A6 - Uveitis

Question 1

Leucokoria

-associated issues

Answer 1

May have:

• strab
• nystagmus
• diff in eye size
• incr IOP
• ct
• tumor
• decr vision
• APD

Question 2

Leucokoria

• complete eval including
• tx
• prognosis

Answer 2

B-scan
Radiology

Tx underlying problem

Poor to guarded

Question 3

Phthisis bulbi

Answer 3

Function has decompensated or gone

Shrinks after trauma, loss of function

Soft, low IOP

B-scan to R/O growths

Not painful
-if becomes, enucleate

Question 4

Uveitis in children

-who

Answer 4

Females

62% Caucasian

Question 5

Uveitis in children

-major etiologies (2)

Answer 5

Idiopathic

JRA

Question 6

Anterior uveitis
-JRA
—what
—uveitis characteristics (general)

Answer 6

Arthritis of at least 6 weeks w/o identifiable cause in children <16 years

Most common cause of ant uv in children
Greater risk in first 4 years after dx
Seen before or after joint symptoms
More aggressive course if interval b/w arthritis and uveitis is short

Question 7

Anterior uveitis
-JRA
—lab to run
—uveitis characteristics - specific signs/symptoms

Answer 7

ANA

Bilateral 
Non-granulomatous
Fine-medium KP
Chronic inflammation leading to:
-band keratopathy
-posterior synechiae
-hypotony
-ct
-glaucoma

Question 8

Intermediate uveitis

• what
• app
• assoc condns

Answer 8

Inflamm at vitreous base over CB, p plana, ant vitreous, and peripheral retina

Will see vitreal cells - snow banking in peripheral retina (near ora)

Sarcoidosis
TB
Syphilis
Lyme
MS
Idiopathic intermediate uveitis (pars planitis)

Question 9

Posterior uveitis
-toxoplasmosis
—cause
—tissues affected
—testing

Answer 9

T. gondii

• cat feces
• undercooked meat/contaminated water
• congenital (TORCH) or acquired

Heart muscle, neural tissue, retina

ELISA

Question 10

Posterior uveitis
-toxoplasmosis
—dormant until
—systemic infection
—treatment

Answer 10

Cyst erupts

Fever, lymphadenopathy, sore throat

Antimicrobials +/- oral steroids

Question 11

Posterior uveitis
-toxoplasmosis
—ocular manifestation

Answer 11

Retinitis, choroiditis, iritis

Active area of retinal inflamm - thickened, cream-colored, with overlying vitritis in macular scar

Atrophic chorioretinal scar (satellite lesion)

Question 12

Posterior uveitis
-toxocariasis
—what, cause
—who

Answer 12

Nematode larvae in dog/cat intestines
Ingestion of contaminated soil

Primarily children - avg onset 11.5 years

Question 13

Posterior uveitis
-toxocariasis
—ocular manifestation

Answer 13

Unilateral

Post pole granuloma, peripheral granuloma, or endophthalmitis
-leukocoria, strab, or decr vision

Question 14

Posterior uveitis
-toxocariasis
—systemic manifestation
—labs

Answer 14

Not assoc with systemic problems

ELISA

Question 15

Posterior uveitis
-toxocariasis
—treatment

Answer 15

Observe peripheral lesions

Periocular or systemic steroid for posterior lesions and endophthalmitis

Surgery for retinal traction, ct, glaucoma

*systemic antiparasitic not useful - parasite is already dead

Question 16

Sarcoidosis

• younger children
• older children
• type of uveitis
• dx

Answer 16

<5 yrs = triad: uveitis, arthritis, rash

Pulmonary and lymph node abnormalities (like adults)

Anterior most common
Can be panuveitis

ACE and chest x-ray
-ACE in healthy children > adults

Question 17

Masqeraders of pediatric uveitis
-Anterior seg: what diagnostic test?
—retinoblastoma
—leukemia
—intraocular FB
—malignant melanoma
—RD

Answer 17

RB: ultrasound, MRI

L: bone marrow biopsy

IOFB: x-ray, ultrasound

MM: flouro angio, ultrasound

RD: fundus eval

Question 18

Masqeraders of pediatric uveitis
-posterior seg: what diagnostic test?
—RP
—MS

Answer 18

RP: ERG, VF

MS: neurological exam

Question 19

Evaluation

-workup of isolated anterior uveitis

Answer 19

Can be deferred until unresponsive or recurrent

Question 20

Uveitis management

• anterior inflamm
• intermediate/posterior uveitis

Answer 20

Topical corticosteroids and cycloplegics

• pred forte Q2hrs -> taper
• atropine 1% BID

Sub-tenon steroid injections

Question 21

Uveitis management

-systemic condns causing uveitis

Answer 21

Short course of oral corticosteroids

Question 22

Uveitis management

-other options (4)

Answer 22

NSAIDs (naproxen)
-watch for GI irritation, rashes, renal toxicity

Sytemic immunosuppression

• for uveitis and arthritis
• may reduce need for steroid

Methotrexate

• antimetabolite used in arthritis and uveitis in children
• GI distrurbances

Surgery
-for complications: band keratopathy, ct, glaucoma