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Anterior Segment Disease > Ciliary Body: Anterior Uveitis > Flashcards

Ciliary Body: Anterior Uveitis Flashcards

1
Q

other names for anterior uveitis

A
  • iritis
  • anterior cyclitis
  • iridocyclitis
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2
Q

anterior uveitis

A

inflammation of the pars plicata and/or iris

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3
Q

anterior uveitis etiology/associations

A
  • idiopathic in ~50% of cases
  • post-operative ocular surgery (cataract surgery)
  • trauma
  • autoimmune, inflammatory systemic disease; most common diseases include: sarcoidosis, SLE, JIA, IBD, Reiter’s, ankylosing spondylitis, psoriatic arthritis, GPA, PAN, Behcet’s
  • HLA-B27 positivity: with or without related systemic disease (UCRAP conditions)
  • systemic infection; most common infections include herpes simplex, herpes zoster, lyme, syphilis, TB; rare infections include mumps, influenza, adenovirus, measles, chlamydia
  • inflammation elsewhere in the globe (cornea, sclera, retina, choroid)
  • anterior segment ischemia (ex: carotid insufficiency, tight scleral buckle, or previous EOM surgery)
  • retinal detachment
  • lens-induced (ex: rupture of hypermature cataract, incomplete cataract extraction)
  • drug induced (ex: rifabutin, cidofovir)
  • masquerading syndrome (cancer, metastasis)
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4
Q

anterior uveitis demographics

A

depends on etiology- think about the demographics of the underlying systemic condition!

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5
Q

anterior uveitis laterality

A
  • depends on etiology

- systemic disease typically causes bilateral uveitis; exception: herpes is typically unilateral

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6
Q

anterior uveitis symptoms

A
  • red eye(s)
  • eye pain; severe&raquo_space; mild; may have tearing
  • photophobia
  • blurred vision
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7
Q

anterior uveitis signs

A
  • injection of the conjunctiva and/or around the limbus (ciliary flush/ circumlimbal flush/ circumlimbal injection)- may range from faint/mild to severe; may not be present if chronic
  • anterior chamber reaction: cells and flare
  • keratic precipitates (KPs)
  • Busacca or Koeppe nodules
  • WBCs in the anterior vitreous
  • peripheral anterior synechia (PAS)
  • posterior synechia (PS)
  • pupillary miosis
  • low IOP more common in acute phase
  • high IOP more common in chronic phase
  • iris atrophy if chronic
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8
Q

anterior chamber reaction: cells

A
  • WBCs in the AC
  • moves with the convection current of aqueous
  • if severe, hypopyon (layer of WBCs in the AC) can form; hypopyon more common in Behcet’s disease and HLA-B27 positive patients
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9
Q

anterior chamber reaction: flare

A
  • protein in the AC

- fibrinous/plasmoid aqueous is more common in HLA-B27 positive patients

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10
Q

grade the severity of the AC rxn by ____

A

estimating the # of cells and severity of flare in a 1 mm by 1 mm slit beam

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11
Q

keratic precipitates (KPs)

A
  • WBCs on the K endothelium
  • typically inferior in Arlt’s triangle
  • if chronic, can become pigmented and irregular
  • fine KPs: small, punctate, white
  • Mutton-fat KPs: large, greasy, yellow
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12
Q

Busacca and Koeppe nodules

A
  • WBCs on the iris
  • Busacca nodules in the midperiphery
  • Koeppe nodules at the pupillary margin
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13
Q

WBCs in the anterior vitreous

A
  • due to inflammatory spillover into the vitreous
  • cells can accumulate and create a hypopyon
  • hypopyon is more common in Behcet’s disease and HLA-B27 positive patients
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14
Q

peripheral anterior synechia (PAS)

A

peripheral iris stuck to peripheral cornea

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15
Q

posterior synechia (PS)

A

iris pupillary zone stuck to lens

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16
Q

pupillary miosis

A
  • more common in chronic uveitis; due to inflammatory mediators; sluggish, minimal, or non-reactive to light
  • pupil may be normal in acute uveitis
  • pupil may also be irregular in shape; more common in recurrent or chronic uveitis; due to synechiae or iris atrophy
17
Q

____ IOP more common in acute phase; if herpetic etiology, may have ____ IOP due to concurrent trabeculitis

A

low;

high

18
Q

____ IOP more common in chronic phase; due to ____

A

high;
inflammatory debris obstructing the TM, > 180 degree PS blocking the pupil, > 180 degree PAS blocking the angle, or steroid use

19
Q

anterior uveitis classifications: onset

A

sudden or insidious

20
Q

anterior uveitis classifications: duration

A

limited (< 3 months) or persistent (> 3 months)

21
Q

anterior uveitis classifications: clinical course

A
  • acute (sudden and limited) or chronic (insidious and persistent)
  • recurrent
22
Q

anterior uveitis classifications: non-granulomatous

  • tends to be due to antigens that ____
  • main cells involved are ____
  • tends to be ____ uveitis
A

the immune system believes it can clear completely –> immune system drives an aggressive inflammatory response;
lymphocytes and plasma cells;
an acute

23
Q

anterior uveitis classifications: granulomatous

  • tends to be due to antigens that ____
  • main cells involved are ____
  • tends to be ____ uveitis
  • tends to occur in ____
  • granulomatous sings include ____
A

have learned to evade the immune system –> immune cells build a wall around the antigens (granuloma) to prevent further growth or spread;
non-phagocytic macrophages called epithelioid cells that fuse together to form giant cells;
a chronic;
sarcoidosis, lyme, syphilis, TB;
mutton-fat KPs and Busacca or Koeppe nodules

24
Q

anterior uveitis complications

A
  • posterior subcapsular cataract (PSC)
  • cystoid macular edema (CME)
  • band keratopathy
  • secondary glaucoma
25
Q

anterior uveitis complications: posterior subcapsular cataract (PSC)

A

due to chronic anterior uveitis or steroid use

26
Q

anterior uveitis complications: cystoid macular edema (CME)

A
  • due to chronic anterior uveitis with inflammatory spillover into the macula
  • dilate your uveitis patients!!
  • can visualize on OCT
  • the macular may appear elevated or irregular on your DFE
  • may improve with topical steroids, may require retinal specialist referral for intra-vitreal anti-VEGF
27
Q

anterior uveitis complications: band keratopathy

A
  • linear band of calcium that deposits in the cornea at the level of Bowman’s layer and anterior stroma
  • due to chronic anterior uveitis
28
Q

anterior uveitis complications: secondary glaucoma

A
  • inflammatory etiology
  • Posner-Schlossman Syndrome aka glaucomatocyclitic crisis
  • due to self-limited, recurrent, prolonged elevated IOP in tandem with anterior chamber inflammation (non-granulomatous)
29
Q

anterior uveitis management

A
  • if posterior synechiae, break with 10% phenyl or 1% atropine; may require synechialysis, commonly done in tandem with cataract surgery
  • topical cycloplegic: for ocular comfort, reduces ciliary spasm
  • topical steroid: for persistent severe inflammation, consider oral steroids or subconj steroid injection
30
Q

always obtain a baseline ____ before starting steroid treatment

A

IOP

31
Q

RTC may vary based on severity and treatment regimetn:

  • more severe = _____
  • more mild = _____
A

1-2 day RTC;

3-7 day RTC

32
Q

intermediate uveitis

A

inflammation of pars plana, peripheral retina, and vitreous

33
Q

posterior uveitis

A
  • inflammation of choroid and/or retina

- can also involve blood vessels (vasculitis) and/or teh ON (optic neuritis)

34
Q

panuveitis

A

anterior + intermediate + posterior uveitis with no predominant site

35
Q

when to order lab work

A

if bilateral, chronic, recurrent, granulomatous, worsening, or in conjunction with an intermediate or posterior uveitis and etiology is unknown, order lab work based on the most likely etiologies

36
Q

if systemic etiology, ____

A

refer out for systemic treatment

37
Q

____ is most common form of uveitis

A

anterior uveitis

38
Q

cannot clinically distinguish between inflammation of the ____ and ____

A

iris; pars plicata

Anterior Segment Disease (22 decks)

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