane, cystoid macular edema.
4. Visual field examination, color vision examination optic neuritis mostly caused visual field changes, such as diffuse dark spots, central dark spots and surrounding dark spots; color vision examination is helpful to find subclinical optic nerve damage, red light color vision abnormalities are usually prominent, in In the acute phase, blue or yellow light defects may be more common.
Diagnosis
Diagnosis and differentiation of uveitis associated with multiple sclerosis
diagnosis
The diagnosis of this disease mainly depends on the temporal and spatial characteristics of its clinical manifestations, that is, the multiple lesions in the space (multiple lesions scattered in the central nervous system) and multiple in time (repetition of recurrence and remission in the course of the disease), magnetic Resonance, cerebrospinal fluid examination, visual evoked potential and other tests can help to determine the diagnosis, ocular electrophysiological examination, fluorescein fundus angiography, visual field examination, etc. can provide useful information for the diagnosis of ocular lesions.
Differential diagnosis
A variety of diseases can cause damage to the central nervous system, optic neuritis and uveitis. These diseases include Behcet's disease, sarcoma-like disease, Lyme's disease, syphilis, herpes virus infection, etc., and should be distinguished from these diseases at the time of diagnosis.
1. Behcet disease Behcet disease can cause cerebral vasculitis, a variety of abnormalities of the nervous system, but patients typically present with recurrent oral ulcers, pleomorphic skin lesions, genital ulcers, arthritis; It is characterized by non-granulomatous anterior uveitis, total uveitis, retinitis, retinal vasculitis, easy to cause anterior chamber empyema, retinal hemorrhage, retinal phantom vessels, etc., while polysclerosive mainly causes the middle uveal Inflammation, and more granulomatous inflammation, according to these characteristics, it is generally not difficult to identify the two.
2. The sarcoma-like sarcoma disease can also cause a variety of neurological changes, optic neuritis and uveitis, but it causes uveitis mostly anterior uveitis, retinal vasculitis (typically candle tear-like lesions ), choroidal granuloma, and patients with skin damage, lymphadenopathy, lung X-ray examination found hilar lymphadenopathy, serum angiotensin-converting enzyme test for diagnosis and differential diagnosis is very helpful.
3. Lyme disease associated with Lyme disease Lyme disease is a spirochete disease caused by infection, mainly caused by fever, migratory erythema, joint pain, can also cause central nervous system damage and uveitis, enzyme-linked immunosorbent assay Adsorption assay combined with immunoblotting is of great value in the identification of pathogens, diagnosis and differential diagnosis.
4. Syphilis syphilis can cause central nervous system and spinal cord lesions, often causing optic disc swelling and optic disc edema, optic atrophy, oculomotor nerve paralysis, uveitis mostly manifested as anterior uveitis or total uveitis, history and serological examination It is important for diagnosis.
5. Uveitis caused by herpes virus infection Herpes simplex virus, herpes zoster virus can cause encephalitis and uveitis, but they often manifest as retinitis, retinal necrosis syndrome, progressive outer retinal necrosis Signs, retinal choroiditis and anterior uveitis, and multiple sclerosis mainly cause intermediate uveitis, serological examination, PCR detection, etc. are important for diagnosis and differential diagnosis.
