DIS - Anterior Uveitis I - Week 3 Flashcards
Is uveitis associated with other diseases or does it occur in isolation? Explain (3).
It may be associated with systemic disease, immune/auto-immune disorders, or occur in isolation
What is the optometrist’s role in uveitis (4)?
Detection
Diagnosis
Primary care/management
Referral
True or false
Acute iritis is a relatively rare form of uveitis
False, it is the most common form of uveitis
Define uveitis. Is it intra- or extraocular only?
Inflammation of any part of the uveal tract
-intraocular only
What four factors affect the classification of uveitis?
Location
Clinical behaviour
Aetiology
Pathology
Define endophthalmitis in the context of uveitis and areas of inflammation (3).
Uveitis with inflammation of intraocular cavities but excluding the sclera
Define panophthalmitis/panuveitis in the context of uveitis and areas of inflammation (4).
Endophthalmitis with inflammation of the sclera, tenons capsule, and orbital tissue
Define vitritis in the context of uveitis (2). What is it usually due to?
Infiltration of inflammatory cells into the vitreous due to uveitis
List the two forms of anterior uveitis. What percentage of all uveitis cases do they make up?
Iritis
Iridocyclitis
they make up 80% of all uveitis cases
List the two forms of intermediate uveitis.
Pars planitis
Chronic cyclitis
List the three forms of posterior uveitis. At what anatomical point is the uveitis considered to be posterior?
Choroiditis
Chorioretinitis/retinochoroiditis
Retinitis
-beyond the vitreous base
List the two forms of diffuse uveitis.
Endophthalmitis
Panuveitis/panophthalmitis
Describe three characteristics of acute uveitis.
Sudden onset
Very symptomatic
Resolves completely in <3 months
List three characteristics of chronic uveitis.
Often insidious
Often asymptomatic
Many months to recover or longer >3/12
What must chronic uveitis be distinguished from?
Recurrent acute uveitis
What can poorly treated acute uveitis lead to?
Chronic uveitis
What is meant by subacute uveitis (2)?
Healing or going to chronic
List three examples of exogenous causes of uveitis. Give two examples.
External injury
Invasion of microorganisms
Other agents from outside the eye
-anterior segment surgery
-infective ulcer, abrasion
List two systemic disorders that can result in uveitis.
Arthritis
Sarcoidosis
Give two examples of parasitic infections that can cause uveitis.
Toxoplasma
Lyme disease
Give three examples of viruses that can cause uveitis.
CMV
HSV
HZO
Give an example of a fungus that can cause uveitis.
Candida
List three examples of endogenous causes of uveitis.
Microorganisms/inflammatory agents from within the body
Systemic disorders
Idiopathic
Distinguish between acute and chronic uveitis in terms of whether they are granulomatous or non-granulomatous.
Acute - non-granulomatous
Chronic - granulomatous
Distinguish between acute and chronic uveitis by injection and pain.
Acute
-grade 4 injection
-grade 3+ pain
Chronic
-grade 1 injection
-grade 1 pain, sometimes none
Distinguish between acute and chronic uveitis by the presence of nodules.
Acute - no nodules
Chronic - grade 2 nodules
Distinguish between acute and chronic uveitis by the appearance of keratic precipitates.
Acute - small/fine
Chronic - mutton fat appearance
Distinguish between acute and chronic uveitis by the main cell types present (2 each).
Acute
-neutrophils
-lymphocytes
Chronic
-macrophages
-giant cells
List the three classifications of uveitis (by cause).
Infectious
Non-infectious
Masquerade
List the 5 sub-classifications of infectious uveitis.
Bacterial
Viral
Fungal
Parasitic
Other
List the 3 sub-classifications of non-infectious uveitis.
Systemic associations
No known systemic associations
Immune related
List the 2 sub-classifications of masquerade uveitis.
Neoplastic
Non-neoplastic
List three ocular drugs that may induce uveitis.
Latanoprost
Brimonidine
Metipranolol
List seven systemic drugs that can induce uveitis.
Cidofovir
-CMV/HIV drug
Bisphosphonates
Oral contraceptives
Systemic sulphonamides
Influenza vaccine
BCG vaccine for TB
Cancer-related chemotherapy
Is drug induced uveitis usually common or uncommon? Are they mild or severe? Granulomatous or non-granulomatous?
Uncommon
Mild
Non-granulomatous
What three other conditions may sometimes occur alongside drug induced uveitis?
Vitritis
Optic neuritis
Panuveitis
What three things does drug induced uveitis respond to?
Withdrawal of the drug
Topical steroids
Topical cycloplegics
At what age does prevalence of uveitis increase?
65 and over
Is uveitis common in the very young? What about the very old?
Less common in both
What two components contribute to the formation of the blood-aqueous barrier? What does inflammation lead to?
Tight junctions in the ciliary epithelium and endothelium of iris capillaries
-inflammation leads to a breakdown in these junctions
What is they key aspect of uveitis?
Breakdown of the blood aqueous barrier
On breakdown of the blood aqueous barrier, what two macromolecules fill the aqueous? What does this result in?
Proteins like albumin
Fibrin/fibrinogen
-passive and due to leakage
Results in flare
Do cells normally leave blood vessels? Explain in the context of uveitis (2).
Normally do not
-only with the breakdown of the blood aqueous barrier and the presence of a chemoattractant
What does the presence of cells in the anterior chamber indicate?
Active inflammation
Capillaries of what two structures form the blood aqueous barrier?
Iris
Ciliary body
List and describe the three types of capillaries. Give an example of an organ where they can be found.
Non-fenestrated
-continuous basal lamina and endothelium
-iris BV
Fenestrated
-continuous basal lamina and fenestrated endothelium
-choroid
Sinusoidal
-fenestrated basal lamina and endothelium
-liver
True or false
The iris stroma has no surface epithelium
What consequence does this have on any capillary leakage?
True
Any capillary leakage is directly into the aqueous
Do iris capillaries normally restrict all cells entry into the anterior chamber?
Yes