anterior and posterior uveitis Flashcards

1
Q

What are sx of anterior uveitis?

A

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

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2
Q

What are signs of anterior uveitis?

A

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.

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3
Q

what is anterior uveitis associated with?

A

HLAB27

also sarcoidosis
syphillis
bechets disease
and TB

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4
Q

what are some complications of anterior uveitis?

A

cataract
glaucoma
macular edema

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5
Q

treatment for anterior uveitis?

A

topical steroids

mydriatics (dilators)

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6
Q

what is posterior uveitis?

A

inflammation of the choroid (the posterior part of the uveal tract)

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7
Q

sx of posterior uveitis

A

floaters

decreased vision

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8
Q

what are some things you may see in posterior uveitis on fundoscopy?

A
optic disc swelling
cotton wool spots
chorioretinal inflammation or scarring
thin vessels
retinal vein occlusion
macular edema
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9
Q

what are some systemic diseases that posterior uveitis can be a part of?

A
toxoplasmosis
sarcoidosis
TB
syphillis
bechets disease
sympathetic ophthalmitis
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10
Q

what are baseline investigations you should do for posterior uveitis to identify cause?

A
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)
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11
Q

What is pars planitis?

A

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.

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12
Q

what is the treatment for pars planitis?

A

topical, periocular or systemic steroids

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13
Q

What are some manifestations of the eye seen in downs syndrome?

A
high refractive error
strabismus
cataract
accommodative insufficiency
lacrimal duct obstruction 
blepharitis
nystagmus
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14
Q

what do you test for optic nerve damage?

A

visual acuity
visual fields
pupil reflexes
colour vision

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15
Q

what are some post op catarcat complications?

A

posterior capsule opacity
dislocated lens
eye inflammation
increased iop

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16
Q

Whta is sjogrens syndrome?

A

primary SS = dry eyes and mouth

secondary SS = dry eyes and mouth and other connective tissue disroder such as RA/SLE

17
Q

what is the vicious circle that occurs in the ocular component of sjogrens?

A

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

18
Q

what are some clinical findings you would fins in sjogrens?

A
dry mouth 
dry eyes 
eating/speaking difficulties
dryness of other mucosal surfaces
enlarged parotid glands
extraglandular involvement
19
Q

what are some extraglandular involvement in sjogrens?

A

skin - dryness, pruritis, reynauds
joints - RA
lungs - dry cough, and recurrent bronchitis
heart - pericarditis
neuro - facial nerve palsies, neuropathies
fatigue

20
Q

what might you see do for a sjogrens patient in ophthal?

A

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).

21
Q

what is the immulogical work up for sjogrens?

A
RF
ANA
ANti-SSA
Anti-SSB
and biopsy of minor salivary glands of inner lower lip