Chapter 3: Examination of the Patient with Uveitis

Question 1

Visual Acuity:

1. A Number of things can cause decreased VA in patients w/Uveitis or retinitis. Name a few
2. What 2 things can compromise Optic Nerve Function?

Answer 1

1. Corneal Opacity, AC Inflammation, Cataract, Vitreous Haze

2. Inflammation or Glaucoma

Question 2

Skin

1. When examining the skin, what 3 things should we look for?

Answer 2

1. Nodules, Rashes, Vitiligo

Question 3

Pupils and Extraocular Muscles

1. Finding of a New Vertical Tropia or Inernuclear Ophthalmoplegia should alert the physician to what?

Answer 3

1. underlying diseases of the CNS that could be associated w/uveitis, like MS, Sarcoidosis, or Non-Hodgkin’s Lymphoma

Question 4

IOPs

1. Why should Fluorescein not be instilled until a proper slit-lamp exam is finished?

Answer 4

1. It enters the Eye and PREVENTS an Accurate assessment of the Amt of Flare in the AC. It can also obscure the view of the Posterior Segment if the pupil is small.

Question 5

Conjunctiva:

1. How can we distinguish TRUE SCLERITIS from Superficial Inflammation (3)?
   a. Scleritis associated with Uveitis is often seen how?
2. Confusion can come when a pt w/intraocular inflammation develops what?

Answer 5

1. Injected Deep Scleral Vessels, Purple Scleral Hue, and severe pain.
   a. Often Nodular and Confined to a Section of the Globe. Ciliary Body injection tends to involve the globe more diffusely
2. an Allergic RxN to Topical Medication

Question 6

Cornea: Keratic Precipitates

1. What is the Most Commonly Reported Corneal Finding in Uveitis?
   a. What are they?
2. How do they normally aggregate on the cornea?
3. How do we seen KP’s with a slit lamp?
4. What are Large KP’s called and when are they seen?
5. What about small KP’s?

Answer 6

1. Keratic Precipitates
   a. Small Aggregates of Inflammatory cells that Accumulate on the Endothelial Surface of the Cornea
2. In a Base down triangle formation (Arlt’s Triangle)
3. Direct or Retroillumination
4. Mutton-Fat Granulomatous KPs made of Macrophages and Giant Cells. Occur in CHRONIC INFLAMMATION
5. Acute Inflammation

Question 7

Other Corneal Findings

1. What can be seen w/Uveitis as a RESULT of HSV?

Answer 7

1. Corneal Dendrites

Question 8

What is a Hypopyon?
a. What is it related to?

b. It’s been associated with what disease?

Answer 8

A Collection of Leukocytes that settles in the lower Angle of the AC. Cause is Unclear and isn’t related just to the Number of cells in the AC.

a. To the PRESENCE of sufficient FIBRIN to cause cells to Clump and Settle.
b. Behcet’s disease, Endophthalmitis, and infection.

Question 9

Iris:

1. What 2 things can occur and what are they?

Answer 9

1. a. Posterior Synechiae (adhesions b/w iris and lens capsule)
   b. Peripheral Anterior Synechiae (PAS): Adhesions b/w Iris and Cornea near the Anterior Chamber Angle (CAN ONLY BE SEEN ON GONIOSCOPY!)

Question 10

What two diseases especially do Vitreous Cells tend to Aggregate into Clumps called “Snowballs?”

Answer 10

Sarcoidosis and Pars Planitis. (usually settle in the Inferior Periphery near the retinal surface).

Question 11

Posterior Vitreous Detachment may be associated with the development of what problem?

Answer 11

Cystoid Macular Edema (CME)

Question 12

How can uveitis affect the Optic Nerve? (3)

2. What is the most common cause of Irreversible Vision loss in the Uveitis Patient?

Answer 12

1. Disc Hyperemia, Papillitis, or Papilledema.

2. Secondary Glaucoma

Question 13

What is MS associated with?

Answer 13

Intermediate Uveitis