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OD3 (S1&2) > DIS - Anterior Uveitis II - Week 3 > Flashcards

DIS - Anterior Uveitis II - Week 3 Flashcards

1
Q

When assessing acute anterior uveitis, what two things should you always do and why?

A

Stain, to look for corneal involvement
Dilate, to look for posterior signs

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2
Q

List 8 common differential diagnoses for acute anterior uveitis. What would make you especially suspicious?

A

Conjunctivitis
Allergy/hypersensitivity
Angle closure glaucoma
Corneal foreign body
Corneal ulceration
Corneal abrasion
Keratitis
Episcleritis
-beware unilateral red eye

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3
Q

List four common diseases that can cause uveitis in order of how common they are.

A

Ankylosing spondylitis
Reiters disease
Psoriatic disease
Inflammatory bowel disease

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4
Q

List four questions that can be asked of a patient, whom you suspect to have uveitis, to work up ankylosing spondylitis as a possible cause.

A

Joint pain (how many)
Diagnosis of arthritis
Back pain/stiffness
-especially in the morning - buttocks
Limited motion of hips

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5
Q

List three questions that can be asked of a patient, whom you suspect to have uveitis, to work up inflammatory bowel disease as a possible cause.

A

Recurrent diarrhoea
Bloody diarrhoea
Abdominal cramps/pain

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6
Q

List four questions that can be asked of a patient, whom you suspect to have uveitis, to work up reactive arthritis as a possible cause.

A

Ulcers/painful lesions in the mouth/genital area
Pus in urine
Blood in urine
Pain with micturition

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7
Q

What question can be asked of a patient, whom you suspect to have uveitis, to work up psoriasis as a possible cause.

A

Any lesions on your scalp, elbow, knees, other lesions

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8
Q

List three questions that can be asked of a patient, whom you suspect to have uveitis, to work up sarcoidosis and TB as a possible cause.

A

Difficulty breathing
Chronic cough
Recent febrile illness

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9
Q

What question can be asked of a patient, whom you suspect to have uveitis, to work up lyme disease and TB as a possible cause (3)?

A

Travel overseas
-USA
-Asia
-Africa

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10
Q

What is ankylosing spondylitis? What area of the body does it involve and is it degenerative? Is it acute or chronic?

A

A chronic spinal joint disease
-inflammatory arthritis of the bone-ligament interface
Isnt degenerative

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11
Q

What occurs in ankylosing spondylosis that causes it to manifest its symptoms (list 2 main ones)?

A

Healing by bony deposition across the joint
-causes fusion (ankylosis)
-loss of spine flexibility

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12
Q

In what age range and gender does ankylosing spondylitis typically occur? After what age is onset rare?

A

20 to 40 year old males
-rare onset after 45

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13
Q

Is ankylosing spondylitis seropositive or -negative?

A

Negative (rheumatoid factor)

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14
Q

What broad aspect of the skeleton does ankylosing spondylitis affect? What part specifically? List four joints that are affected.

A

Axial skeleton
The spine mostly
Sacro-iliac joint
Facet joints of the spine
-articular processes of the vertebrae
Costal-vertebral joint
Peripheral joints/tendon insertions

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15
Q

List 6 early signs of ankylosing spondylitis.

A

Ache/stiffness
Lower back/buttock pain/stiffness
Referred pain at night or morning
Accentuated by rest/inactivity
Improves with activity/exertion
Intermittent > constant

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16
Q

What can the referred pain in ankylosing spondylitis be likened to?

A

Sciatica

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17
Q

List 4 later features of ankylosing spondylitis.

A

Fixed flexion deformity of the spine
Rigid spine (poker spine)
Bending from hips instead of vertebrae
Limited reach in attempting to bend forward

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18
Q

How long does acute anterior uveitis last in ankylosing spondylitis and in what form? Is it generally recurrent? Is it granulomatous? What may be seen on the lens?

A

Acute iridocyclitis lasing <6 to 8 weeks
Recurrent
Non-granulomatous
Posterior synechiae are common

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19
Q

When do symptoms of acute iridocyclitis in ankylosing spondylitis begin relative to signs?

A

1 to 2 days before signs

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20
Q

In what percentage of cases is acute iridocyclitis seen in ankylosing spondylitis?

A

20 to 25%

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21
Q

What is an important feature to look out for with acute iridocyclitis in ankylosing spndylitis?

A

Cells and flare

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22
Q

What is reiters syndrome also known as?

A

Reactive arthritis

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23
Q

List the triad of reactive arthritis. Do people commonly have all three?

A

Urethritis
Conjunctivitis
Sero-negative arthritis
Many cases dont have all three

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24
Q

What percentage of reactive arthritis cases will develop acute anterior uveitis?

A

12%

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25
Q

Are posterior synechiae common in reactive arthritis?

A

Yes

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26
Q

List two types of infectious agents that can trigger an immune response to result in reactive arthritis. What would you expect to see in both types?

A

STD or enteric infections
-painless mouth ulcers in both types

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27
Q

What major feature of reactive arthritis occurs first and what may it result in (2)?

A

Initial bacterial infection
-urethritis
-dysentery/enteric infection

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28
Q

What is often the cause of urethritis in reactive arthritis?

A

Non-gonococcal bacteria
-often chlamydia

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29
Q

What generally occurs three weeks after urethritis in reactive arthritis? How long does it last and what happens after (3)? Is there permanent damage?

A

Acute arthritis 3 weeks after urethritis
Lasts 10 to 30 days
Becomes chronic, progressive, and recurrent
Usually no permanent damage

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30
Q

When does conjunctivitis typically occur relative to other components in the triad of reactive arthritis? In what percentage of cases does it occur?

A

After urethritis, but before arthritis
Occurs in 30-60% of cases

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31
Q

Is the conjunctivitis in reactive arthritis mucopurulent or serous? Are follicles present?

A

Mucopurulent, without follicles

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32
Q

Whatis the prevalence of psoriatic arthritis?

A

1-2%

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33
Q

What causes psoriasis?

A

Hyper-proliferation of the epidermis

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34
Q

What areas of the body are generally affected by psoriasis (8)?

A

Scalp, joint, lower back, groin, legs, feet, nails

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35
Q

Do a large or small percentage of psoriasis patients develop arthritis?

A

Small

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36
Q

What percentage of psoriasis patients will develop acute anterior uveitis?

A

7% of the arthritic group

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37
Q

What two things do patients with acute anteior uveitis associated with psoriatic arthritis respond well to?

A

Steroid
Cycloplegia

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38
Q

Define crohns disease (2). Where does it most often affect?

A

Inflammation of any part of the bowel or any part of the bowel wall
Most often the small intestine

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39
Q

Define ulcerative colitis.

A

Inflammation of the colon, usually the lining
-often with ulcers

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40
Q

List four symptoms of inflammatory bowel disease.

A

Abdominal pain/cramping
Diarrhoea (multiple times per day)
Bloody stools
Weight loss

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41
Q

What is behcets disease considered to be?

A

Idiopathic multi-system disease

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42
Q

What is the ratio of behcets disease between male and female?

A

3:2 m/f

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43
Q

Describe the cause of behcets disease.

A

Abnormal circulating immune complexes resulting in obstructive vasculitis

44
Q

What may behcets disease be precipitated by (2)?

A

Viral or streptococcal infection

45
Q

In what two world regions, gender, and age group is behcets disease typical?

A

Young males from the east mediterranean and japan

46
Q

What is behcets disease sometimes called?

A

Silk road disease

47
Q

List 5 features of behcets disease.

A

Recurrent mouth ulcers (v. painful)
Genital ulcers
Skin lesions
Uveitis
-anterior and posterior
Multiple systemic complications

48
Q

List the requirements of diagnosing behcets disease (2).

A

Requires 3 major features or
2 major features and 2 minor features

49
Q

What are genital ulcerations in women with behcets disease commonly misdiagnosed as?

A

Herpetic cause

50
Q

What is often the first sign of behcets disease?

A

Recurrent oral ulcers

51
Q

List 6 minor features of behcets disease.

A

Thrombophlebitis
Arthritis
Colitis/peptic ulcers
CNS lesions
-including EOM palsies
Cardiovascular lesions
-sterial occlusions/pericarditis
Positive family history

52
Q

What kind of anterior uveitis is present with behcets disease? Is it recurrent? How severe or mild is it?

A

Anterior iridocyclitis
It is acute, recurrent, and severe

53
Q

How long does acute anterior uveitis last with behcets disease?

A

2 to 4 weeks

54
Q

What four ocular signs may you see with uveitis in behcets disease?

A

Vitritis
Keratitis
Episcleritis
Conjunctivitis

55
Q

What may acute anterior uveitis evolve into in behcets disease? What is there a risk of?

A

Chronic anterior uveitis
-risk of phthysis

56
Q

What is commonly seen with uveitis in behcets disease?

A

Hypopyon

57
Q

What are the three main forms of posterior uveitis seen in behcets disease?

A

Diffuse vascular leakage
Retinal vasculitis
Retinitis

58
Q

What is the visual prognosis of behcets disease like if there are posterior changes?

A

Poor

59
Q

What three diseases are sometimes associated with acute anterior uveitis? Are they more or less commonly associated with chronic anterior uveitis?

A

Sarcoidosis
Syphilis
Tuberulosis
More likely to be associated with CAU

60
Q

Is the incidence of syphilis rising or declining the past few years?

A

Rising

61
Q

What is the most common ocular finding in syphilis?

A

Posterior uveitis
-can also cause anterior uveitis

62
Q

What is the GP referral criteria for acute anterior uveitis (2)?

A

Any repeat attacks to review medical status
Any patient who reports medical complications

63
Q

What is the ophthalmologist referral criteria for acute anterior uveitis (7)?

A

Any posterior cause
Complicated IOP response
Hypopyon
Plastic AC/AAU
Uniocular patients
Very young/old patients with the first episode
Patients with protracted response

64
Q

Is juvenile idiopathic arthritis seropositive or -negative?

A

Seronegative

65
Q

When is the onset of juvenile idiopathic arthritis?

A

<16yoa

66
Q

List the three subgroups of juvenile idiopathic arthritis.

A

Systemic JIA
Polyarticular JIA
Pauciarticular JIA

67
Q

In which type of uvenile idiopathic arthritis may uveitid develop (2)? Is it dependent or independent to the activity of arthritis?

A

May develop with any type
-but especially pacuiarticular JIA
-independent to activity of arthritis

68
Q

Is uveitis in juvenile idiopathic arthritis acute or chronic? Is it uni- or bilateral? Is it granulomatous?

A

Chronic
Bilateral
Non-granulomatous

69
Q

What percentage of uveitis in juvenile idiopathic arthritis cases are female?

A

75%

70
Q

What is the onset of uveitis in juvenile idiopathic arthritis always like?

A

Asymptomatic

71
Q

What five ocular signs may you see at the onset of uveitis in juvenile idiopathic arthritis?

A

Cells
Keratic precipitates
Posterior synechaie
CMO
Band keratopathy

72
Q

What is the review and screening for uveitis like when examining a patient with juvenile idiopathic arthritis (3)?

A

At or within 6 weeks of diagnosis
2 monthly for 6 months
4 monthly until 11yoa

73
Q

What kind of uveitis occurs in fuchs uveitis syndrome? What else is it called?

A

Anterior uveitis
Fuchs heterochromic iridocyclitis

74
Q

What age group does fuchs uveitis syndrome typically affect?

A

Young adult

75
Q

Is fuchs uveitis syndrome typically symptomatic or asymptomatic?

A

Asymptomatic

76
Q

Is there good or poor visiion with fuchs uveitis syndrome?

A

Good

77
Q

Can fuchs uveitis syndrome result in chronic uveitis? Explain (2).

A

Yes
Chronic non granulomatous and unilateral

78
Q

Is iris heterochromia a reliable indicator of fuchs uveitis syndrome? Which eye does it typically affect? Explain the eye colours.

A

It is an inconsistent feature
Affected eye is hypochromic
-brown eyes are less brown
-blue eyes are more saturated

79
Q

Aside from heterochromia, what other features of the iris are present in fuchs uveitis syndrome (4)?

A

Iris crypts lost
Stromal atrophy
Patchy iris pigment loss
Iris vessels visible

80
Q

What anterior condition relating to the iris may be present in fuchs uveitis syndrome (aside from heterochromia and atrophy)?

A

Rubeosis

81
Q

What two conditions complicate chronic fuchs uveitis syndrome?

A

Cataract and primary open angle glaucoma

82
Q

Who can best manage fuchs uveitis syndrome?

A

Ophthalmologists

83
Q

Are steroids typically used for fuchs uveitis syndrome?

A

No, useless

84
Q

What can sarcoidosis be described as?

A

Multi-system granulomatous, idiopathic inflammation

85
Q

Does sarcoidosis have consistent or variable racial prevalence? Explain (2).

A

Variable
-higher in afro-americans and swedes

86
Q

What is sarcoidosis characterised by?

A

Non-caseating granulomas

87
Q

What five organs does sarcoidosis commonly involve? List 5 less commonly involved organs.

A

Common
-lungs
-lymph nodes
-skin
-liver
-eyes
Less common
-spleen
-CNS
-bone
-joints
-heart

88
Q

When does ocular sarcoidosis often occur?

A

4th to 6th decade

89
Q

What kind of keratic precipitates can often be seen with ocular sarcoidosis? List another thing you may see.

A

Mutton fat KP very large
Iris nodules

90
Q

Is ocular sarcoidosis often uni- or bilateral?

A

Bilateral

91
Q

What 3 diseases does ocular sardcoidosis increase the risk of?

A

Cataract
Glaucoma
Phthysis

92
Q

In what percentage of ocular sarcoidosis does uveitis occur and what kind?

A

Chronic anterior uveitis in 60% of ocular sarcoidosis cases

93
Q

How long after skin lesions emerge does uveitis occur in herpes zoster ophthalmicus?

A

1 to 2 weeks

94
Q

What can be seen of the iris in HZO?

A

Patchy atrophy

95
Q

What three things can be seen of the cornea in HZO?

A

Dendritic keratitis
Stromal keratitis
Exposure keratitis

96
Q

Describe glaucoma associated with HZO.

A

Often severe with high IOP

97
Q

Is phthysis present in HZO?

A

Yes

98
Q

What is the ocular management for HZO (4)?

A

Topical antiviral
Topical steroid
Cycloplegia
Glaucoma medications

99
Q

What is the oral management for HZO?

A

Oral acyclovir

100
Q

Is uveitis in syphilis generally granulomatous?

A

Generally granulomatous but not always

101
Q

What type of uveitis is more likely with TB (2)?

A

Chronic anterior uveitis
-acute is possible

102
Q

Is TB hard or easy to catch?

A

Hard to catch

103
Q

What are the three essentials of therapeutic management for acute anterior uveitis?

A

Determining the underlying cause
Controlling inflammation
Controlling complications

104
Q

What is a difficulty with long term treatment/management of chronic anterior uveitis?

A

Substantial risk of tissue damage

105
Q

What is the purpose of cycloplegia with acute anterior uveitis (2)?

A

Pain and synechiae control

106
Q

In what 6 cases of uveitis is periocular injections of steroids considered?

A

Severe anterior uveitis
Intermediate uveitis
Chronic uveitis
Poorly compliant patients
At surgery
Poor response to topical drugs

107
Q

What is usually the treatment for posterior uveitis (2)?

A

Systemic/oral steroids

OD3 (S1&2) (114 decks)

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