Anterior uveitis

Question 1

Anterior uveitis

Answer 1

Inflammation in the anterior part of the uvea - iris

Question 2

Pathophysiology of anterior uveitis

Answer 2

Inflammation and immune cells in the anterior chamber of the eye

Question 3

Chronic anterior uveitis association

Answer 3

Ganulomatous - either TB or sarcoidosis

Syphilis
Lyme disease
Herpes virus

Question 4

Features of chronic anterior uveitis association

Answer 4

Less severe

Longer duration of symptoms

Lasts > 3 months

Question 5

Acute anterior uveitis associations

Answer 5

Sarcoidosis
Herpes zoster virus
Syphiliis
TB

Associated with HLA B27 related conditions:

• Ankylosing spondylitis
• Inflammatory bowel disease
• Reactive arthritis

Question 6

Presentation of anterior uveitis

Answer 6

Unilateral

May occur with a flare of an associated disease such as reactive arthritis

Symptoms:
- Dull, aching, painful red eye

Reduced visual acuity

Floaters and flashes

Photophobia

Pain on movement

Excessive tear production (lacrimation)

Question 7

Signs of anterior uveitis

Answer 7

Ciliary flush

Decreased visual acuity

Miosis - sphincter muscle contraction

Posterior synechiae - iris stuck to lens

Hypopyon

Keratic precipitates

Cells and fibrin in the anterior chamber

Question 8

Ciliary flush

Answer 8

A ring of red spreading from the cornea outwards

Question 9

Why does photophobia occur

Answer 9

Due to ciliary muscle spasm

Question 10

Posterior synechiae

Answer 10

Adhesions pulling the iris into abnormal shapes

Question 11

Hypopyon

Answer 11

Collection of WCC in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level

Question 12

Management of anterior uveitis

Answer 12

Refer to ophthalmologist:

Topical steroids

Cycloplegic (paralysing the ciliary muscle) - mydriatic (dilating the pupils) medications - cyclopentolate or atropine eye drops.

Immunosuppressants - DMARDS and TNF inhibitors

Severe cases:
Laser therapy, cryotherapy or surgery (vitrectomy)

Question 13

Investigations for anterior uveitis

Answer 13

Fundoscopy
OCT
Slit lamp assessment

Question 14

Cyclopentolate and atropine

Answer 14

Antimuscarinic medications -blocks the action of the iris sphincter muscles and ciliary body.

Dilate the pupil and reduce pain associated with ciliary spasm

Question 15

What is the uvea

Answer 15

Pigmented layer of the eye

Question 16

Parts of the uvea

Answer 16

Anterior - iris
Intermediate - ciliary body
Posterior - Choroid

Question 17

Intermediate uveitis

Answer 17

Inflammation of the ciliary body - ciliaritis

Question 18

Posterior uveitis

Answer 18

Inflammation of the choroid - choroiditis

Question 19

Causes of uveitis

Answer 19

Autoimmune:

• Sarcoid
• SLE
• MS
• Behcets

Infection:

• CMV, HSV, VZV
• Candida
• Toxoplasma
• TB, syphilis

Drug induced

Trauma

Question 20

Which medication can cause uveitis

Answer 20

Bisphosphonates
Rifabutin
Antivirals - cidofovir

Question 21

Recurrent uveitis

Answer 21

Episodes more than 3 months apart

Question 22

Chronic uveitis

Answer 22

Frequent recurrence with a gap of less than 3 months

Question 23

How to break posterior synechiae

Answer 23

Using dilating drops

Question 24

Presentation of intermediate uveitis

Answer 24

Blurring of vision

Floaters

Question 25

Signs of intermediate uveitis

Answer 25

``` Cells in vitreous Snow balls Snowbanking Sheathing of the blood vessels Macular oedema ```

Question 26

Specific investigations to find cause

Answer 26

Bloods - FBC, U+Es, LFTs Autoimmune: - Sarcoid ACE - CXR, biopsy - SLE - anti dsDNA - MS - MRI whole spine - Behcets - HLA B51 Infection: - CMV, HSV, VZV - PCR - Candida - PCR - Toxoplasma - IgG and IgM - TB - Quantiferon gold test - Syphilis - Treponemal antibody

Question 27

Treatment of intermediate/posterior uveitis

Answer 27

Topical steroids or steroid implant Systemic therapy: - pulse therapy - oral steroids - immunosuppression - treat underlying cause

Question 28

Side effects of steroid implant

Answer 28

Cataracts | Raised intraocular pressure

Question 29

Complications of posterior uveitis

Answer 29

Chorio-retinal atrophy or scarring Glaucoma Cataract Retinal detachment