Inflammatory eye disease

Question 1

What is normally the cause of episcleritis?

Answer 1

Idiopathic

Question 2

What are the symptoms of episcleritis?

Answer 2

Mild ache/burn
Tender to touch
Epiphora
Poss recurrent

Question 3

What are the signs of episcleritis?

Answer 3

Sectoral/diffuse redness
Dilated episcleral vessels (move with cotton bud and blanch with phenylephrine)
no AC/corneal inflam
VA unaffected

Question 4

What is the management for episcleritis?

Answer 4

Cold compress
NSAID (ibuprofen)
Topical steroid if prolonged but usually self resolves

Question 5

What are the types of scleritis?

Answer 5

Anterior (diffuse, nodular, necrotising)
Posterior

Question 6

What are the possible aetiologies of scleritis?

Answer 6

Autoimmune
Infection
Idiopathic

Question 7

What are the symptoms of scleritis?

Answer 7

Extreme pain (worse on movement) which can disturb sleep
Photophobia
VA affected
Eye tender to touch

Question 8

What are the signs of scleritis?

Answer 8

All vessels enflamed - superficial and deeper
No blanching with phenylephrine or movement with cotton bud
Poss AC/corneal inflam
Scleral thinning
Posterior inflam (only visible on ultrasound)

Question 9

How should scleritis be managed?

Answer 9

Urgent HES referral
Oral steroid (severe) or NSAID (mild)

Question 10

What can cause anterior uveitis?

Answer 10

Idiopathic
Autoimmune
Infection
Uveitis syndromes
Reactive (post-op or trauma)

Question 11

What are the symptoms of anterior uveitis?

Answer 11

Dull ache, worse on pupil constriction
Photophobia
Redness
VA slightly reduced
Epiphora

Question 12

What are the signs of anterior uveitis?

Answer 12

Circumlimbal hyperaemia
Keratic precipitates
Aqueous cells
Hypopyon (severe)
Posterior synechiae
Iris nodules (only specific causes)

Question 13

How should anterior uveitis be managed?

Answer 13

Check posterior segment to rule out intermediate/posterior involvement
Exclude infectious causes
Topical steroid (frequency dependent on severity)
Cycloplegia for pain relief in acute phase
If recurrent, bilateral or 60+ and first episode: refer to HES

Question 14

Where does intermediate uveitis affect?

Answer 14

Vitreous
Peripheral retina (pars plana)

Question 15

What are the causes of intermediate uveitis?

Answer 15

Idiopathic
Autoimmune e.g. MS, IBS
Infectious e.g. Lyme disease
Systemic disease e.g. sarcoidosis
Masquerades e.g. lymphoma

Question 16

What are the symptoms of intermediate uveitis?

Answer 16

No pain
No redness
Blurred vision
Increased floaters

Question 17

What are the signs of intermediate uveitis?

Answer 17

Mild AC inflammation (spill over)
Reduced VA
Possible vascular sheath inflammation (peripheral periphlebitis)
Vitreous cells and haze
Vitreous white cells (snow balls and snow banking)
CMO (up to 50% of cases)

Question 18

What are the signs of chronic intermediate uveitis?

Answer 18

ERM
Cataract
Glaucoma

Question 19

How should intermediate uveitis be managed?

Answer 19

Urgent referral to HES

Question 20

What is the BIO score?

Answer 20

Classification of vitreous haze based on how clearly the posterior pole can be seen

Question 21

What are the causes of posterior uveitis?

Answer 21

Idiopathic
Infection (viral/fungal/bacterial)
Autoimmune (e.g. MS)
Systemic (e.g. lymphoma)
White dot syndromes

Question 22

What are the symptoms of posterior uveitis?

Answer 22

No pain (unless infection)
Blurred vision
Floaters
Photopsia

Question 23

What are the signs of posterior uveitis?

Answer 23

Mild vitritis
Ill-defined discoloured patches
Posterior pole lesions
Peripheral vascular shutdown
Neovasc
CNV

Question 24

How should posterior uveitis be managed?

Answer 24

Urgent referral

Question 25

What is choroiditis?

Answer 25

Choroidal/RPE inflammation Usually not isolated

Question 26

What is retinitis?

Answer 26

Retinal inflammation Usually with choroiditis and vasculitis Inflammation is usually demarcated and will leave atrophic areas Haem and exudates often present

Question 27

What is vasculitis?

Answer 27

Vessel inflammation Not usually isolated Inflammation follows vessels: Perivascular sheathing Exudates CWS Vessel occlusion Neovasc

Question 28

What is neuroretinitis?

Answer 28

Optic nerve, peripapillary area and neuro retina inflammation Clinically similar to hypertensive retinopathy

Question 29

What can cause infectious posterior uveitis?

Answer 29

Toxoplasmosis Toxocara

Question 30

What can cause viral posterior uveitis?

Answer 30

HSV HZV

Question 31

What can cause fungal posterior uveitis?

Answer 31

Candida

Question 32

What can cause bacterial posterior uveitis?

Answer 32

TB Syphilis Lyme disease

Question 33

What can cause autoimmune posterior uveitis?

Answer 33

MS Sarcoidosis VKH Bechets

Question 34

What is MS?

Answer 34

demyelination of neurones due to inflammation

Question 35

What is Sarcoidosis?

Answer 35

Granulomas form all over body (collections of inflammatory cells)

Question 36

What is VKH?

Answer 36

Melanin pigmented tissues affected, multisystem autoimmune (skin, ears, eyes), granulomatous

Question 37

What is Bechet's?

Answer 37

Idiopathic multisystem disease with ulcers, uveitis, vasculitis. Whole uvea inflamed CNS and cardio comps common 5% mortality at 5 years

Question 38

What investigations are performed for intermediate uveitis?

Answer 38

Blood tests OCT OCTA FA

Question 39

What investigations are performed for posterior uveitis?

Answer 39

Bloods Chest x-ray CT Brain MRI OCT OCTA ICG FFA

Question 40

What is the treatment for intermediate uveitis?

Answer 40

Oral/implant steroid Poss immunosuppression (e.g. methotrexate) Underlying cause treated Manage any cataract and glaucoma

Question 41

What is the treatment for posterior uveitis?

Answer 41

Treat underlying cause Steroids (after excluding infection) Anti-VEGF if CNV present Immunosuppressants (e.g. methotrexate) Biologic blockers

Question 42

What is the prognosis for uveitis?

Answer 42

Dependent on cause and area but good if macula not involved