anterior and posterior uveitis Flashcards
What are sx of anterior uveitis?
pain - aching sensation that may be aggravated by reading
redness
photophobia - from reactive spasm of the inflamed iris miosis (constriction of eye)
watering
blurred vision
What are signs of anterior uveitis?
redness which in the early stages may only be circumcorneal injection
inflammatory cells and flare may be seen on slit lamb as protein exudates create the ‘smoke in room’ effect
if severe a hypopion may be seen
keratitic precipitates in the cornea
miosis due to spasm of the iris muscle
later on posterior synechiae may form (adhesions between lens and iris)
fundus should be examined to exclude posterior uveitis.
what is anterior uveitis associated with?
HLAB27
also sarcoidosis
syphillis
bechets disease
and TB
what are some complications of anterior uveitis?
cataract
glaucoma
macular edema
treatment for anterior uveitis?
topical steroids
mydriatics (dilators)
what is posterior uveitis?
inflammation of the choroid (the posterior part of the uveal tract)
sx of posterior uveitis
floaters
decreased vision
what are some things you may see in posterior uveitis on fundoscopy?
optic disc swelling cotton wool spots chorioretinal inflammation or scarring thin vessels retinal vein occlusion macular edema
what are some systemic diseases that posterior uveitis can be a part of?
toxoplasmosis sarcoidosis TB syphillis bechets disease sympathetic ophthalmitis
what are baseline investigations you should do for posterior uveitis to identify cause?
general and ocular hx funds fluroscein angiogram esr complete blood count toxoplasmo serology ACE level (elevated in sarcoidosis) syphillis serology chest xray (TB and sarcoidosis)
What is pars planitis?
inflammation of the ciliary body
typically affects teenagers and young adults
presents with floaters and blurred vision in one or both eyes.
causes macular edema and cataract
look for the word ‘snow banking’ in fundoscopy report.
what is the treatment for pars planitis?
topical, periocular or systemic steroids
What are some manifestations of the eye seen in downs syndrome?
high refractive error strabismus cataract accommodative insufficiency lacrimal duct obstruction blepharitis nystagmus
what do you test for optic nerve damage?
visual acuity
visual fields
pupil reflexes
colour vision
what are some post op catarcat complications?
posterior capsule opacity
dislocated lens
eye inflammation
increased iop
Whta is sjogrens syndrome?
primary SS = dry eyes and mouth
secondary SS = dry eyes and mouth and other connective tissue disroder such as RA/SLE
what is the vicious circle that occurs in the ocular component of sjogrens?
reduced tear production due to structural changes in the lacrimal gland
Tear hyperosmolarity, as a proinflammatory stimulus, induces an inflammatory cascade on the ocular surface
This causes an immune response in the ocular surface epithelium, and local cytokine production
The end result is damage to the epithelium, already vulnerable from poor tear film protection, evidenced as epithelial erosions, surface irregularity and impaired vision
what are some clinical findings you would fins in sjogrens?
dry mouth dry eyes eating/speaking difficulties dryness of other mucosal surfaces enlarged parotid glands extraglandular involvement
what are some extraglandular involvement in sjogrens?
skin - dryness, pruritis, reynauds
joints - RA
lungs - dry cough, and recurrent bronchitis
heart - pericarditis
neuro - facial nerve palsies, neuropathies
fatigue
what might you see do for a sjogrens patient in ophthal?
look for ocular redness
dullness of the corneal reflex due to irregularity of the cornea
might find coexistent blepharitis which should be treated
poor tear film production
stain rose bengal to identify dehydrated and devitalised cells (dead).
what is the immulogical work up for sjogrens?
RF ANA ANti-SSA Anti-SSB and biopsy of minor salivary glands of inner lower lip
