ant uveitis Flashcards
Non-granulomatous
acute, painful, red, short, small/fine KP, PMNs, lymphoctes
Granulomatous
insidious, less pain, less red, mutton fat KP, nodular lesions, macrophages, giant cells, nodules in AC, long
Pathophysiology of anterior uveitis
Breakdown of BAB (tight junctions) due to inflammation of ciliary epithelium and iris capillaries.
Aqueous fills with macromolecules (flare) and cells.
Iris capillaries
Non-fenestrated (tight junctions) - endothelial cells
Ciliary body capillaries
Stroma- fenestrated
Inner epi - NPE (tight junctions)
Outer epi - PE (gap junctions) - controls aqueous production (uveitis –> decrease IOP)
Signs of acute anterior uveitis (AAU)
- Hyperaemia
- Cells in AC (= active inflammation)
- Hypopyon
- Flare
- Synechiae (PAS, posterior)
- KP
- Miotic pupil (iris sphincter spasm - substance P)
- Vitreous cells
- IOP (early: decreased, later: increased - TM inflamed, poor drainage)
- psuedo-ptosis
- CMO
iris atrophy
corneal oedema
AAU underlying systemic disease
HLA-b27 +ve: Ankylosing spondilitis, Crohn’s disease, Reactive arthritis, Psoriasis
HLA-B27 -ve: sarcoid, TB, Behcet’s disease, Syphilis
Features of ankylosing spondylitis
- Chronic spinal joint disease
Ache/ stiffness, back ache, rigid spine
Morning stiffness, gets better with exercise
Features of reactive arthritis (reiter’s syndrome)
- triad: urethritis, conjunctivitis, sero-neg arthritis
- depending on source: STD: M>F, enteric: M=F
Features of psoriatic arthritis
- hyperproliferation of epidermis
- Small % of psoriasis px develop arthritis
- 7% arthritic group develop AAU
Features of inflammatory bowel disease
- Colitic arthritis = affects joints, skin
- Crohn’s disease = bowel inflammation (SI)
- Ulcerative colitis = inflammation of colon
- Symptoms: pain, diarrhoea, weight loss, bloody stool
Features of Behcet’s disease (Adamantiades’ disease)
Idiopathic
young males
mouth ulcers, genital ulcers, uveitis (post and ant)
Anterior iridocyclitis (hypopyon, keratitis, vitritis, episcleritis, conjunctivitis)
Posterior - diffuse vascular leakage, retinal vasculitis, retinitis
Syphillis
- More common in posterior uveitis
- mx: antibiotics, iv penicillin G (4 units every 4 hours)
Signs of chronic anterior uveitis (CAU)
- mild hyperaemia normal pupil KP iris nodules iris atrophy secondary cataract band keratopathy CMO IOP (high- glaucoma, low - hypotony) Phthisis bulbi (shrivelled eye) Rubeosis and fibrovascular membrane
Systemic disease associated with CAU
Juvenille idiopathic arthritis (JIA) Syphilis Fuch's uveitis syndrome/ Fuch's heterochromatic iridocyclitis Sarcoidosis Herpes Zoster Ophthalmicus TB
Features of juvenille idiopathic arthritis (JIA)
bilateral, non-granulomatous, <16yrs onset, chronic - 85% female - cells (vitreous/AC) KP - med/small post. synechiae CMO band keratopathy examine: 6 weeks of JIA dx --> 2 monthly for 6 months --> 4 monthly until 11yo
Features of Fuch’s uveitis syndrome
Fuchs dystrophy = corneal endo cell death –> corneal oedema
- Unilateral, insidious onset, non-granulomatous, no hyperaemia, no post. synechiae, no CMO
- Cells and flare
KP - small, grey, stellate
VA declines later
Features of sarcoidosis
- multi-systemic inflammation
Granulomatous, idiopathic
involves: lungs, lymph nodes, skin, liver, eyes
Ocular sarcoid (60% have uveitis) - large mutton fat KP, iris nodules, bilateral, cataract, glaucoma, phthisis risk
Features of Herpes zoster ophthalmicus
iris atrophy
cornea (dendritic keratitis, stromal & exposure keratitis), large KP
Glaucoma (high IOP), phythsis
mx: topical antiviral, topical steroid, cycloplegia, glaucoma, oral acyclovir
Features of TB
most likely CAU, AAU possible
HIV/aids
Posner-Schlossman syndrome/ Glaucomato-cyclitic crisis features
- v high IOP w open angle during attack unilateral, recurrent non-granulomatous trabeculitis 30-60yrs self-limiting, few KPs 55% develop OAG with age
