Anterior uveitis Flashcards
Anterior uveitis
Inflammation in the anterior part of the uvea - iris
Pathophysiology of anterior uveitis
Inflammation and immune cells in the anterior chamber of the eye
Chronic anterior uveitis association
Ganulomatous - either TB or sarcoidosis
Syphilis
Lyme disease
Herpes virus
Features of chronic anterior uveitis association
Less severe
Longer duration of symptoms
Lasts > 3 months
Acute anterior uveitis associations
Sarcoidosis
Herpes zoster virus
Syphiliis
TB
Associated with HLA B27 related conditions:
- Ankylosing spondylitis
- Inflammatory bowel disease
- Reactive arthritis
Presentation of anterior uveitis
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)
Signs of anterior uveitis
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
Ciliary flush
A ring of red spreading from the cornea outwards
Why does photophobia occur
Due to ciliary muscle spasm
Posterior synechiae
Adhesions pulling the iris into abnormal shapes
Hypopyon
Collection of WCC in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level
Management of anterior uveitis
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)
Investigations for anterior uveitis
Fundoscopy
OCT
Slit lamp assessment
Cyclopentolate and atropine
Antimuscarinic medications -blocks the action of the iris sphincter muscles and ciliary body.
Dilate the pupil and reduce pain associated with ciliary spasm
What is the uvea
Pigmented layer of the eye
Parts of the uvea
Anterior - iris
Intermediate - ciliary body
Posterior - Choroid
Intermediate uveitis
Inflammation of the ciliary body - ciliaritis
Posterior uveitis
Inflammation of the choroid - choroiditis
Causes of uveitis
Autoimmune:
- Sarcoid
- SLE
- MS
- Behcets
Infection:
- CMV, HSV, VZV
- Candida
- Toxoplasma
- TB, syphilis
Drug induced
Trauma
Which medication can cause uveitis
Bisphosphonates
Rifabutin
Antivirals - cidofovir
Recurrent uveitis
Episodes more than 3 months apart
Chronic uveitis
Frequent recurrence with a gap of less than 3 months
How to break posterior synechiae
Using dilating drops
Presentation of intermediate uveitis
Blurring of vision
Floaters
Signs of intermediate uveitis
Cells in vitreous Snow balls Snowbanking Sheathing of the blood vessels Macular oedema
Specific investigations to find cause
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
Treatment of intermediate/posterior uveitis
Topical steroids or steroid implant
Systemic therapy:
- pulse therapy
- oral steroids
- immunosuppression
- treat underlying cause
Side effects of steroid implant
Cataracts
Raised intraocular pressure
Complications of posterior uveitis
Chorio-retinal atrophy or scarring
Glaucoma
Cataract
Retinal detachment
