ant uveitis

Question 1

Non-granulomatous

Answer 1

acute, painful, red, short, small/fine KP, PMNs, lymphoctes

Question 2

Granulomatous

Answer 2

insidious, less pain, less red, mutton fat KP, nodular lesions, macrophages, giant cells, nodules in AC, long

Question 3

Pathophysiology of anterior uveitis

Answer 3

Breakdown of BAB (tight junctions) due to inflammation of ciliary epithelium and iris capillaries.
Aqueous fills with macromolecules (flare) and cells.

Question 4

Iris capillaries

Answer 4

Non-fenestrated (tight junctions) - endothelial cells

Question 5

Ciliary body capillaries

Answer 5

Stroma- fenestrated
Inner epi - NPE (tight junctions)
Outer epi - PE (gap junctions) - controls aqueous production (uveitis –> decrease IOP)

Question 6

Signs of acute anterior uveitis (AAU)

Answer 6

• 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

Question 7

AAU underlying systemic disease

Answer 7

HLA-b27 +ve: Ankylosing spondilitis, Crohn’s disease, Reactive arthritis, Psoriasis
HLA-B27 -ve: sarcoid, TB, Behcet’s disease, Syphilis

Question 8

Features of ankylosing spondylitis

Answer 8

• Chronic spinal joint disease
  Ache/ stiffness, back ache, rigid spine
  Morning stiffness, gets better with exercise

Question 9

Features of reactive arthritis (reiter’s syndrome)

Answer 9

• triad: urethritis, conjunctivitis, sero-neg arthritis

- depending on source: STD: M>F, enteric: M=F

Question 10

Features of psoriatic arthritis

Answer 10

• hyperproliferation of epidermis
• Small % of psoriasis px develop arthritis
• 7% arthritic group develop AAU

Question 11

Features of inflammatory bowel disease

Answer 11

• Colitic arthritis = affects joints, skin
• Crohn’s disease = bowel inflammation (SI)
• Ulcerative colitis = inflammation of colon
• Symptoms: pain, diarrhoea, weight loss, bloody stool

Question 12

Features of Behcet’s disease (Adamantiades’ disease)

Answer 12

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

Question 13

Syphillis

Answer 13

• More common in posterior uveitis

- mx: antibiotics, iv penicillin G (4 units every 4 hours)

Question 14

Signs of chronic anterior uveitis (CAU)

Answer 14

- 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

Question 15

Systemic disease associated with CAU

Answer 15

Juvenille idiopathic arthritis (JIA)
Syphilis 
Fuch's uveitis syndrome/ Fuch's heterochromatic iridocyclitis 
Sarcoidosis 
Herpes Zoster Ophthalmicus 
TB

Question 16

Features of juvenille idiopathic arthritis (JIA)

Answer 16

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

Question 17

Features of Fuch’s uveitis syndrome

Answer 17

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

Question 18

Features of sarcoidosis

Answer 18

• 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

Question 19

Features of Herpes zoster ophthalmicus

Answer 19

iris atrophy
cornea (dendritic keratitis, stromal & exposure keratitis), large KP
Glaucoma (high IOP), phythsis
mx: topical antiviral, topical steroid, cycloplegia, glaucoma, oral acyclovir

Question 20

Features of TB

Answer 20

most likely CAU, AAU possible

HIV/aids

Question 21

Posner-Schlossman syndrome/ Glaucomato-cyclitic crisis features

Answer 21

- v high IOP w open angle during attack 
unilateral, recurrent non-granulomatous trabeculitis 
30-60yrs 
self-limiting, few KPs
55% develop OAG with age