Anterior Uveitis Flashcards
Anterior uveitis is the inflammation of
Pars plicata and/or the iris.
idiopathic in __% of cases
50
Etiology/associations
50% idiopathic Post op Trauma Autoimmune- SLE, JIA, IBD, ankylosing spondylitis. HLA B27 positive Systemic infection- Herpes simplex or zoster, TB. Inflammation elsewhere in globe Anterior segment ischemia Retinal detachment Lens or drug induced. Cancer
Laterality
Systemic disease usually causes bilateral.
Exception- herpes usually unilateral.
Symptoms
Red eye Eye pain Tearing Photophobia Blurred vision
Signs
Injection of the conj and/or around the limbus (ciliary flush, circumlimbal flush)
AC rxn- WBC in AC. If severe, hypopyon can form.
Flare in AC (protein)
Ciliary flush
KP
Busacca/Koeppe nodules
PAS or PS
Pupillary mitosis
Low IOP in acute phase, High in chronic phase due to inflammatory disease obstructing TM or steroids.
Iris atrophy
ciliary flush, circumlimbal flush
Injection of the conj and or around the limbus
Keratic precipitates (KP)
WBCs on the K endothelium.
Fine KPs
Small, punctate, white WBCs on the K endothelium
Mutton Fat KPs
Large, greasy, yellow WBCs on the K endothelium. Typically inferior in arlt’s triangle.
Arlt’s triangle
Characteristic of granulatomous infection. Triangle inferior K endothelium
Busacca/Koeppe nodules
WBCs on the iris.
Busacca- mid periphery
Koeppe nodules keep to the pupillary margin
Peripheral anterior synechia (PAS)
Peripheral iris stuck to peripheral cornea
Posterior synechia (PS)
Iris pupillary zone stuck to the anterior lens.
How does IOP changed based on acute or chronic uveitis?
Acute- Lower IOP. (higher if herpetic etiology)
Chronic- Higher IOP. Due to inflammatory debris obstructing the TM or use of steroids.
Complications
Cystoid macular edema (CME)
PSC
Band keratopathy (Linear band of calcium that deposits at the level of bowman’s layer and anterior stroma)
Glaucoma
Cystoid macular edema (CME)
Due to chronic anterior uveitis with spillover into the macula.
What is band keratopathy?
Linear band of calcium that deposits at the level of bowman’s layer and anterior stroma
Management
Topical cycloplegic
Topical steroid (oral for severe)
Break PS with 10% phenyl or 1% atropine
Consider IOP lowering med (prostaglandins can make inflam worse)
Order lab work if bilateral, chronic, recurrent
Refer out for systemic tx
Most common form of uveitis
Anterior uveitis
Can you clinically distinguish between inflammation of iris and pars plicata?
No
Can patients have symptoms a few days before clinical signs are present?
Yes
Intermediate uveitis
Inflammation of pars plana, peripheral retina and vitreous
Posterior uveitis
Inflammation of choroid/retina
Can also involve blood vessels (vasculitis) and/or the ON (optic neuritis)
Panuveitis
Anterior + intermediate + posterior uveitis with no predominant site
Dilation with uveitis can lead to
Shedding of pigment cells into the aqueous.
But always want to dilate to check for posterior involvement.
How to describe the inflammatory response
Onset - sudden or insidious
Duration- limited (less than 3 months) or chronic (greater than 3 months)
Clinical course- acute (sudden/limited) or chronic (insidious and persistent) or recurrent.
Non granulomatous- Strong immune response. Main cells involved are lymphocytes and plasma cells. Tends to be acute uveitis.
Granulomatous- Main cells involved are non phagocytic macrophages called epithelia cells that fuse together to create granuloma. Tends to be chronic uveitis.
Granulomatous signs
Chronic uveitis
Mutton fat KPs
Busacca or Koeppe nodules.
Fibrinous/plasmoid aqueous is more common in ___ positive patients
HLA B27
Hypopyon is more common in ___ disease and ____ positive pts
Bechet’s and HLA B27