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Anterior Segment Disease > Ciliary Body: Ocular Conditions Associated With Anterior Uveitis > Flashcards

Ciliary Body: Ocular Conditions Associated With Anterior Uveitis Flashcards

1
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis)

A

acute, recurrent anterior uveitis with markedly elevated IOP

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2
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) etiology/associations

A
  • idiopathic

- however, evidence suggests connection with herpes simplex (HSV) or cytomegalovirus (CMV) infection

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3
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) demographics

A

typically occurs between the ages of 20-50 years

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4
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) laterality

A

unilateral&raquo_space;> bilateral

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5
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) symptoms

A
  • asymptomatic
  • mild to no red eye
  • mild eye pain- “dull ache” or “pressure”
  • mild photophobia
  • halos
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6
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) signs

A
  • white eye or minimal injection of the conj and/or limbus (no ciliary flush)
  • mild AC rxn (cells much more common than flare)
  • few fine KPs, non-granulomatous
  • markedly increased IOP, typically 40-60 mmHg
  • microcystic corneal edema, secondary to elevated IOP
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7
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) complications

A

-secondary glaucoma (inflammatory): due to inflammatory debris obstructing the TM or trabeculitis, additional risk of ONH damage over time from IOP spikes

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8
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) management

A
  • self-limiting (occur and resolve spontaneously regardless of treatment); attacks usually subside within a few hours to a few weeks; intervals between attacks vary from a few days to several years
  • topical steroid during acute attacks; may or may not improve inflammatory response; Pred Acetate 1% qid-q1h until improved, then taper
  • IOP lowering meds during acute attacks (in tandem with steroid Tx); prostaglandins can make the inflammation worse; between episodes, IOP is typically within a normal range; if glaucoma develops, treatment will be ongoing
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9
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis):

  • must monitor for ____
  • how?
A

glaucoma;

  • IOP
  • gonioscopy
  • thorough DFE
  • baseline testing, to repeat as indicated to assess for progression: ONH photos, ONH OCT (RNFL), GCC, HVF (start with 24-2, then 10-2 if needed)
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10
Q

Posner-Schlossman Syndrome (glaucomatocyclitic crisis) clinical pearls:

  • treatment only necessary during _____
  • when condition recurs it involves _____
  • eventually, episodes _____
  • rare after _____
A

“outbreak”;
the same eye;
appear to stop;
age 60

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11
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC)

A

chronic anterior uveitis with non-hereditary heterochromia

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12
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) etiology/assocations

A
  • idiopathic

- however, evidence suggests connections to rubella viral infection

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13
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) demographics

A

typically begins between the ages of 20-30 years

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14
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) laterality

A

unilateral > bilateral

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15
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) symptoms

A
  • typically asymptomatic
  • if symptoms occur: mild redness and mild pain, “discomfort”
  • may notice discoloration of iris (change in color over time is pathognomonic for FHIC)
  • blurry vision; cataract development
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16
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) signs

A
  • minimal to no injection of the conj and/or limbus
  • mild AC rxn: cells, may also present in anterior vitreous
  • diffuse iris stromal atrophy leading to a lighter colored iris with TIDs
  • diffuse fine, stellate KPs, non-granulomatous
  • fine vascularization of the angle (TM) and iris root
  • rare: Koeppe or Busacca nodules, iris sphincter atrophy –> irregular pupil shape
17
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) complications

A
  • PSC: due to chronic anterior uveitis, typically the cause of visual changes
  • secondary glaucoma (inflammatory): due to inflammatory debris or blood obstructing the TM
  • hyphema (blood in AC): due to leakage of blood from fine blood vessels in the angle; recurrent, spontaneous
18
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) management

A
  • inflammatory response generally unresponsive to steroids
  • a trial of steroids may be attempted, but they should be tapered quickly if there is no response
  • elevated IOP typically does not improve with topical treatment
19
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC):

  • must monitor for _____
  • how?
A

glaucoma;

  • IOP
  • gonioscopy
  • thorough DFE
  • baseline testing, to repeat as indicated to assess for progression: ONH photos, ONH OCT (RNFL), GCC, HVF (start with 24-2, then 10-2 if needed)
20
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC):

-if glaucoma develops, 70% failure on _____; best IOP control with ____

A

topical therapy;

trabeculectomy and shunt surgeries (Ahmed Glaucoma Valve)

21
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC):

-if PSC/cataract develops, _____

A

cataract surgery (phacoemulsification with PCIOL)

22
Q

Fuchs’ Heterochromic Iridocyclitis (FHIC) clinical pearls:

  • accounts for ____% of all uveitis cases
  • overall incidence of glaucoma ranges from _____%
  • cataract development is seen in over ___% of eyes with FHIC (may refer for cataract surgery sooner than “standard” cataract patients)
A

1-3;
13-60;
80

23
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH)

A

anterior uveitis with elevated IOP, pigment dispersion, and/or hyphema post cataract surgery

24
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) etiology

A
  • chafing/disruption of the iris or CB by an IOL
  • mechanical trauma from IOL malpositioning; less likely with PCIOL placed in the capsular bag; more likely with an ACIOL or sulcus PCIOL
25
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) demographics

A

pseudophakes (patients that have had cataract surgery and received an IOL)

26
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) laterality

A

unilateral

27
Q

ACIOL

A

can see entire extent of IOL in the AC, with haptics (arms) of the IOL inserted or sutured into the iris

28
Q

PCIOL

A

positioned behind the iris, where the natural lens used to be, with haptics (arms) of the IOL inserted into the capsular bag or the sulcus

29
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) symptoms

A
  • red eye
  • eye pain: ranges mild to severe, may have tearing
  • photophobia
  • blurred vision: from the anterior uveitis and/or the malpositioned IOL, typically worse after exercise
30
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) signs

A
  • injection of the conj and/or limbus
  • AC rxn, low-grade
  • displaced IOL, touching the iris or pars plicata
  • iris atrophy with TIDs
  • elevated IOP: from pigment release or hyphema
  • hyphema: mechanical breakdown of blood-aqueous barrier
31
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) complications

A
  • CME: due to chronic anterior uveitis with spillover into the macula
  • secondary glaucoma (inflammatory): due to inflammatory debris or blood obstructing the TM
32
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) management

A

begin topical cycloplegic + topical steroid + IOP lowering meds; prostaglandins can make the inflammation worse

33
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH):

  • must monitor for ____
  • how?
A

xglaucoma;

  • IOP
  • gonioscopy
  • thorough DFE
  • baseline testing, to repeat as indicated to assess for progression: ONH photos, ONH OCT (RNFL), GCC, HVF (start with 24-2, then 10-2 if needed)
34
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH):

-patient will required _____

A

surgical repositioning, replacement, or removal of the IOL

35
Q

Uveitis-Glaucoma-Hyphema syndrome (UGH) clinical pearls:

  • ____ can aid in viewing a displaced ACIOL
  • ____ can aid in viewing a displaced PCIOL
A

ASeg OCT;

UBM

Anterior Segment Disease (22 decks)

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