Intraocular Inflammations Flashcards
How is uveitis classified
By location.
- Anterior uveitis - iritis, iridiocyclitis, cyclitis
- Intermediate uveitis- pars planitis
- Posterior uveitis- choroiditid, chororetinitis, retinochoroiditis, retinitis
- Pan uveitis- affecting uvea
Classification by duration.
- Acute. Less that 6weeks. Maybe recurrent
- Chronic. More than 6weeks. White eye? Mild or no sx
How would one get uveitis
Genetics
Infection
Trauma
Anterior uveitis
Most common. Espesh in younger Px
Risk factors include- systemic conditions. Previous history. Blunt trauma?
Associated with syphillis, herpes simplex, herpes zoster, tb, hypermature cataract
Usually unilateral, assymetrical, red eye, painful, sight threatening.
Acute anterior uveitis - IRITIS
Red eye Pain Blurred Vision Photophobia Tearing
Reduced va due to corneal odeama, anterior flare and cells and cystoid macular odeama.
6/6-6/9 is mild
6/9-6/30 is mod
Less than 6/30 is severe va loss
What would u see on slit lamp for anterior uveitis
Peribal injection - red eye Ac flare and cells Keratitic precipitates Pupil miosis- slugish fixed pupil Hypopyon- strong inflammation Band keratopathy- deposits in cornea Fibrin in ac Cells in anterior vitreous Peripheral anterior synechie Posterior synichea Rubeosis irisdis Mutton fat kp Iris nodules Boggy iris- swelled
What does tonometry for anterior uveitis show
Either decreased, increased or just the same.
Gonioscopy on anterior uveitis
peripheral anterior synechiae
Whats the goals in managing anterior uveitis
preserve vision relieve ocular pain eliminate any infection- identify the actual sour prevent formation of synechiae control IOP
How would u manage anterior uveitis
Topical corticosteroid therapy:
- to reduce inflammation
- to reduce exudate leakage
- increase cell wall stability
- inhibit circulation of lymphocytes
- inhibit lysozyme release by granulocytes
Cyclopegia: relieve pain and prevent posterior synechiea and stabilise blood aqueous barrier
Systemic steroid therapy
Systemic NSAID therapy (asprin/iburprofen)
How would u review a px with anterior uveitis
initial- after a few days- good if sx and signs reduced
Review after depending on severity and inflammation, risk of complications and compliance
Optoms role in anterior uveits DDD
Detect- H+S, check IOP, examination
Differentiation
Diagnose
REFER IMMEDIATELY
Could co-manage- monitor IOP, sunglasses, near add rx for cyclopegia?
Whats intermediate uveitis
Vitritis
Inflammation of vitreous and anterior retina
white eye
but blurry va
floaters
white opacities- snow balls/snow banks
cystic macular odeama and optic disk odeama
What are the complications of intermediate uveitis
Synechiae band keratopathy glaucoma cataract neovas heammorages
How would u manage intermediate uveitis
usually managed in hospital- follow up every 1-4 weeks
for cystic macular odeama- consider fl angiography
If va- good- monitor
if va detoriated- topical/periocular steroids- monitor IOP for px on steroids
immunosuppressive therapy
Sx of posterior uveitis
Blurred vision
floaters
pain?
photophobia?
What are the signs of posterior uveitis
cystic macular odeama neovas infiltrates vitreitis mild anterior segmant inflammation vascular sheating
Fuch’s Iridocyclitis
Insidious onset- affects young px Iris heterochromia Keratitic Precipitates NO posterior synechiae Spontaneous haemorrhage in the AC during cataract operation
Complications: cataract, glaucoma
Posner Schlossman Syndrome
glaucomatocyclitic crisis
affects one eye at a time
Young adults
Males
Recurrent episodes of acute, unilateral elevation of IOP associated with mild non-glanulomatous and non-painful uveitis
Possible viral infection? Allergic response?
Sx: high IOP (>45), white eye, ocular discomfort, blurred vision, cell/flare, corneal oedema, small KP
Treatment: IOP-lowering drops and steroids
Ocular TB
Mycobacterium tuberculosis
Rare
Anterior uveitis, panuveitis, choroiditis
Choroidal lesions- severity of systemic disease TB and HIV
Ocular Sarcoidosis
granulomatous disease affecting the lungs, skin, eyes
-conjunctival sarcoid, anterior, intermediate and posterior uveitis, panuveitis, choroidal nodules, ON involvement, lacrimal gland and extra-ocular muscles involvement.
Toxoplasmosis
Toxoplasma gondii
Congenital transmission
May spontaneously reactivate
child may have-strabismus, nystagmus, low vision
Sx: none or blurred vision
Signs: inactive scar or active retinochoroiditis

Syphilitic Uveitis
STI- caused by Treponema pallidum
Stages: primary, secondary and tertiary
Ophthalmic manifestation usually in the tertiary stage
Salt and pepper fundus RPE atrophy
Uveitis
Periphlebitis
Vasculitis Choroiditis Retinitis Papillitis Haemorrhages
Sympathetic Ophthalmia
Bilateral granulomatous uveitis -history of eye trauma
10 days-years after the trauma
Cause: unknown. immune reaction against the patient’s uveal pigment??????
Inflamed first, then the other eye follows “sympathetically”
anti- inflammatory drugs
