Behcet’s disease


Clinical diagnosis:

  1. Oral or genital ulcers
  2. Skin rashes/lumps or bumps
  3. Family/ancestors from Turkey, Middle East, central Asia
  4. *BRVO (vasculitic changes) with posterior uveitis*
  5. Anterior uveitis with shifting/sterile hypopyon + white eye
  6. Macular retinitis
  7. Smoky vitreous without condensations (vitritis)
  8. ONH neuropathy (risk becoming atrophic) – life threatening! Refer to medics

Investigations:

  1. HLA-B51
  2. Inflammatory markers – FBC / CRP / ESR
  3. Syphilis serology and Quantiferon-TB Gold test – rule out the differentials
  4. MRI brain – if neurological involvement
  5. FFA – determine areas of ischaemia for treatment
  6. Refer to physician

Differential diagnosis: TB ; Syphilis

Management:

  1. Anterior uveitis – treat aggressively with topical steroids and mydrilates.
  2. Laser photocoagulation – areas of ischaemia or macular oedema.
  3. Neurology symptoms – physician involvement urgently
  4. For any neurology associated symptoms or vasculitis or macular retinitis – pulsed IVMP then oral prednisolone (long-term). This is followed by immunosuppression.
  5. Immunosuppression – mycophenolate mofetil (common) ; alternatives – cyclosporin or azathioprine.
  6. Biologics – anti TNF agents (infliximab or adalimumab).
  7. Interferon alpha.
  8. RRD – rare – usually after intravitreal steroid treatment or tractional related cause from prolonged vitritis – treat with scleral buckle or PPV

BRVO: Branch retinal vein occlusion; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; FBC: full blood count; FFA: fundus fluorescein angiogram; IVMP: intravenous methylprednisolone; ONH: optic nerve head; PPV: pars plana vitrectomy; RRD: retinal detachment; TNF: Tumour necrosis factor


Reference: Behcet’s disease: An overview (Ocular immunology and Uveitis Foundation)


Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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