1-15 Uveitis Flashcards
Describe Anterior Uveitis
- 2 types?
- Causes/associations?
Most common uveitis
- Acute or chronic (acute more common)
- 50% idiopathic, 20-30% due to Human Leukocyte Antigen subtype B27 (HLA-B27) (This subtype makes body attack itself so autoimmune).
- Associated w/ autoimmune disorders e.g. ankylosing spondylitis, reactive arthritis, IBD…
Anterior uveitis signs?
Ciliary (circumlimbal) injection = Redness around limbus, mostly near ciliary body.
Miosis = Sphincter spasm.
- Predispose to posterior synechiae.
- 360 degree adhesion = Seclusio pupillae
- Adhesion Tx w/ strong dilator (e.g. Cyclopentolate). Will leave iris imprint behind and treats spasm pain
AC reaction = blood-aqueous barrier destroyed so stuff leaks in.
- Cells (WBCs) + flare (haziness) (protein)
- Keratic precipitates (cells land on back of cornea. Can coalesce into larger droplets appearing as “mutton fat KPs” which organise in a triangle pattern due to gravity known as Arlt triangle)
- Hypopyon (pool of inflammatory exudate at bottom)
Iris nodules
- Koeppe nodules (near pupil margin) = Larger, granulomous e.g. macrophage, epitheliod, multinucleated giant cells…
- Busacca nodules (near iris stroma) = Granulomatous + Non-granulomatous
Anterior Uveitis symptoms?
If acute, rapid onset + unilateral
- redness
- Photophobia
- Ocular pain/hx
- Watery discharge
- Vision impairment (depends on severity)
Recurrence in predisposed Pxs common.
Describe intermediate uveitis
- Onset?
- Causes/associations?
Isidious onset, chronic, relapsing
- 50 – 70% idiopathic
- Otherwise, associated w/ systemic disease e.g. MS, sarcoidosis, lyme disease, syphilis, TB
Intermediate uveitis symptoms?
- Increasing floaters
- Blurry vision w/o pain/redness.
Intermediate uveitis signs?
VC reaction
- Cells in vitreous (mostly ant.)
- Condesation, haze
- Gelatinous exudates of inflammatory cells.
- Snowballs = cells + exudate clumps (seen in fundus image). Snowbanking = snowballs clumped to fall inferiorly
Mild AC reaction (spillover)
Retinal periphlebitis (surrounding veins) (especially in MS pxs)
- White surrounding veins of retina
Posterior uveitis symptoms?
Rarer, most associated w/ vision loss w/ chronic, insidious onset.
- Floaters w/ painless + vision loss
- No red eyes
Posterior uveitis signs?
- VC reaction
- Mild AC reaction
Retinitis:
White cloudy/fluffy lesions w/ indistinct borders - Obscures retinal BVs
- As leakage resolves, fluffiness decreases
Either: - Focal (single point)
- Multifocal (many points)
- Geographic (one area)
- Diffuse (widespread)
Choroiditis:
Deep yellow/grey roundish patches w/ defined borders
- Overlying retinal BVs visible
- When inactive, become white, atrophic patches w/ pigmentation
Either:
- Focal
- Multifocal
- Goegraphic
- Diffuse
Vasculitis:
Fluffy, white haze surrounds BVs (perivascular “cuffing”)
- Veins more often affected
- Patchy, irregular extensions outside vessel wall
- Haemorrhages possible
- If granulation, there’s focal aggregates of inflammation along a BV (“candlewax drippings”)
Sequelae of uveitis?
Glaucoma:
- Inflammation -> IOP
- Inflammatory cells + debri at TM -> IOP/PAS
- Posterior synechiae -> pupillary block -> iris bombe -> IOP/PAS
- Corticosteroid treatment -> IOP
- NVI -> IOP/angle close
Cataracts:
- Unknown reason as to why
- Ant. uvieitis, especially chronic
- Posterior subcapsular mostly
- Uncontrolled sustained inflammation or corticosteroid treatment.
Cystoid Macular Oedema:
- Most common complication of posterior uveitis (but all uveitis can cause this)
- BRB affected by inflammation -> oedema.
Describe Toxoplasmosis
- Who it affects?
- What causes it?
- Different forms?
- Most common posterior uveitis cause in immunocompetent Pxs.
- Infection from Toxoplasma gondii
3 forms: - Oocysts excreted by cats
- Bradyzoites dormant in tissue
- Tachyzoites proliferate and destroy tissue.
Toxoplasmosis complication to eye?
- How it complicates eye?
- Appearance?
Toxoplasmosis Retinitis. Usually from reactivation of prenatal infection.
- Retinochoroiditis -> resolution -> local scars
- Old healed congenital scars -> recurrent inflammation (cysts inside scar rupture)
“Satellite lesions” of white + fluffy inflammatory foci
- Associated w/ pigmneted chorioretinal scar
- Other posterior uveitis signs
- 1 – 4 month heal time -> atrophic scar -> recurrent
Describe toxocariasis
- Caused by?
- How it damages eye?
- Types?
Infection of Toxocara canis
- Intestinal roundworm in dogs faeces
- Ova become larvae that penetrate human intestinal wall to reach other organs like eyes.
- Larvae die and cause granulomas to form as part of inflammatory reaction.
– Visceral toxocariasis = severe systemic infestation in young children (not eye)
– Ocular toxocariasis = eye involved infestation in older children/adult
Appearance of Toxocariasis
Granuloma
- Round yellow-white solid granuloma
- Anterior to equator, or at macula/ONH
- Vitreous bands extend from lesion to posterior pole
- “Dragging” of ONH/macula due to fibrous tissue sticks to vitreous.
Chronic endopthalmitis
- Intraocular fluids inflammed
- Anterior uveitis, vitritis, chorioretinitis, papillitis
White reflex of eyes.
