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Year 4 Ophthalmology > Anterior uveitis > Flashcards

Anterior uveitis Flashcards

1
Q

Anterior uveitis

A

Inflammation in the anterior part of the uvea - iris

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2
Q

Pathophysiology of anterior uveitis

A

Inflammation and immune cells in the anterior chamber of the eye

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3
Q

Chronic anterior uveitis association

A

Ganulomatous - either TB or sarcoidosis

Syphilis
Lyme disease
Herpes virus

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4
Q

Features of chronic anterior uveitis association

A

Less severe

Longer duration of symptoms

Lasts > 3 months

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5
Q

Acute anterior uveitis associations

A

Sarcoidosis
Herpes zoster virus
Syphiliis
TB

Associated with HLA B27 related conditions:

  • Ankylosing spondylitis
  • Inflammatory bowel disease
  • Reactive arthritis
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6
Q

Presentation of anterior uveitis

A

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)

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7
Q

Signs of anterior uveitis

A

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

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8
Q

Ciliary flush

A

A ring of red spreading from the cornea outwards

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9
Q

Why does photophobia occur

A

Due to ciliary muscle spasm

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10
Q

Posterior synechiae

A

Adhesions pulling the iris into abnormal shapes

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11
Q

Hypopyon

A

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

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12
Q

Management of anterior uveitis

A

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)

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13
Q

Investigations for anterior uveitis

A

Fundoscopy
OCT
Slit lamp assessment

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14
Q

Cyclopentolate and atropine

A

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

Dilate the pupil and reduce pain associated with ciliary spasm

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15
Q

What is the uvea

A

Pigmented layer of the eye

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16
Q

Parts of the uvea

A

Anterior - iris
Intermediate - ciliary body
Posterior - Choroid

17
Q

Intermediate uveitis

A

Inflammation of the ciliary body - ciliaritis

18
Q

Posterior uveitis

A

Inflammation of the choroid - choroiditis

19
Q

Causes of uveitis

A

Autoimmune:

  • Sarcoid
  • SLE
  • MS
  • Behcets

Infection:

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

Drug induced

Trauma

20
Q

Which medication can cause uveitis

A

Bisphosphonates
Rifabutin
Antivirals - cidofovir

21
Q

Recurrent uveitis

A

Episodes more than 3 months apart

22
Q

Chronic uveitis

A

Frequent recurrence with a gap of less than 3 months

23
Q

How to break posterior synechiae

A

Using dilating drops

24
Q

Presentation of intermediate uveitis

A

Blurring of vision

Floaters

25
Q

Signs of intermediate uveitis

A 
Cells in vitreous 
Snow balls 
Snowbanking 
Sheathing of the blood vessels 
Macular oedema
26
Q

Specific investigations to find cause

A

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
27
Q

Treatment of intermediate/posterior uveitis

A

Topical steroids or steroid implant

Systemic therapy:

  • pulse therapy
  • oral steroids
  • immunosuppression
  • treat underlying cause
28
Q

Side effects of steroid implant

A

Cataracts

Raised intraocular pressure

29
Q

Complications of posterior uveitis

A

Chorio-retinal atrophy or scarring
Glaucoma
Cataract
Retinal detachment

Year 4 Ophthalmology (27 decks)

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