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OD3 (S1&2) > DIS - Posterior Uveitis II - Week 4 > Flashcards

DIS - Posterior Uveitis II - Week 4 Flashcards

1
Q

What is cytomegalovirus also known as?

A

Human herpesvirus type 5

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2
Q

Is cytomegalovirus widespread among adults, children, or rare in humans? Explain why.

A

Affects most of the adult population
Post infection, it remains latent in the host
-possible reactivation

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3
Q

What percentage of adults are seropositive to cytomegalovirus? What about people with HIV?

A

Normal - 50%
HIV - 95-100%

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4
Q

What kind of syptoms are associated with systemic cytomegalovirus (2)?

A

Mononucleosis-like symptoms or none
-asymptomatic

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5
Q

Is cytomegalovirus retinitis common or rare? In wha four populations is it particularly more common?

A

Uncommon/rare in normals
Prospers with immunodeficiency:
-HIV
-elderly
-leukaemia
-immunosuppression via steroid, chemotherapy, etc

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6
Q

When did cytomegalovirus come into prominence?

A

With the rise of HIV/AIDS

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7
Q

When does cytomegalovirus retinitis tend to occur relative to HIV? What is the prognosis like from the first sign of infection (for life, not visual prognosis)?

A

Relatively late occurence
Short average time to death from the first sign of CMV infection

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8
Q

What cells does HIV target?

A

CD4+

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9
Q

What is the most common intraocular infection in HIV/AIDS?

A

CMV retinitis

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10
Q

What type of vision loss does untreated cytomegalovirus retinitis result in and when?

A

Progressive visual loss creeping
-when CD4+ count drops to 50-100 cells/uL

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11
Q

What eventually results from cytomegalovirus retinitis (2)?

A

Eventual blindness from full thickness retinal necrosis and retinal detachment

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12
Q

In what percentage of patients is cytomegalovirus retinitis bilateral? In what percentage is the macula involved?

A

Bilateral in 10-20%
Macular involvement in 50%

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13
Q

Describe what full thickness retinitis/retinal necrosis appears like (including colour). What is it often adjacent to? What else would you expect to see and what can its appearance be likened to?

A

Multiple yellow/white geographic lesions
Often adjacent to vessels
Vascilitis often present
Looks like ketchup on cottage cheese

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14
Q

Is vitritis seen with cytomegalovirus retinitis? Explain.

A

Yes, mild vitritis

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15
Q

What is the management for cytomegalovirus retinitis?

A

IV Gancyclovir

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16
Q

List three other general AIDS-related retinal disorders, aside from CMV.

A

HIV retinopathy
Candidiasis
Other causes of posterior uveitis
-syphilis, TB, candida, pneumocystitis, etc

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17
Q

List four other viral AIDS-related retinal disorders.

A

Acute retinal necrosis
-necrotising retinitis
HSV1 (younger)
HSV2 and VSV (older)
Progressive outer retinal necrosis

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18
Q

What is the interaction between progressive outer retinal necrosis and VZV?

A

Aggressive reaction

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19
Q

What is kaposi’s sarcoma aused by and in what condition is it usually seen?

A

Human herpes virus type 8

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20
Q

How is syphilis generally transmitted?

A

Sexually transmitted infection (STI/STD)

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21
Q

What causes syphilis? What shape is it?

A

Trepenoma pallidum
-spirochaete

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22
Q

Briefly describe primary (1), secondary (1), and tertiary (3) syphilis.

A

Primary - initial STD
Secondary - rash and systemic symptoms
Tertiary
-neurosyphilis
-cardiovascular
-gummatous (granulomas)

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23
Q

Can syphilis be contracted from blood transfusion or open skin lesions?

A

Yes, occasionally

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24
Q

What effect has improved HIV survivability had on syphilis prevalence?

A

Increased prevalence of syphilis

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25
Q

What kind of keratitis occurs with congenital syphilis?

A

Interstitial keratitis

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26
Q

What kind of uveitis can occur with syphilis and at what stage?

A

Anterior or posterior, at any stage

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27
Q

Is anterior uveitis from syphilis often granulomatous or non-granulomatous?

A

Often non-granulomatous

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28
Q

List the four types of postrior uveitis that may be seen with syphilis.

A

Chorioretinitis
-disseminated
-posterior placoid
Retinitis
Retinal vasculitis

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29
Q

Describe the appearance of disseminated chorioretinitis. What classic appearance does it have when congenital? Is vitritis present?

A

Multiple yellow/grey lesions
-vitritis often present
Classic salt/pepper appearance when congenital

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30
Q

Describe the appearance of posterior placoid chorioretinitis. Where is it generally found? Is vitritis present?

A

Around the disc
-yellow/grey lesions with pale centres
-vitritis often present

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31
Q

Describe retinal vasculitis and what it often resembles.

A

Isolated retinal vessel inflammation
-mild leakage to extreme
-often resembles BVO

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32
Q

What is responsible for tuberculosis?

A

Mycobacterium tuberculosis

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33
Q

In what patients and countries is ocular TB often seen?

A

HIV patients
Endemic countries

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34
Q

What is a typical feature of posterior segment TB? List 5 additional things you may see.

A

Choroidal granuloma
-granulomatous
Also:
Vasculitis
Keratitis
Scleritis
Anterior uveitis
Retinitis

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35
Q

What can hypersensitivity to TB organisms result in (2)?

A

Occlusion of vessels, leading to ischaemia

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36
Q

What is sympathetic ophthalmia and what does it generally follow? What can occur in the fellow eye and why?

A

Bilateral granulomatous uveitis
Follows penetrating trauma
Trauma to the first eye also excites inflammation in the fellow eye

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37
Q

After what surgery is sympathetic ophthalmia most common? Comment in rarity after cataract surgery, malignant melanoma, and cyclo-cryotherapy.

A

Vitrectomy - most common antecedent event
Rarely occurs in the others

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38
Q

Are rates of sympathetic ophthalmia increasing or decreasing?

A

Increasing

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39
Q

What is the typical onset for sympathetic ophthalmia post-exciting and what is the range?

A

Typically 3 months
-days to decades

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40
Q

List 3 anterior features of sympathetic ophthalmia.

A

Mild anterior uveitis
-granulomatous
Mutton fat keratic precipitates

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41
Q

List 4 posterior features of sympathetic ophthalmia.

A

Vitritis
-moderate to severe
Posterior uveitis
-multiple peripheral yellow/white lesions
papillitis
Circumpapillary choroidal lesions

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42
Q

What is the treatment for sympathetic ophthalmia (2)?

A

Systemic steroids
-high dose, tapered over 3/12
Immunosuppression
-cyclosporin

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43
Q

Define white dot syndrome.

A

Distinct inflammatory disorders of uncertain aetiology

44
Q

Describe the lesions in white dot syndrome, including colour, size, and position.

A

Some are yellow rather than white
Often larger than dots
More superficial dots tend to be white and probably represent retinitis

45
Q

List 5 examples of diseases that can be considered white dot syndrome.

A

Acute multifocal posterior pigment placoid epitheliopathy
-AMPPPE
Multiple evansecent white dot syndrome
-MEWDS
Birdshot retino-choroidopathy
Acute retinal pigment epitheliitis
Punctate inner choroidopathy

46
Q

What will you often see with acute multifocal posterior pigment placoid epitheliopathy and what is it thought to be secondary to?

A

Choroidal vasculitis secondary to RPE dysfunction

47
Q

What may you see in acute multifocal posterior pigment placoid epitheliopathy with recent viral illness?

A

Hypersensitivity-induced occlusive vasculitis of choroidal lobules

48
Q

What appearance do lesions have in acute multifocal posterior pigment placoid epitheliopathy? Include colour, position, and layer.

A

Multiple large plaque-like lesions
-cream-coloured
-initially at the posterior pole
-RPE level

49
Q

What kind of vision loss (VA and VF) is present with acute multifocal posterior pigment placoid epitheliopathy? What will patients often initially experience?

A

VA - 6/12 to 6/120
Central/paracentral scotoma
Sudden onset of blurred vision or photopsia
-possible flashing lights up to a few weeks before

50
Q

What age does acute multifocal posterior pigment placoid epitheliopathy tend to occur?

A

<30

51
Q

What event does acute multifocal posterior pigment placoid epitheliopathy tend to follow?

A

Viral illness

52
Q

Is acute multifocal posterior pigment placoid epitheliopathy usually uni- or bilateral?

A

Bilateral

53
Q

True or false
Anterior uveitis and vitritis may be seen with acute multifocal posterior pigment placoid epitheliopathy

A

True

54
Q

Describe the typical angiography pattern for acute multifocal posterior pigment placoid epitheliopathy (2).

A

Initial dark hypo-fluorescence
late slow hyperfluorescence

55
Q

What eventually happens with acute multifocal posterior pigment placoid epitheliopathy?

A

Slow spontaneous recovery

56
Q

What age and gender does multiple evanescent white dot syndrome tend to occur?

A

Young women

57
Q

Is multiple evanescent white dot syndrome usually uni- or bilateral?

A

Unilateral

58
Q

Describe the lesions in multiple evanescent white dot syndrome including size, colour, layer, and position (2). Are cells present in the vitreous?

A

multiple small discrete white lesions in deep layers (RPE)
Found at the posterior pole
-perifoveal but not foveal
Cells in the vitreous

59
Q

Describe what vision loss is opften like with multiple evanescent white dot syndrome. Is RAPD present?

A

Sudden drop in VA (up to 6/60)
Possible RAPD

60
Q

Is multiple evanescent white dot syndrome self-limiting or does it require urgent treatment?

A

Self-limiting ~2 months

61
Q

What is the visual outcome following multiple evanescent white dot syndrome expected to be?

A

6/6 to 6/12

62
Q

Describe the appearance of birdshot retinochoroidopathy.

A

Scattered lesions like shotgun scatter

63
Q

Is birdshot retinochoroidopathy typically uni- or bilateral? Is it inflammatory? Is it chronic or acute?

A

Bilateral chronic inflammatory disease

64
Q

Is birdshot retinochoroidopathy common or uncommon?

A

Uncommon

65
Q

What age does birdshot retinochoroidopathy typically occur? What race and gender?

A

6th to 7th decade
-white
-female

66
Q

List four symptoms of birdshot retinochoroidopathy. Is pain often present?

A

Blurred vision
Dsturbed colour vision
Night vision difficulty
Floaters
No pain

67
Q

Is vitritis present with birdshot retinochoroidopathy?

A

Yes (diffuse)

68
Q

True or false
Snowbanking is present with birdshot retinochoroidopathy.

A

False

69
Q

What is VA like with birdshot retinochoroidopathy?

A

6/12 to 6/18

70
Q

Describe the lesions seen in birdshot retinochoroidopathy including shape, colour, size, and position (2).

A

Round ovoid subretinal lesions
Cream coloured
Small
Numerous
-macula and midperiphery
-mostly macula

71
Q

Would you see vasculitis with birdshot retinochoroidopathy?

A

Yes, significant

72
Q

What would you expect to see on fluorescein angiography with birdshot retinochoroidopathy?

A

Hyperfluorescence/leakage

73
Q

What percentage of patients will recover from birdshot retinochoroidopathy? What about the rest (and why this outcome for them)?

A

20% will recover
The rest have exacerbations or poor VA due to CMO or atrophic scars

74
Q

What is the treatment for birdshot retinochoroidopathy (2)?

A

Steroids/cyclosporins

75
Q

What visual changes occur with acute retinal pigment epitheliitis (2)?

A

Acute VA drop and/or metamorphopsia

76
Q

What age does acute retinal pigment epitheliitis tend to occur?

A

Young

77
Q

What do you expect to see with acute retinal pigment epitheliitis (2)?

A

Subtle RPE changes
-deep grey/dark spots with a yellow halo clustered around the posterior pole
Central serous retinopathy

78
Q

True or false
EOG is normal with acute retinal pigment epitheliitis
What does this indicate?

A

False, it is abnormal
-indicates widespread RPE upset

79
Q

What kind of aetiology is acute retinal pigment epitheliitis thought to have?

A

Viral

80
Q

What is puncate inner choroidopathy part of (2)? What is the diagnosis for this condition?

A

Part of multifocal choroiditis and panuveitis
Dx ocular histoplasmosis

81
Q

In what age, gender, and ametropic status does puncate inner choroidopathy tend to occur?

A

Young myopic females

82
Q

What is vision (VA and VF) often like with puncate inner choroidopathy?

A

Blurred vision
Light flashes
Paracentral scotoma

83
Q

Is intraocular inflammation present with puncate inner choroidopathy?

A

No

84
Q

Describe the lesions of puncate inner choroidopathy, including deepness, elevation, colour, number, and position.

A

Multiple, deep, yellow punched out appearance

85
Q

Do lesions of puncate inner choroidopathy resolve?

A

Yes, after a few weeks
-atrophic/pigmented

86
Q

What risk do lesions of puncate inner choroidopathy present?

A

CNV

87
Q

What is the prognosis of puncate inner choroidopathy like?

A

Good, if the macula is unaffected

88
Q

Describe serpiginous choroidopathy, mentioning whether it is uni- or bilateral, acute or progressive.

A

Idiopathic bilateral progressive inflammation

89
Q

What is the onset of serpiginous choroidopathy?

A

4th to 6th decade

90
Q

What is vision like with serpiginous choroidopathy (2)?

A

Blurred vision ± metamorphopsia

91
Q

What are lesions like with serpiginous choroidopathy? Include colour, borders, shape, and where they spread to.

A

Yellow-white subretinal infiltrates
Spreads outwards to the macula

92
Q

Is vitritis and anterior uveitis present with serpiginous choroidopathy?

A

Yes

93
Q

Do remisison/reactivation cycles occur with serpiginous choroidopathy?

A

Yes

94
Q

What is the treatment of serpiginous choroidopathy (3)?

A

Steroids
Cyclosporin
Azathyoprine

95
Q

What is ophthalmomyiasis caused by? Is it common or rare?

A

Intraocular larval infestation
-rodent fly
-rare

96
Q

Is ophthalmomyiasis anterior or posterior?

A

Can be either

97
Q

How does ophthalmomyiasis appear on funduscopy?

A

Tracks in the sub-retinal space
-can still be moving

98
Q

What is the treatment option for ophthalmomyasis if the causative agent is alive (1) or dead (1)?

A

Alive - laser PC
Dead - removal via vitrectomy

99
Q

List four causes of visual loss with active inflammation in posterior uveitis.

A

Vitritis
CMO
Disc oedema
Obliterative retinal vasculitis

100
Q

List five causes of visual loss with non-inflammatory causes in posterior uveitis.

A

Cataract
Vitreous debris
Chronic macular problem
Glaucoma
Optic atrophy

101
Q

List 5 examples of chronic macular problems that can lead to visual loss in posterior uveitis with non-inflammatory causes.

A

Persistent/chronic CMO
RPE disturbance
ERM
SRNVM
Macular hole (full/partial)

102
Q

What is usually the treatment for posterior uveitis (5)? What about systemic treatment (5)?

A

Systemic/oral steroids unless
-condition is selflimiting or minimally sight threatening
-steroids aggravating condition/contraindicated
-specific drug used
-causative agent/organism is known
Systemic
-treat autoimmune aspect of uveitis
-antimetabolites
-cyclophosphamides
-cyclosporin
-tacrolimin

103
Q

What three conditions would you consider if you see multiple white lesions on funduscopy with no inflammation?

A

POHS
PIC
Dystrophies

104
Q

What three conditions would you consider if you see multiple white lesions on funduscopy with minimal inflammation?

A

AMPPPE
MEWS
RPE epitheliitis

105
Q

What eight conditions would you consider if you see multiple white lesions on funduscopy with lots of inflammation?

A

Multifocal choroiditis including
-sympathetic ophthalmia
-birdshot
-sarcoid
-behcets
-VKH
-infections
-post-op/trauma

OD3 (S1&2) (114 decks)

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