Intraocular Inflammatory Disease: Diagnosis and Management

Question 1

What makes up the Uvea or Uvea-vascular tunic?

Answer 1

Iris, ciliary body and choroid

Question 2

What is the function of the Uveal?

Answer 2

-Aqueous Humor Dynamics
-Remove Waste
-Absorb light
-Control light
-Blood-aqueous barrier

Question 3

What are the three main events that relate to inflammation in the eye?

Answer 3

Increase blood supply
Augmented vessel permeability
WBC Migration

Question 4

What is unique about inflammation in the eye?

Answer 4

-Limited regeneration occurs
-Unique Immune Requirements

Question 5

What is inflammation generated by?

Answer 5

-Release of chemical mediators by cells (due to injury)
-Presence of certain pathogen-associated molecules
-Release pro-inflammatory molecules by immune cells

Question 6

What are the 3 classifications of Uveitis?

Answer 6

Anterior
Posterior
Panuveitis

Question 7

What are signs of ocular uveitis?

Answer 7

episcleral injection, ciliary flush, corneal edema, miosis, synechiae, aqueous flare, hyphema, hypopyon, keratic precipitates, rubiosis irides

Question 8

What is Ciliary flush?

Answer 8

360-degree vascularization

Question 9

What is corneal edema?

Answer 9

-Fluid buildup in stroma
-altered function of corneal endothelium (Job is to remove fluid, protein and inflammatory cells)

Question 10

What is Miosis?

Answer 10

-Pupillary constriction
-Painful spasm of ciliary muscle

Question 11

What is synechiae?

Answer 11

Adherence of the iris to the cornea or lens lead by inflammatory cells, fibrin and fibroblasts

Question 12

What type of synechiae is most common with uveitis?

Answer 12

Posterior

Question 13

What is aqueous flare?

Answer 13

Protein in aqueous humor (anterior chamber) - disrupt BAB

View as hazy anterior chamber

Question 14

What is hypopyon?

Answer 14

WBC in aqueous humor (anterior chamber) - neutrophils

Question 15

What is hyphema?

Answer 15

RBC in aqueous humor (anterior chamber)

Question 16

What are keratic precipitates?

Answer 16

Inflammatory cells, fibrin and iris pigment adhereed to the endothelium (innermost layer of cornea)

Question 17

What is rubiosis irides?

Answer 17

Injection of the iridal blood vessels (only see in iris)

Question 18

What is hypotony?

Answer 18

Low intraocular pressure (increase outflow of AH)

Question 19

What are some potential complications of Uveitis?

Answer 19

Synechiae, iris bombe, corneal edema and degeneration, cataracts, Lense instability, vitreous degeneration, retinal detachment, secondary glaucoma, phthisis bulbi

Question 20

What is the most critical potential complication?

Answer 20

Secondary glaucoma

Question 21

What are the key requirements for an Opthalmic exam?

Answer 21

Dark room and good light source

Question 22

What are common clues that you have a case of uveitis?

Answer 22

Miosis, Low IOP, Aqueous flare, hypopyon and hyphemia

Question 23

What are common causes of Uveitis?

Answer 23

Primary Ocular Disease: Cataract, Lense rupture, corneal ulcer, intraocular mass

Manifestation systemic disease: Infectious, metabolic, immune mediated and neoplasia

Idiopathic

Trauma

Question 24

What are some common infectious causes of uveitis?

Answer 24

Mycoses - blasto, histo, coccidio, crypto, aspergillus

Rickettsial: ehrlicia, rickettsia,

Protozoal: toxo, neopspora, leishmania

Viral: ICH, Herpes, DHPP, FIV, FIP, FELV

Bacterial: Lepto, brucella, tuberculosis, nocardia, borreliosis, baronella

Question 25

What are some common causes of uveitis in dogs?

Answer 25

Infectious, Lense induced uveitis, reflex uveitis, neoplastic (melenoma and lymphoma), breed/immune mediated (uveodermatologic syndrome, pigmented uveitis GRU), Metabolic

Question 26

What are common causes ofuveitis in cats?

Answer 26

Infectious - FELV, FIP, FIV, FH1, Bartonella, Histoplasma, blastomyces, coccidiodise, toxoplasmea,
Systemic hypertension
Lymphoma

Question 27

How do you diagnose Uveitis?

Answer 27

History - vaccination, life style, acute, chronic, previous med

Physical exam

Opthalmic exam

CBC, chem, ua

Serology

Thoracic or absominal rads

Ocular ultrasound

Systemic testing

Question 28

What are the treatment goals of uveitis?

Answer 28

Control pain, prevent Sequella, stabilize and restore blood aqueous barrier, treat underlying cause

Question 29

What are some topical treatments for uveitis?

Answer 29

Anti-inflammatory - corticosteroids (pred and dex) and nonsteroidals (diclofenac)

Topical atropine (mydratic, cycloplegic and stabalize BAB)

Question 30

What are the contraindications of steroids?

Answer 30

Potentiate infection, decrease wound healing, ulcerative keratolysis, corneal lipid/calcium deposition
(check stain in eye)

Question 31

What are contraindications of atropine?

Answer 31

Lense instability, glaucoma, dry eye

Bitter taste and drooling of cats

Question 32

What are some systemic treatments of uveitis?

Answer 32

Systemic antinflammatories (corticosteroids)

Antimicrobial, antifungals or immunodulatory drugs

Question 33

What is the overall management of uveitis?

Answer 33

Direct at cause
Topical steroid if no ulcer, atropine if no synechia and there is pain (no dry eye or glaucoma), systmeic NSAID, no systemic steroid until diagnose complete

Question 34

What does the follow up for glaucoma look like?

Answer 34

Week or less (topical 3-4 times a day)
-Check complication (secondary glaucoma)
-Lessening of signs
-Gradual tapering of medications
-Client education