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OD3 - Clinical Optometry Practice > DIS - Anterior Uveitis I - Week 3 > Flashcards

DIS - Anterior Uveitis I - Week 3 Flashcards

1
Q

Is uveitis associated with other diseases or does it occur in isolation? Explain (3).

A

It may be associated with systemic disease, immune/auto-immune disorders, or occur in isolation

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2
Q

What is the optometrist’s role in uveitis (4)?

A

Detection
Diagnosis
Primary care/management
Referral

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3
Q

True or false

Acute iritis is a relatively rare form of uveitis

A

False, it is the most common form of uveitis

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4
Q

Define uveitis. Is it intra- or extraocular only?

A

Inflammation of any part of the uveal tract

-intraocular only

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5
Q

What four factors affect the classification of uveitis?

A

Location
Clinical behaviour
Aetiology
Pathology

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6
Q

Define endophthalmitis in the context of uveitis and areas of inflammation (3).

A

Uveitis with inflammation of intraocular cavities but excluding the sclera

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7
Q

Define panophthalmitis/panuveitis in the context of uveitis and areas of inflammation (4).

A

Endophthalmitis with inflammation of the sclera, tenons capsule, and orbital tissue

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8
Q

Define vitritis in the context of uveitis (2). What is it usually due to?

A

Infiltration of inflammatory cells into the vitreous due to uveitis

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9
Q

List the two forms of anterior uveitis. What percentage of all uveitis cases do they make up?

A

Iritis
Iridocyclitis
they make up 80% of all uveitis cases

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10
Q

List the two forms of intermediate uveitis.

A

Pars planitis

Chronic cyclitis

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11
Q

List the three forms of posterior uveitis. At what anatomical point is the uveitis considered to be posterior?

A

Choroiditis
Chorioretinitis/retinochoroiditis
Retinitis
-beyond the vitreous base

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12
Q

List the two forms of diffuse uveitis.

A

Endophthalmitis

Panuveitis/panophthalmitis

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13
Q

Describe three characteristics of acute uveitis.

A

Sudden onset
Very symptomatic
Resolves completely in <3 months

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14
Q

List three characteristics of chronic uveitis.

A

Often insidious
Often asymptomatic
Many months to recover or longer >3/12

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15
Q

What must chronic uveitis be distinguished from?

A

Recurrent acute uveitis

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16
Q

What can poorly treated acute uveitis lead to?

A

Chronic uveitis

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17
Q

What is meant by subacute uveitis (2)?

A

Healing or going to chronic

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18
Q

List three examples of exogenous causes of uveitis. Give two examples.

A 
External injury
Invasion of microorganisms
Other agents from outside the eye
-anterior segment surgery
-infective ulcer, abrasion
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19
Q

List two systemic disorders that can result in uveitis.

A

Arthritis

Sarcoidosis

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20
Q

Give two examples of parasitic infections that can cause uveitis.

A

Toxoplasma

Lyme disease

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21
Q

Give three examples of viruses that can cause uveitis.

A

CMV
HSV
HZO

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22
Q

Give an example of a fungus that can cause uveitis.

A

Candida

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23
Q

List three examples of endogenous causes of uveitis.

A

Microorganisms/inflammatory agents from within the body
Systemic disorders
Idiopathic

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24
Q

Distinguish between acute and chronic uveitis in terms of whether they are granulomatous or non-granulomatous.

A

Acute - non-granulomatous

Chronic - granulomatous

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25
Q

Distinguish between acute and chronic uveitis by injection and pain.

A 
Acute
-grade 4 injection
-grade 3+ pain
Chronic
-grade 1 injection
-grade 1 pain, sometimes none
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26
Q

Distinguish between acute and chronic uveitis by the presence of nodules.

A

Acute - no nodules

Chronic - grade 2 nodules

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27
Q

Distinguish between acute and chronic uveitis by the appearance of keratic precipitates.

A

Acute - small/fine

Chronic - mutton fat appearance

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28
Q

Distinguish between acute and chronic uveitis by the main cell types present (2 each).

A 
Acute
-neutrophils
-lymphocytes
Chronic
-macrophages
-giant cells
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29
Q

List the three classifications of uveitis (by cause).

A

Infectious
Non-infectious
Masquerade

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30
Q

List the 5 sub-classifications of infectious uveitis.

A 
Bacterial
Viral
Fungal
Parasitic
Other
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31
Q

List the 3 sub-classifications of non-infectious uveitis.

A

Systemic associations
No known systemic associations
Immune related

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32
Q

List the 2 sub-classifications of masquerade uveitis.

A

Neoplastic

Non-neoplastic

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33
Q

List three ocular drugs that may induce uveitis.

A

Latanoprost
Brimonidine
Metipranolol

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34
Q

List seven systemic drugs that can induce uveitis.

A 
Cidofovir
-CMV/HIV drug
Bisphosphonates
Oral contraceptives
Systemic sulphonamides
Influenza vaccine
BCG vaccine for TB
Cancer-related chemotherapy
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35
Q

Is drug induced uveitis usually common or uncommon? Are they mild or severe? Granulomatous or non-granulomatous?

A

Uncommon
Mild
Non-granulomatous

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36
Q

What three other conditions may sometimes occur alongside drug induced uveitis?

A

Vitritis
Optic neuritis
Panuveitis

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37
Q

What three things does drug induced uveitis respond to?

A

Withdrawal of the drug
Topical steroids
Topical cycloplegics

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38
Q

At what age does prevalence of uveitis increase?

A

65 and over

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39
Q

Is uveitis common in the very young? What about the very old?

A

Less common in both

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40
Q

What two components contribute to the formation of the blood-aqueous barrier? What does inflammation lead to?

A

Tight junctions in the ciliary epithelium and endothelium of iris capillaries
-inflammation leads to a breakdown in these junctions

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41
Q

What is they key aspect of uveitis?

A

Breakdown of the blood aqueous barrier

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42
Q

On breakdown of the blood aqueous barrier, what two macromolecules fill the aqueous? What does this result in?

A

Proteins like albumin
Fibrin/fibrinogen
-passive and due to leakage
Results in flare

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43
Q

Do cells normally leave blood vessels? Explain in the context of uveitis (2).

A

Normally do not

-only with the breakdown of the blood aqueous barrier and the presence of a chemoattractant

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44
Q

What does the presence of cells in the anterior chamber indicate?

A

Active inflammation

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45
Q

Capillaries of what two structures form the blood aqueous barrier?

A

Iris

Ciliary body

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46
Q

List and describe the three types of capillaries. Give an example of an organ where they can be found.

A 
Non-fenestrated
-continuous basal lamina and endothelium
-iris BV
Fenestrated
-continuous basal lamina and fenestrated endothelium
-choroid
Sinusoidal
-fenestrated basal lamina and endothelium
-liver
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47
Q

True or false
The iris stroma has no surface epithelium
What consequence does this have on any capillary leakage?

A

True

Any capillary leakage is directly into the aqueous

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48
Q

Do iris capillaries normally restrict all cells entry into the anterior chamber?

A

Yes

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49
Q

What protein percentage do iris capillaries maintain in the anterior chamber?

A

They restrict protein outflow so there is <1% in the aqueous

50
Q

Do iris capillaries allow the flow of amino acids into/out of the anterior chamber?

A

Yes, concentration is equal in aqueous and blood

51
Q

Are ciliary body capillaries fenestrated, non-fenestrated, or sinusoidal? Where in the ciliary body is it found?

A

Fenestrated

-ciliary body stroma

52
Q

What is the non-pigmented epithelium of the ciliary bodies a continuation of?

A

Neuroepithelium

53
Q

Do ciliary body capillaries have tight junctions?

A

Yes

54
Q

How many layers tick is the epithelium of the ciliary body?

A

2

55
Q

What is the outer layer of the ciliary body adjacent to and is it pigmented or non-pigmented?

A

Adjacent to the stroma

Pigmented

56
Q

What is the pigmented epithelium of the ciliary body a continuation of?

A

The RPE

57
Q

Does the pigmented epithelium of the ciliary body have gap junctions? What does this allow for?

A

Yes

Allows lateral diffusion between cells

58
Q

What kind of junctions are destroyed in inflammation (uveitis)? Where are these present (2)?

A

Tight junctions

  • ciliary body - non-pigmented epithelium
  • iris - capillary endothelium
59
Q

What happens to IOP with uveitis? Explain why.

A

Reduction

Reduced osmotic difference between the blood and aqueous giving less aqueous formation

60
Q

What causes red eye in uveitis and via what structure?

A

Inflammatory cytokines drain via the trabecular meshwork into conjunctival veins to give a vascular response

61
Q

Are tight junctions permanently destroyed with uveitis?

A

No, they are replaced

62
Q

What is a key marker for inflammation in uveitis?

A

Cells

63
Q

Is flare considered significant for uveitis? Does it suggest inflammation? Explain.

A

Flare is generally persistent, less significant, and less suggestive of inflammation

64
Q

What can prolonged/uncontrolled inflammation lead to?

A

Permanent damage to the blood aqueous barrier

65
Q

List four symptoms of acute anterior uveitis.

A

Redness
Pain
Photophobia
Lacrimation without discharge

66
Q

Is acute anterior uveitis typically uni- or bilateral?

A

Usually unilateral

67
Q

What is vision like with acute anterior uveitis?

A

Normal

68
Q

What is the onset of acute anterior uveitis like?

A

Rapid

69
Q

List 12 key signs of acute anterior uveitis.

A 
Hyperaemia
Cells
Flare
Miotic pupil
Keratic precipitates
Hypopyon
Synechiae (anterior/posterior)
Vitreous cells
IOP
Pseudo-ptosis
Normal VA
Iris nodules
70
Q

What is the cause of iris miosis with anterior uveitis? What does this cause induce to result in miosis?

A

Substance P - an inflammatory cytokine

Induces sphincter contraction

71
Q

What ocular drug has less effect in the presence of substance P?

A

Atropine

72
Q

What else does substance P contribute to?

A

Hyperaemia

73
Q

where is redness greatest with uveitis?

A

Next to the limbus

74
Q

Does a decrease in the number of cells present in the anterior chamber with uveitis indicate improvement?

A

Yes

75
Q

What can cells and fibrin in uveitis form?

A

Keratic precipitates

76
Q

What does flare represent?

A

Turbidity created by increased concentration of plasma proteins and fibrinogen

77
Q

Are cytokines needed for flare?

A

No

78
Q

Is flare a good or poor indicator of inflammation?

A

Poor

79
Q

True or false

Flare may persist after active inflammation subsides

A

True

80
Q

What activates fibrinogen and to form what? What is the activator released from?

A

Thromboxane to form fibrin

Thromboxane is released from arachidonic acid of inflammed cell membranes

81
Q

Does the aqueous clot due to the presence of fibrin? Explain.

A

It does not because platelets are absent

82
Q

What do fibrin strands form? What does it mean?

A

Forms plastic iritis

-stagnation of cells

83
Q

What does the presence of fibrin suggest? What does it promote the formation of?

A

Suggests more serious inflammation

Promotes synechial formation

84
Q

What inhibits fibrin formation?

A

Steroid

-by inhibiting thrombin

85
Q

What does hypopyon indicate of the blood aqueous barrier?

A

Severe breakdown

86
Q

Is hypopyon short- or longlived?

A

Shortlived

87
Q

What may usually be present in the contents of hypopyon (3)?

A

Cells
Protein
Fibrin

88
Q

What is usually found in hypopyon with acute anterior uveitis? Is it dense or mobile? Does it resorb quickly or slowly?

A

High fibrin content
Dense and immobile
Resorbs slowly

89
Q

What is usually found in hypopyon with behcets disease? Is it dense or mobile? Does it resorb quickly or slowly?What

A

Minimal fibrin
Moves easily with head movement
May disappear quickly

90
Q

What are keratic precipitates formed by?

A

Lymphocytes or macrophages

91
Q

Where on the cornea are keratic precipitates found?

A

Sticky on the corneal endothelium

92
Q

How do new and old keratic precipitates appear in terms of colour and regularity?

A

New - white/round

Old - irregular/pigmented

93
Q

Where are keratic precipitates generally distributed and why? what does a generalised distribution across the chamber indicate?

A

Inferior distribution due to aqueous convention currents

-if generalised, indicates chronic inflammation

94
Q

If you see mutton fat appearing keratic precipitates, what should you think?

A

Granulomatous

95
Q

What is posterior synechiae? What is it promoted by?

A

Adhesion of the iris to the lens (pupil border)

Promoted by fibrin and inflammatory mediators

96
Q

What does posterior synechiae increase the risk of?

A

Pupil block

97
Q

What does posterior synechiae develop with? Is it slow or rapid?

A

Develop rapidly with severe inflammation

98
Q

Do posterior synechiae tend to rupture? Explain.

A

May rupture with iris movement

99
Q

What minimises the formation of posterior synechiae?

A

Active iris

100
Q

What may pigment on the lens indicate?

A

Previous synechial event

101
Q

What is peripheral anterior synechiae?

A

Iris-corneal adhesion

102
Q

How many clock hours of peripheral anterior synechiae will cause aqueous outflow impediment?

A

> 4 clock hours

103
Q

Are cells in the vitrous common in acute anterior uveitis?

A

Yes

104
Q

What causes cells in the vitreous?

A

Spillover from inflamed tissue

105
Q

Describe how you may distinguish between iritis. iridocyclitis, and posterior uveitis based on cells in the anterior chamber and vitreous.

A

Iritis - AC cells&raquo_space; vitreous cells
Iridocyclitis - AC cells = vitreous cells
Posterior uveitis - AC cells &laquo_space;vitreous cells

106
Q

What is it like to look at the vitreous in posterior uveitis?

A

Like looking through fog

107
Q

How do cells appear in the vitreous in posterior uveitis?

A

Headlamps through fog

108
Q

If you suspect acute anterior uveitis, but IOP is increased, what would you think (2)?

A

Inflamed TM and draining poorly
-trabeculitis
TM may also be obstructed with inflammatory debris

109
Q

In what type of uveitis is IOP the key aspect? What can it be described as?

A

Posner-schlossman syndrome

Glaucomato-cyclitic crisis

110
Q

Describe posner-schlossman syndrome. Is it uni- or bilateral? What age does it occur? Is it self-limiting?

A

Unilateral, recurrent, non-granulomatous trabeculitis in 30-60 year olds
Very high IOP with open angle during attack
Self-limiting

111
Q

What may individuals with posner-schlossman syndrom develop with age?

A

Open angle glaucoma

112
Q

What are three other important features of uveitis?

A

Cystoid macular oedema
Corneal oedema
Iris atrophy

113
Q

If you suspect uveitis, what should you always consider as a possible cause of decreased VA?

A

Cystoid macular oedema

114
Q

What is cystoid macular oedema mainly caused by in uveitis (2)?

A

Severe or recurrent uveitis

115
Q

What kind of corneal oedema may you see in uveitis (2)?

A

Stromal/endothelial

116
Q

What is iris atrophy mainly caused by in uveitis?

A

Recurrent anterior uveitis

117
Q

In what four diseases is chronic anterior uveitis often seen in?

A

Fuchs iridocyclitis
Juvenile idiopathic arthritis
HZV
HZO

118
Q

List three symptoms of chronic anterior uveitis (4).

A

Mild ache
Lacrimation
Photophobia
-often asymptomatic

119
Q

What are pupils like with chronic anterior uveitis?

A

Normal

120
Q

What are iris nodules? What are they called if seen at the pupil margin? What about the iris stroma?

A

Accumulations of inflammatory cells on the iris
-a granuloma
Pupil margin - koeppe nodule
Iris stroma - bussaca nodule

121
Q

Are iris nodules common in acute anterior uveitis? Explain why.

A

No, because nodules indicate high probability of granulomatous disease

122
Q

What iris change can Fuchs iridocyclitis cause?

A

Heterochromia

OD3 - Clinical Optometry Practice (114 decks)

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