Ciliary Body: Anterior Uveitis Flashcards
other names for anterior uveitis
- iritis
- anterior cyclitis
- iridocyclitis
anterior uveitis
inflammation of the pars plicata and/or iris
anterior uveitis etiology/associations
- 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)
anterior uveitis demographics
depends on etiology- think about the demographics of the underlying systemic condition!
anterior uveitis laterality
- depends on etiology
- systemic disease typically causes bilateral uveitis; exception: herpes is typically unilateral
anterior uveitis symptoms
- red eye(s)
- eye pain; severe»_space; mild; may have tearing
- photophobia
- blurred vision
anterior uveitis signs
- 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
anterior chamber reaction: cells
- 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
anterior chamber reaction: flare
- protein in the AC
- fibrinous/plasmoid aqueous is more common in HLA-B27 positive patients
grade the severity of the AC rxn by ____
estimating the # of cells and severity of flare in a 1 mm by 1 mm slit beam
keratic precipitates (KPs)
- 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
Busacca and Koeppe nodules
- WBCs on the iris
- Busacca nodules in the midperiphery
- Koeppe nodules at the pupillary margin
WBCs in the anterior vitreous
- 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
peripheral anterior synechia (PAS)
peripheral iris stuck to peripheral cornea
posterior synechia (PS)
iris pupillary zone stuck to lens
pupillary miosis
- 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
____ IOP more common in acute phase; if herpetic etiology, may have ____ IOP due to concurrent trabeculitis
low;
high
____ IOP more common in chronic phase; due to ____
high;
inflammatory debris obstructing the TM, > 180 degree PS blocking the pupil, > 180 degree PAS blocking the angle, or steroid use
anterior uveitis classifications: onset
sudden or insidious
anterior uveitis classifications: duration
limited (< 3 months) or persistent (> 3 months)
anterior uveitis classifications: clinical course
- acute (sudden and limited) or chronic (insidious and persistent)
- recurrent
anterior uveitis classifications: non-granulomatous
- tends to be due to antigens that ____
- main cells involved are ____
- tends to be ____ uveitis
the immune system believes it can clear completely –> immune system drives an aggressive inflammatory response;
lymphocytes and plasma cells;
an acute
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 ____
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
anterior uveitis complications
- posterior subcapsular cataract (PSC)
- cystoid macular edema (CME)
- band keratopathy
- secondary glaucoma
