Anterior Uveitis Flashcards
Uveitis typically occurs in what age range?
Young adults (2nd-4th decade)
Uveitis generally only occurs in adults over 70 if associated with what 2 things?
Toxoplasmosis
Herpes zoster
Uveitis occurs secondary to what?
Breakdown of the blood-aqueous barrier
What are the 3 locations of the blood aqueous barrier?
- Non-pigmented ciliary epithelium (NPCE)
- Iris vessels
- Schlemm’s canal
50% of patients with acute anterior uveitis are positive for what gene?
HLA-B27
What conditions are associated with the HLA-B27 gene?
(CRAP) Crohn's Reactive arthritis Ankylosing spondylitis Psoriatic arthritis
What are the two types of anterior uveitis?
Acute, non-granulomatous
Chronic, granulomatous (bilateral)
What is the most common systemic cause of anterior, acute, non-granulomatous uveitis?
Ankylosing spondylitis
Chronic, bilateral, granulomatous uveitis is commonly associated with what 3 conditions?
Sarcoid
TB
Syphilis
Keratic precipitates are commonly found in which type of anterior uveitis?
Chronic, granulomatous
Rank the types of uveitis from most common to least common.
- Anterior uveitis (iritis, iridocyclitis)
- Posterior or panuveitis
- Intermediate (pars planitis)
Stellate KPs are commonly seen in what two conditions?
Fuch’s heterochromic iritis
Herpes
What are the common symptoms of uveitis?
Pain Redness Photophobia Lacrimation Mildly decreased VA (especially with CME)
Which nerves are causing the pain in anterior uveitis?
Anterior ciliary nerves
What are the common signs of anterior uveitis?
WBCs in the anterior chamber Flare Hypopyon Circumlimbal injection IOP elevation (early stages) KPs
IOP may be decrease during which stages of uveitis, and in which eye?
Early stages
Affected eye
What are the main threats to vision in uveitis?
PAS
PS
CME
Cataract formation
What type of cataract is common in anterior uveitis?
PSC
Why might IOP increase in the affected eye in the later stages of uveitis?
PAS or PS formation
Fine KPs are characteristic of (granulomatous/non-granulomatous) etiology.
Non-granulomatous
Granulomatous etiology of uveitis is more common with what cause?
Infection (TB, syphilis)
What iris nodules may be found in granulomatous uveitis?
Koeppe
Busacca
In what layer of the iris are Koeppe and Busacca nodules found?
Iris stroma
What make up mutton fat KPs?
Macrophages
What are Koeppe nodules?
Collections of WBCs on the pupillary margin
What are Busacca nodules?
Collections of WBCs of any part of the iris stroma that is not the pupillary margin
Busacca nodules are pathognomonic what what etiology of uveitis?
Granulomatous
Koeppe nodules are associated with which etiology of uveitis?
Both granulomatous and non-granulomatous
What are the most common corneal findings in anterior uveitis?
KPs
Acute, non-granulomatous, anterior uveitis is commonly associated with what 7 diseases?
IBS Reactive arthritis Ankylosing spondylitis Psoriatic arthritis Behcet's disease Lyme disease Glaucomatocyclitis Crisis (Posner-Schlossman)
What characterizes reactive arthritis?
Young males with urethritis, polyarthritis, and conjunctivitis (with iritis)
What characterizes psoriatic arthritis?
Peripheral, small joint pain
Psoriatic lesions on the knees, elbows, and scalp
What characterizes Behcet’s disease?
Acute, recurrent hypopyon iritis
Mouth and genital ulcers
Chronic, granulomatous, anterior uveitis may be associated with what major 4 conditions?
Sarcoidosis
TB
Herpes Simplex/Zoster
Syphilis
Sarcoidosis associated uveitis is typically (unilateral/bilateral).
Bilateral
What type of uveitis is associated with sarcoidosis?
May be either posterior or panuveitis
What abnormal findings are common in sarcoidosis?
Abnormal chest x-ray
Increased ACE levels
What are common signs/symptoms of TB?
Positive PPD
Abnormal chest x-ray
Night sweats
What type of uveitis is commonly associated with TB?
Posterior
Panuveitis
Herpes simplex/zoster associated uveitis is commonly associated with increased what of the involved eye?
IOP
What type of KPs may be present in herpes associated uveitis?
Stellate KPs
What are common ocular findings of herpes associated uveitis?
KPs
Corneal edema
Epithelial defects
What 3 things characterize syphilis?
Maculopapular rash of palms and/or soles
Positive VDRL or RPR
Positive FTA-ABS or MHA-TP
Syphilis associated uveitis may have what associated corneal finding?
Interstitial keratitis
What is interstitial keratitis?
Stromal inflammation without primary involvement of the epithelium or endothelium
What characterizes interstitial keratitis?
Acute stromal inflammatory edema and neo
What are the most common causes of interstitial keratitis?
Congenital syphilis
TB
Herpes simplex
What is the triad of congenital syphilis?
Hutchinson’s teeth (small, spaced teeth)
Deafness
Interstitial keratitis
Chronic, non-granulomatous, anterior uveitis may be associated with what two main conditions?
Juvenile idiopathic arthritis (JRA)
Fuchs’ heterochromic iridocyclitis
What three drugs/classes can cause anterior uveitis?
Rifabutin
Systemic sulfonamides
Cidofovir
What is the most common knowns cause of uveitis in kids?
Juvenile idiopathic arthritis
Which gender typically gets JRA (or JIA)?
Young girls
What is the classic presentation of JRA (JIA)?
Bilateral uveitis in young girls
Patients with JRA (JIA) typically have what RF and ANA findings?
Negative RF
Positive ANA
Fuchs’ heterochromic iridocyclitis occurs most frequently in patients with what color eyes?
Blue
What characterizes Fuchs’ heterochromic iridocyclitis?
Unilateral, mild uveitis
Fine stellate KPs
Angle neo
Iris heterochromia
Pars planitis is associated with what systemic conditions?
None - trick question!
