Anterior Uveitis Flashcards
What is anterior uveitis?
Inflammation in the anterior part of the uvea (the uvea involves the iris, ciliary body and choroid)
What is the choroid?
This is the layer between the retina and the sclera all the way around the eye, sometimes anterior uveitis is referred to ad iritis.
What does uveitis involve?
Inflammation and immune cells in the anterior chamber of the eye, the anterior chamber of the eye becomes infiltrated with neutrophils, Lymphocytes and macrophages.
What are the reasons for floaters in the patients vision?
The inflammatory cells in the anterior chamber cause floaters.
What are the causes of uveitis?
Autoimmune Infection Trauma Ischaemia Malignancy
What is the difference between acute and chronic anterior uveitis?
Chronic anterior uveitis is more granulomatous (has more macrophages) and has a less severe and longer duration of symptoms, lasting more than 3 months.
What is acute anterior uveitis associated with?
Acute anterior uveitis is associated with HLA B27 related conditions…
Ankylosing spondylitis
IBD
Reactive arthritis
Ŵhat is chronic anterior uveitis associated with?
Sarcoidosis Syphilis Lyme disease Tuberculosis Herpes virus
What is the presentation of anterior uveitis?
It usually presents with unilateral symptoms that start spontaneously, without a history of trauma or precipitating events
They may occur with a flare of an associated disease like reative arthritis
Dull aching painful red rye Ciliary flush Reduced visual acuity Floaters and flashes Sphincter muscle contraction causing miosis Photophobia Pain on movement Excessive tear production (lacrimation) Abnormally shaped pupils- posterior synechiae (adhesions) pulling the iris into abnormAl shapes Hypopyon
What Is the management of uveitis?
They need same day assesment by an opthalmologist
They need fully slit lamp assesment of the different stricture of the eye and intraocular pressures to establish the diagnosis
What would you see on examination of someone with uveitis?
Ciliary flush (ring of red spreading from the cornea outwards)
Hypopyon (collection of white blood cells in the anterior chamber- yellowish fluid collection)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
What are the treatment options for uveitis?
Steroids (oral, topical or IV)
Cycloplegic- mydriatic meds (cycloplegic means paralysing the ciliary muscles whereas mydriatic means dilating the pupils) examples are cyclopentolate and atropine (antimiscarinic)
Immunosuppressants- DMARDS and TNF inhibitors
Laser therapy, cryotherapy or surgery (vitrectomy) are options in severe cases
