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Anterior Segment > Block 16: Anterior Uveitis > Flashcards

Block 16: Anterior Uveitis Flashcards

1
Q

What is anterior uveitis?

A

Inflammation of the anterior-most portion of the uveal tract (iris + anterior part of ciliary body)

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2
Q

What is the anterior part of the ciliary body called?

A

Pars plicata

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3
Q

Inflammation of all uveal structures is called ____?

A

Panuveitis

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4
Q

What are two other names sometimes used when referring to anterior uveitis?

A
  1. Iritis

2. Iridocyclitis

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5
Q

What is the most common cause of anterior uveitis?

A

Idiopathic (50%)

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6
Q

What is the second most common cause/association of anterior uveitis?

A

Non-infections, associated with being HLA-B27 positive

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7
Q

What is the cause of a clinical presentation that looks like anterior uveitis, but is not “true anterior chamber inflammation”

A

Masquerade

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8
Q

How can the onset of anterior uveitis be described? (2 answers)

A
  • Sudden

- Insidious (chronic/slow development)

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9
Q

What is the time frame that denotes whether anterior uveitis is limited or persistent.

A

3 months - anything lasting longer than 3 months is persistent

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10
Q

If the course of anterior uveitis is described as having a sudden onset with limited duration, this is known as ____?

A

Acute Anterior Uveitis

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11
Q

If the course of anterior uveitis is described as repeated episodes of inflammation separated by untreated periods without inflammation, this is known as ____?

A

Recurrent Anterior Uveitis

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12
Q

If the course of anterior uveitis is described as lasting longer than 3 months and recurring within 3 months if left untreated, this is known as _____?

A

Chronic Anterior Uveitis

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13
Q

Which is the most common onset of anterior uveitis? (acute or chronic?)

A

Acute

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14
Q

How is the pain frequently described in anterior uveitis?

A

Dull/achy

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15
Q

Anterior uveitis can be asymptomatic until complications such as ______ develop

A

Cataracts

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16
Q

Where is the redness mostly concentrated in an eye with anterior uveitis?

A

Perilimbal or Circumlimbal Injection

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17
Q

In anterior uveitis, “ciliary flush” or “ciliary body flush” refers to ____?

A

Perilimbal injection (redness around limbus/corneal margin)

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18
Q

What is a common difference in a red eye due to conjunctivitis versus a red eye due to anterior uveitis?
(Referring to the location of the redness…)

A
  • Conjunctivitis is often more red further away from limbus, especially in fornices.
  • Anterior Uveitis is more red around limbus
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19
Q

Is the pupil often constricted or dilated in anterior uveitis?
What causes this?

A
  • Constricted (miosis)

- Due to spasm of iris sphincter muscle from the inflammation

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20
Q

A constricted pupil in anterior uveitis predisposes to _____?

A

Posterior synechiae

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21
Q

Which feature is KEY in both diagnosing anterior uveitis and grading the severity?

A

Cells in anterior chamber

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22
Q

What is the convection current in the eye?

A

The increasing warmth towards the back of the eye causes cells in anterior chamber to float upward further back in the AC (towards the lens) and downward further forward in the AC (towards cornea)

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23
Q

The presence of white inflammatory cells settling in the bottom of the anterior chamber is called ____?
This indicates anterior uveitis that is _____? (how severe?)

A
  • Hypopyon

- Moderate to severe uveitis

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24
Q

Which surface of the cornea to keratic precipitates form on in anterior uveitis?

A

Posterior surface

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25
Q

Keratic precipates forming in a triangle that is wider inferiorly in anterior uveitis is called ____?

A

Arlt’s Triangle

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26
Q

What is the reason that keratic precipates often occur more inferiorly on cornea?

A

Convection current - cells move downward towards front of anterior chamber

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27
Q

What causes hazy flare in anterior uveitis?

A

Increased amounts of inflammation causing a leakage of protein from blood vessels. (Protein = flare)

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28
Q

Inflammatory cell precipitates forming on surface of the iris near the pupillary margin are called ____?

A

Koeppe Iris Nodules

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29
Q

Inflammatory cell precipates forming on peripheral surface of iris are called _____?

A

Busacca

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30
Q

Where do Koeppe iris nodules form?

A

Surface of iris at pupillary margin

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31
Q

Where do Busacca iris nodules form?

A

Peripheral surface of iris

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32
Q

If you dilate a patient with anterior uveitis and notice a small, pigmented ring on the pupil, what does this indicate?

A

Posterior synechiae - pigmented ring is where iris was stuck to anterior surface of lens

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33
Q

What can help break up posterior synechiae?

A

Dilation

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34
Q

Using retroillumination in a patient with anterior uveitis can help determine the presence or absence of ____?

A

Iris atrophy

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35
Q

Is iris atrophy more common in acute or long-standing inflammation?

A

Long-standing

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36
Q

How can anterior uveitis affect IOP?

A

Can be high or low

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37
Q

Is IOP usually high or low initially in anterior uveitis?

A

Low IOP

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38
Q

What causes IOP to be low in initial and active anterior uveitis?

A

Inflamed ciliary body cannot produce and secrete aqueous humor as well. But the drainage system (through the trabecular meshwork) is unaffected.

Aqueous humor exits at normal rate, but is produced at a slower rate = decreased IOP

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39
Q

How may persistent anterior uveitis affect IOP?

Why?

A

Increase IOP

Because the inflammatory cells can clog the trabecular meshwork and slow the drainage of aqueous from the eye

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40
Q

How often should you dilate a patient with anterior uveitis?

Why?

A
  • 100% of the time

- Checking for posterior segment inflammation

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41
Q

When would further investigation of anterior uveitis NOT be needed?

A
  • First episode of mild to moderate acute anterior uveitis with no indication of underlying ocular/systemic disease (or underlying disease is already known)
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42
Q

List 3 indications for further investigation in anterior uveitis.

A
  1. Acute anterior uveitis that is recurrent, severe, or bilateral
  2. Any anterior uveitis that is chronic, granulomatous, resistant to treatment
  3. Suggestion of underlying disease based on ocular or systemic findings
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43
Q

Acute anterior uveitis has a strong association with which HLA?

A

HLA-B27

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44
Q

HLA-B27 is often associated with anterior uveitis that is chronic or acute?

A

Acute

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45
Q

What is a disadvantage of blood tests when investigating anterior uveitis?

A

Never 100% specific/sensitive

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46
Q

When a specific disorder is suspected to be associated with anterior uveitis, what is the best action an optometrist should make in determining the disorder?

A

Consult with appropriate specialist

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47
Q

What is a CBC finding with parasitic infections?

A

Eosinophilia

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48
Q

What does a CBC finding with exceptionally high leukocytosis usually indicate?

A

Malignancy

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49
Q

A chest Xray helps detect which two associated conditions of anterior uveitis?

A
  1. TB

2. Sarcoidosis

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50
Q

An X-ray of _______ can help detect seronegative ankylosing spondylitis

A

Sacroiliac joint

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51
Q

What is a common X-ray finding in a patient with TB?

A

Hilar adenopathy

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52
Q

What treatment is used in most cases of anterior uveitis to suppress inflammation?

A

Topical steroid: Prednisone Acetate 1%

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53
Q

How often should a patient use a topical steroid in most cases of anterior uveitis?

A

Frequent initial doses - hourly

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54
Q

Cycloplegic drops are used in most cases of anterior uveitis for ______? (2 answers)

A
  1. Preventing and/or breaking up posterior synechiae

2. Promoting comfort by relaxing ciliary muscle

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55
Q

What needs to be monitored when using a treatment to suppress inflammation in most cases of anterior uveitis?

A

IOP

56
Q

What are 2 alternatives to topical steroids when trying to suppress inflammation in anterior uveitis?

A
  1. Steroid injections or pills

2. NSAIDs/anti-metabolites

57
Q

An example of a drop used in most cases of anterior uveitis to promote comfort by relaxing ciliary muscle is ____?

A

Homatropine 5%

58
Q

Any joint disease of the vertebral column is called a ______?

A

Spondyloarthropathy

59
Q

3 common features of spondyloarthropathies are _____?

A
  1. HLA-B27 positive
  2. Rheumatoid factor seronegative
  3. Enthesitis
60
Q

How should chronic anterior uveitis that is associated with a spondyloarthropthy be treated?

A

Second-line systemic immunosuppressant (biological blocker) - handled by sub-specialist

61
Q

What is an “Enthesis”

A

Point where ligament or tendon attaches to bone

62
Q

Inflammation of the point where a ligament or tendon attaches to bone is called ____?

A

Enthesitis

63
Q

Ankylosing Spondylitis most commonly presents in what types of patients? (3 features)

A
  1. Men
  2. 20-30 years old
  3. HLA-B27 +
64
Q

Radiology demonstrates early changes ______ with Ankylosing Spondylitis

A

Sacroiliac joint

65
Q

Late ankylosing spondylitis is often described as____?

A

“Bamboo spine”

66
Q

What is the correlation between eye and joint involvement in ankylosing spondylitis? (little or high?)

A

Little correlation

67
Q

Bony fusion of the spine refers to ____?

A

Ankylosing spondylitis

68
Q

Reactive arthritis is known as ____?

A

Reiter’s Syndrome

69
Q

What are the 3 characterizations of Reiter’s Syndrome?

A
  1. Urethritis
  2. Conjunctivitis
  3. Arthritis
70
Q

What percent of patients are HLA-B27 positive in Reiter’s Syndrome?

A

75%

71
Q

What can cause Reactive Arthritis?

A

Triggering infection by various organisms

72
Q

Acute anterior uveitis occurs in what percent of patients with Reactive Arthritis?

A

20%

73
Q

Arthritis develops in 40% of patients affected with ____?

A

Psoriasis

74
Q

What race and age group is most likely to develop Psoriatic Arthritis?

A
  • Caucasians

- Middle age

75
Q

25% of males with acute anterior uveitis have ____?

A

Ankylosing spondylitis

76
Q

The most common form of psoriasis is ___?

A

Plaque-type (well-demarcated raised silvery inflamed plaques on scalp, trunk, arms, legs)

77
Q

Acute anterior uveitis occurs in what percent of patients with Psoriatic arthritis?

A

7%

78
Q

What are 2 examples of inflammatory bowel disease?

A
  1. Ulcerative colitis

2. Crohn’s disease

79
Q

What age group do both ulcerative colitis and crohn’s disease often present?

A

10-30 years old

80
Q

What percent of patients with Ulcerative colitis or Crohn’s disease develop acute anterior uveitis?

A
  • Ulcerative Colitis: 5%, especially if HLA-B27 positive and/or have arthritis
  • Crohn’s Disease: 3%
81
Q

Long-standing abdominal cramps + bloody diarrhea are common symptoms of ______ and may develop _____ cancer.

A
  • Ulcerative colitis

- Colon cancer

82
Q

Crohn’s disease is _____ (type?) inflammation of the ________ (location?)

A

Granulomatous inflammation of intestinal wall

83
Q

Biological blockers have been endorsed by the American Uveitis Society for the treatment of what type of anterior uveitis?

A
  • Chronic
  • Vision-threatening
  • Associated Spondyloarthropathy
84
Q

Treating anterior uveitis with an associated spondyloarthropathy with _____ (drug?) has serious side effects and should be handled by ______ (person?)

A
  • Biological blockers

- Sub-specialist

85
Q

How is acute anterior uveitis treated when associated with a spondyloarthropathy?

A

Treated same as normal acute cases…

  1. Most use topical steroid to suppress inflammation
  2. Most use cycloplegic drops for post synechiae and promote comfort
86
Q

A chronic, usually unilateral ocular inflammation of unknown cause is known as ____?

A

Fuchs Uveitis Syndrome

87
Q

Describe the symptoms in fuchs uveitis syndrome

A

Minima - usually incidental finding

88
Q

How is the anterior chamber reaction labeled in fuchs uveitis syndrome? (absent, mild, severe?)

A

Mild cells

89
Q

How is the hyperemia described in fuchs uveitis syndrome? (absent, mild, severe?)

A

Absent

90
Q

The majority of patients with Fuchs Uveitis Syndrome eventually develop _____?

A

Glaucoma

91
Q

What is a very common finding in the lens with Fuchs Uveitis Syndrome?

A

Cataract

92
Q

What age does Fuchs Uveitis Syndrome typically present?

A

40

93
Q

What finding is always absent in Fuchs Uveitis Syndrome?

A

Hyperemia

94
Q

How is the iris affected in Fuchs Uveitis Syndrome?

What is the appearance of an affected brown eye vs blue eye?

A
  • Iris atrophy/heterochromia
  • Affected eye becomes hypochromic (loses pigmentation)
  • Change is subtle in brown eyes
  • Blue eyes may appear brownish due to posterior pigment layer showing through
95
Q

What type of treatment is usually NOT indicated in Fuchs Uveitis Syndrome?

A

Steroids

96
Q

What type of treatment may be considered in a case of severe Fuchs Uveitis Syndrome?

(this tx is generally NOT indicated for average cases)

A

Steroid drops (gtt)

97
Q

Regular, long-term monitoring for _____ is necessary in Fuchs Uveitis Syndrome?

A

Glaucoma

98
Q

An arthritis of unknown cause that occurs before age 16 and lasts at least 6 weeks is called _____?

A

Juvenile Idiopathic Arthritis

99
Q

Juvenile Idiopathic Arthritis is usually chronic or acute? Unilateral or bilateral?

A

Chronic and bilateral

100
Q

What are 4 potential causes of significant compromise in Juvenile Idiopathic Arthritis?

A
  1. Band keratopathy
  2. Cataract
  3. Glaucoma
  4. Maculopathies
101
Q

What is a key cause of morbidity in juvenile idiopathic arthritis?

A

Anterior uveitis

102
Q

Anterior uveitis is most common in what form of juvenile idiopathic arthritis?

A

Oligoarticular

103
Q

Why is detection of anterior uveitis in juvenile idiopathic arthritis often delayed?

A

Because it is often asymptomatic and has no injection/redness (even with severe AC reactions)

104
Q

Describe endothelium during acute exacerbations of anterior uveitis in juvenile idiopathic arthritis?

A

Entire endothelium shows “dusting” by hundreds of cells

105
Q

The most common systemic disease associated with childhood anterior uveitis is _____?

A

Juvenile Idiopathic Arthritis

106
Q

Hypopyon is often present or absent in juvenile idiopathic arthritis?

A

Absent

107
Q

Posterior synechiae is common or uncommon in long-standing, undetected cases of anterior uveitis in juvenile arthritis?

A

Common

108
Q

What are 3 examples of signs parents may eventually notice in anterior uveitis with juvenile idiopathic arthritis?

A
  1. Strabismus
  2. Abnormal appearance of eye due to….
    - Band keratopathy
    - Cataract
109
Q

How often should children known to have juvenile idiopathic arthritis be screened?

A

Every 3-4 months until age 12

110
Q

What type of treatment is proven effective in most cases of anterior uveitis in juvenile idiopathic arthritis?

A

Topical steroids

111
Q

What can be used to prevent posterior synechiae in anterior uveitis (with juvenile idiopathic arthritis)?

A

Mydriasis

112
Q

Why should mydriasis be short acting and discontinued ASAP in anterior uveitis with juvenile idiopathic arthritis?

A

Increased risk of amblyopia

113
Q

An immune response to lens proteins is called ____?

A

Lens-induced (phacogenic) uveiits

114
Q

What are 3 potential causes of lens induced phacogenic uveitis?

A
  1. Incomplete cataract extraction
  2. Trauma
  3. Capsular degeneration in mature cataract (rare)
115
Q

A chronic disorder of unknown cause that manifests with non-caseating granulomatous inflammatory foci is _____?

A

Sarcoidosis

116
Q

The most common ocular sign of Sarcoidosis is ___?

A

Granulomatous anterior uveitis

117
Q

“Mutton fat” in sarcoidosis refers to _____?

A

Keratic precipitates or iris nodules

118
Q

Chest X-ray often shows _____ in Sarcoidosis?

A

Bilateral hilar lymphadenopathy

119
Q

A patient with Sarcoidosis will have a positive or negative TB test?

A

Negative

120
Q

What is commonly used to treat ocular sarcoidosis?

A

Steroids

121
Q

Is sarcoidosis usually unilateral or bilateral?

A

Bilateral

122
Q

An idiopathic multi system syndrome characterized by recurrent oral ulcers, genital ulceration, and uveitis is ____?

A

Bechet’s Disease

123
Q

What is the main cause of visual impairment in Bechet’s disease?

A

-Retinal vascular disease

124
Q

A common sign of anterior uveitis in Bechet’s disease is ___

A

Bilateral mobile hypopyon in relatively white eye

125
Q

Anterior uveitis affects what percent of patients with herpes zoster ophthalmicus?

A

50%

126
Q

When is the onset of anterior uveitis in HZV?

A

1-3 weeks after acute skin rash

127
Q

How is the iris often affected in HZV anterior uveitis?

A

Sectoral iris ischemia and atrophy

128
Q

How is corneal sensation often affected in HZV anterior uveitis?

A

Reduced corneal sensation

129
Q

What are 3 common components to treatment in HZV anterior uveitis?

A
  1. Topical steroids
  2. Mydriatics/Cycloplegics
  3. Oral antiviral within 72 hours of rash onset
130
Q

A relatively quiet eye with a few keratic precipitates, high repeated IOP spikes, and absence of heterochromia/iris atrophy and cataract formation is known as ____?

This may be confused for ____?

A
  • Positive Schlussmann Syndrome or Glaucomatocyclitic Crisis

- Can be confused for Fuchs Uveitis Syndrome

131
Q

What is a key difference in iris atrophy in anterior uveitis caused by a virus versus other causes?

A

Virus-Related anterior uveitis causes patchy/sectorial iris atrophy
(rather than even distribution in other cases)

132
Q

A chief complaint of blurred vision is common in HZV and HSV anterior uveitis due to ___?

A

Corneal edema

133
Q

Diffuse keratic precipitate (rather than Arlt’s triangle where they settle inferiorly) typically indicates anterior uveitis caused by ____?

A

Virus

134
Q

How can you differentiate a dendritic pattern on cornea due to HSV Anterior Uveitis versus HSV Keratitis?

A

HSV Anterior Uveitis: Ulcer is actually keratic precipitates forming on endothelium of cornea. If you stain this cornea, it would be clear

HSV Keratitis: Ulcer is due to epithelial defect and staining would show dendritic ulcer

135
Q

Redness that is more intense toward fornices and less intense near limbus is most likely ____?

A

Conjunctivitis

136
Q

A “bulls-eye rash” + anterior uveitis indicates ______ as the probable cause of anterior uveitis?

A

Lyme’s disease

137
Q

Anterior uveitis + VDRL positive test indicates ____ as the probably cause of anterior uveitis?

A

Syphilis

Anterior Segment (3 decks)

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