Ciliary Body: Ocular Conditions Associated With Anterior Uveitis Flashcards
Posner-Schlossman Syndrome (glaucomatocyclitic crisis)
acute, recurrent anterior uveitis with markedly elevated IOP
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) etiology/associations
- idiopathic
- however, evidence suggests connection with herpes simplex (HSV) or cytomegalovirus (CMV) infection
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) demographics
typically occurs between the ages of 20-50 years
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) laterality
unilateral»_space;> bilateral
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) symptoms
- asymptomatic
- mild to no red eye
- mild eye pain- “dull ache” or “pressure”
- mild photophobia
- halos
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) signs
- 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
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) complications
-secondary glaucoma (inflammatory): due to inflammatory debris obstructing the TM or trabeculitis, additional risk of ONH damage over time from IOP spikes
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) management
- 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
Posner-Schlossman Syndrome (glaucomatocyclitic crisis):
- must monitor for ____
- how?
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)
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) clinical pearls:
- treatment only necessary during _____
- when condition recurs it involves _____
- eventually, episodes _____
- rare after _____
“outbreak”;
the same eye;
appear to stop;
age 60
Fuchs’ Heterochromic Iridocyclitis (FHIC)
chronic anterior uveitis with non-hereditary heterochromia
Fuchs’ Heterochromic Iridocyclitis (FHIC) etiology/assocations
- idiopathic
- however, evidence suggests connections to rubella viral infection
Fuchs’ Heterochromic Iridocyclitis (FHIC) demographics
typically begins between the ages of 20-30 years
Fuchs’ Heterochromic Iridocyclitis (FHIC) laterality
unilateral > bilateral
Fuchs’ Heterochromic Iridocyclitis (FHIC) symptoms
- 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
Fuchs’ Heterochromic Iridocyclitis (FHIC) signs
- 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
Fuchs’ Heterochromic Iridocyclitis (FHIC) complications
- 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
Fuchs’ Heterochromic Iridocyclitis (FHIC) management
- 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
Fuchs’ Heterochromic Iridocyclitis (FHIC):
- must monitor for _____
- how?
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)
Fuchs’ Heterochromic Iridocyclitis (FHIC):
-if glaucoma develops, 70% failure on _____; best IOP control with ____
topical therapy;
trabeculectomy and shunt surgeries (Ahmed Glaucoma Valve)
Fuchs’ Heterochromic Iridocyclitis (FHIC):
-if PSC/cataract develops, _____
cataract surgery (phacoemulsification with PCIOL)
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)
1-3;
13-60;
80
Uveitis-Glaucoma-Hyphema syndrome (UGH)
anterior uveitis with elevated IOP, pigment dispersion, and/or hyphema post cataract surgery
Uveitis-Glaucoma-Hyphema syndrome (UGH) etiology
- 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
Uveitis-Glaucoma-Hyphema syndrome (UGH) demographics
pseudophakes (patients that have had cataract surgery and received an IOL)
Uveitis-Glaucoma-Hyphema syndrome (UGH) laterality
unilateral
ACIOL
can see entire extent of IOL in the AC, with haptics (arms) of the IOL inserted or sutured into the iris
PCIOL
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
Uveitis-Glaucoma-Hyphema syndrome (UGH) symptoms
- 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
Uveitis-Glaucoma-Hyphema syndrome (UGH) signs
- 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
Uveitis-Glaucoma-Hyphema syndrome (UGH) complications
- CME: due to chronic anterior uveitis with spillover into the macula
- secondary glaucoma (inflammatory): due to inflammatory debris or blood obstructing the TM
Uveitis-Glaucoma-Hyphema syndrome (UGH) management
begin topical cycloplegic + topical steroid + IOP lowering meds; prostaglandins can make the inflammation worse
Uveitis-Glaucoma-Hyphema syndrome (UGH):
- must monitor for ____
- how?
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)
Uveitis-Glaucoma-Hyphema syndrome (UGH):
-patient will required _____
surgical repositioning, replacement, or removal of the IOL
Uveitis-Glaucoma-Hyphema syndrome (UGH) clinical pearls:
- ____ can aid in viewing a displaced ACIOL
- ____ can aid in viewing a displaced PCIOL
ASeg OCT;
UBM
