Intraocular Inflammatory Disease: Diagnosis and Management Flashcards
What makes up the Uvea or Uvea-vascular tunic?
Iris, ciliary body and choroid
What is the function of the Uveal?
-Aqueous Humor Dynamics
-Remove Waste
-Absorb light
-Control light
-Blood-aqueous barrier
What are the three main events that relate to inflammation in the eye?
Increase blood supply
Augmented vessel permeability
WBC Migration
What is unique about inflammation in the eye?
-Limited regeneration occurs
-Unique Immune Requirements
What is inflammation generated by?
-Release of chemical mediators by cells (due to injury)
-Presence of certain pathogen-associated molecules
-Release pro-inflammatory molecules by immune cells
What are the 3 classifications of Uveitis?
Anterior
Posterior
Panuveitis
What are signs of ocular uveitis?
episcleral injection, ciliary flush, corneal edema, miosis, synechiae, aqueous flare, hyphema, hypopyon, keratic precipitates, rubiosis irides
What is Ciliary flush?
360-degree vascularization
What is corneal edema?
-Fluid buildup in stroma
-altered function of corneal endothelium (Job is to remove fluid, protein and inflammatory cells)
What is Miosis?
-Pupillary constriction
-Painful spasm of ciliary muscle
What is synechiae?
Adherence of the iris to the cornea or lens lead by inflammatory cells, fibrin and fibroblasts
What type of synechiae is most common with uveitis?
Posterior
What is aqueous flare?
Protein in aqueous humor (anterior chamber) - disrupt BAB
View as hazy anterior chamber
What is hypopyon?
WBC in aqueous humor (anterior chamber) - neutrophils
What is hyphema?
RBC in aqueous humor (anterior chamber)
What are keratic precipitates?
Inflammatory cells, fibrin and iris pigment adhereed to the endothelium (innermost layer of cornea)
What is rubiosis irides?
Injection of the iridal blood vessels (only see in iris)
What is hypotony?
Low intraocular pressure (increase outflow of AH)
What are some potential complications of Uveitis?
Synechiae, iris bombe, corneal edema and degeneration, cataracts, Lense instability, vitreous degeneration, retinal detachment, secondary glaucoma, phthisis bulbi
What is the most critical potential complication?
Secondary glaucoma
What are the key requirements for an Opthalmic exam?
Dark room and good light source
What are common clues that you have a case of uveitis?
Miosis, Low IOP, Aqueous flare, hypopyon and hyphemia
What are common causes of Uveitis?
Primary Ocular Disease: Cataract, Lense rupture, corneal ulcer, intraocular mass
Manifestation systemic disease: Infectious, metabolic, immune mediated and neoplasia
Idiopathic
Trauma
What are some common infectious causes of uveitis?
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
What are some common causes of uveitis in dogs?
Infectious, Lense induced uveitis, reflex uveitis, neoplastic (melenoma and lymphoma), breed/immune mediated (uveodermatologic syndrome, pigmented uveitis GRU), Metabolic
What are common causes ofuveitis in cats?
Infectious - FELV, FIP, FIV, FH1, Bartonella, Histoplasma, blastomyces, coccidiodise, toxoplasmea,
Systemic hypertension
Lymphoma
How do you diagnose Uveitis?
History - vaccination, life style, acute, chronic, previous med
Physical exam
Opthalmic exam
CBC, chem, ua
Serology
Thoracic or absominal rads
Ocular ultrasound
Systemic testing
What are the treatment goals of uveitis?
Control pain, prevent Sequella, stabilize and restore blood aqueous barrier, treat underlying cause
What are some topical treatments for uveitis?
Anti-inflammatory - corticosteroids (pred and dex) and nonsteroidals (diclofenac)
Topical atropine (mydratic, cycloplegic and stabalize BAB)
What are the contraindications of steroids?
Potentiate infection, decrease wound healing, ulcerative keratolysis, corneal lipid/calcium deposition
(check stain in eye)
What are contraindications of atropine?
Lense instability, glaucoma, dry eye
Bitter taste and drooling of cats
What are some systemic treatments of uveitis?
Systemic antinflammatories (corticosteroids)
Antimicrobial, antifungals or immunodulatory drugs
What is the overall management of uveitis?
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
What does the follow up for glaucoma look like?
Week or less (topical 3-4 times a day)
-Check complication (secondary glaucoma)
-Lessening of signs
-Gradual tapering of medications
-Client education
