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Intraocular Inflammation and Uveitis > Noninfectious Ocular Inflammatory Disease > Flashcards

Noninfectious Ocular Inflammatory Disease Flashcards

1
Q

Name the only 2 noninfectious causes of uveitis that can present with a hypopyon

A

seronegative spondyloarthropathies and Behcet’s

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2
Q

ear pain, nose pain, joint pain, scleritis

A

relapsing polychondritis

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3
Q

relapsing unilateral acute anterior uveitis that may affect either eye but only one at a time

A

seronegative spondyloarthropathies

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4
Q

percentage of acute anterior uveitis that are HLA-B27 positive

A

50%

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5
Q

type of back pain in ankylosing spondylitis

A

morning stiffness and pain that improves throughout day and improves with exertion

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6
Q

studies to order for acute anterior uveitis and morning back stiffness

A

HLA-B27 and sacroiliac films

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7
Q

bout of diarrhea 2 weeks ago. now painful urination, joint pain, and red eyes: diagnosis, demographics, 2 additional physical exam findings, and most common ophthalmologic findings

A

reactive arthritis. young adult males. keratoderma blennorrhagicum (scaly rash on palms and soles), and circinate balanitis (scaly circumferential rash on distal penis).

mucopurulent papillary conjunctivitis

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8
Q

two subsets of IBD-related uveitis

A
  1. HLA-B27 positive, acute anterior uveitis, sacroiliitis

2. HLA-B27 negative, sclerouveitis, RA-like symptoms

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9
Q

scaly skin rash, inflamed DIP joints, eye pain

A

psoriatic arthritis

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10
Q

demographics, diagnostic criteria, and eye findings for TINU (tubulointerstitial nephritis and uveitis syndrome)

A
  • adolescent girls and young women.
  • uveitis + elevated Cr + U/A abnormalities + systemic symptoms (fever, myalgias, etc)
  • bilateral nongranulomatous anterior uveitis with fibrin, posterior synechiae, large KP, and rarely a hypopyon
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11
Q

HLA association for TINU?

A

HLA-DRB1

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12
Q

Intermittent episodes lasting from a few hours to a few days of eye pain, always in the same eye: Diagnosis, HLA association, proposed etiology

A
  • glaucomatocyclitic crisis (Posner-Schlossman syndrome): recurrent unilateral uveitis with high IOP
  • HLA-B54
  • CMV infection
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13
Q

2 types of lens-associated uveitis with etiology and findings

A
  1. phacoantigenic uveitis: injury to lans capsule exposes lens material and leads to inflammation. IOP often elevated
  2. phacolytic uveitis: lens protein leaks through uninjured capsule, and macrophages swollen with lens protein clog TM and cause acutely increased IOP
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14
Q

most common cause of UGH today

A

one piece acrylic lens erroneously placed in sulcus

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15
Q

IOL type and location of choice to avoid UGH

A

one piece acrylic IOL in bag

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16
Q

systemic, topical, and injectable drugs associated with drug-induced uveitis

A
  • systemic: rifabutin, fluoroquinolones (esp moxi), sulfonamides, diethylcarbamazapine, OCPs, vaccines (BCG, influenza, PPD), etanercept
  • topical: metipranolol, anticholinesterase inhibitors prostaglandin F2 analogues
  • injectable: antibiotics, anti-VEGF, cidofovir, urokinase
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17
Q

3 subsets of JIA with brief descriptions

A
  1. Still disease: young children, fever + systemic illness, delayed joint involvement, uveitis rare
  2. Polyarticular: More than 4 joints. If RF-positive, may not get uveitis
  3. Oligoarticular (pauciarticular): 4 or fewer joints, vast majority of JIA-associated uveitis
    - -3a: young girls, ANA positive, chronic uveitis
    - -3b: older boys, HLA-B27+, acute and recurrent uveitis
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18
Q

risk factors for development of uveitis in JIA

A

female sex, ANA positivity, oligoarticular onset

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19
Q

T or F regarding JIA:

  1. uveitis generally develops within 5-7 years of onset of joint disease
  2. eye is frequently white and asymptomatic
  3. long-term sequelae are rare
  4. there is generally correlation between joint and ocular inflammation
A
  1. true
  2. true
  3. false
  4. false
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20
Q

Frequency of ophthalmic exam for JIA patients?

A

Every 3 months if:
- Oligo or polyarthritis, ANA positive, age of onset = 6 and disease duration = 4 years

Every 12 months if:

  • greater than 7 years disease duration
  • Stills disease variant
  • Oligo or polyarthritis, ANA positive, age of onset > 6 and disease duration > 4 years
  • Oligo or polyarthritis, ANA negative, age of onset > 6 or disease duration > 4 years

All others every 6 months

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21
Q

IMT of choice in JIA

A

once weekly methotrexate

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22
Q

Guidelines fo IOL implants in JIA patients

A
  1. acrylic IOLs only
  2. inflammation must be controlled for 3 months
  3. must use IMT pre and post-operatively
  4. close and long-term follow-up w/ low threshold for explantation
  5. treat band keratopathy prior to surgery
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23
Q

unilateral stellate KP, PSC, and iris atrophy: diagnosis, proposed etiology, and treatment

A

Fuchs heterochromic iridocyclitis. Rubella. Observation (self-limiting; generally don’t treat cell or use cycloplegics). Do well with cataract surgery

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24
Q

snowballs v snowbanking

A

snowballs: inflammatory cells clumping in vitreous
snowbanking: accumulation of cells at inferior pars plana; more severe

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25
Q

major cause of vision loss in pars planitis

A

CME

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26
Q

T or F regarding pars planitis:

  1. usually bilateral
  2. bimodal distribution
  3. females affected more
  4. peripheral retinal phlebitis and retinal venous sheathing are common
  5. neovascularization at the inferior snowbank is very rare
A
  1. true
  2. true
  3. false (no sex predilection)
  4. true
  5. false (10% get NV)
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27
Q

DDx for pars planitis

A

syphilis, lyme, TB, sarcoid, MS, toxocara, primary intraocular lymphoma

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28
Q

3 types of clinical courses of pars planitis

A
  1. self-limiting, benign course (10%)
  2. smoldering course with remissions and exacerbations (30%)
  3. prolonged course without exacerbations (60%)
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29
Q

Treatment algorithm for pars planitis

A

Goal is to treat CME. Without CME, treatment not necessarily needed

subtenons steroids –> intravitreal steroids –> systemic steroids –> IMT (and consider laser photocoagulation of snowbank and/or PPV if recalcitrant to IMT)

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30
Q

most common type of MS-associated uveitis

A

bilateral intermediate uveitis

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31
Q

relative risk of uveitis in MS patients, and percent of MS patients who get uveitis?

A

10 x more common. 30%

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32
Q

HLA association of MS with uveitis?

A

HLA-DR15

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33
Q

retinal finding in MS

A

periphlebitis (primarily affects veins)

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34
Q

retinal/choroidal findings in SLE

A

ischemic retinal vasculitis manifested by cotton wool spots, vascular occlusive disease and choroidopathy

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35
Q

extraocular ophthalmic findings in SLE

A

eyelid discoid lesions, secondary Sjogren’s, neuro-ophthalmologic findings (CN palsies, optic neuropathy, etc.; from vascular insults)

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36
Q

fever, fatigue, and weight loss followed by wrist drop and foot drop: diagnosis, ocular findings, systemic findings

A
  • polyarteritis nodosa.
  • retinal findings thath mimic hypertensive retinopathy. neuro-ophth issues 2/2 vasculitis
  • varied, to include renal problems, hypertension, cutaneous and GI involvement
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37
Q

classic triad of granulomatosis with polyangiits

A

necrotizing granulomatous inflammation of upper and lower respiratory tract, focal segmental glomerulonephritis, and necrotizing vasculitis of small arteries and veins

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38
Q

most characteristic clinical feature of granulomatosis with polyangiits

A

involvement of paranasal sinus (bloody rhinorrhea, sinus pain)

39
Q

bloody nasal discharge, dyspnea, polyarthritis, lower extremity purpura

A

granulomatosis with polyangiits

40
Q

most common mechanism of orbital involvement of granulomatosis with polyangiits

A

direct extension of inflammation from paranasal sinuses. can cause mass effect

41
Q

Laboratory test sensitive and specific for granulomatosis with polyangiits? For microscopic polyangiitis?

A

c-ANCA (anti proteinase 3)

p-ANCA (anti myeloperoxidase)

42
Q

encephalopathy, hearing loss, and BRAOs

A

SUSAC syndrome a.k.a. SICRET syndrome

43
Q

ovoid creamy lesions radiating from optic nerve

A

Birdshot

44
Q

white dot syndromes that block early and stain late

A

Birdshot, APMPPE, Serpiginous, MCP

45
Q

white dot syndromes that present acutely, are self-limiting, and generally have good prognosis without treatment

A

APMPPE, PIC, MEWDS, ARPE

46
Q

whit dot syndromes with normal ERG? Which one has abnormal EOG

A

serpiginous, PIC, ARPE

ARPE

47
Q

white dot syndromes that are unilateral

A

MEWDS and ARPE (24% of AZOOR is unilateral. serpiginous is asymmetrically bilateral)

48
Q

rare but serious association of APMPPE?

A

cerebral vasculitis

49
Q

HLA associations with APMPPE

A

HLA-B7 and -DR2

50
Q

multiple, large, flat, yellow-white placoid lesions

A

APMPPE

51
Q

gray-white lesions extending from optic nerve in geographic manner

A

serpiginous choroiditis

52
Q

test to order in patient with serpiginous choroiditis

A

PPD or quantiferon to rule out TB

53
Q

White dot syndromes that affect older patients? Affect females and males equally?

A

Birdshot and serpiginous

APMPPE, serpiginous, ARPE

54
Q

small, punched out chorioretinal lesions with pigmented borders, as well as small creamy, nonpigmented lesions. with vitritis

A

MCP (diagnosis of exclusion: must rule out sarcoid, syphilis, TB)

55
Q

white dot syndrome most associated with CNV

A

PIC. also high in serpiginous

56
Q

main difference between MCP and PIC

A

vitritis almost always in MCP but never in PIC

57
Q

white dot syndromes most associated with young, myopic females

A

MCP, PIC, subretinal fibrosis and uveitis syndrome, MEWDS, AZOOR

58
Q

white dot syndrome with granular macular pigmentary change

A

MEWDS

59
Q

white dot syndrome with punctate, wreath-like, late-staining perifoveal lesions on FA

A

MEWDS

60
Q

white dot syndrome with normal fundus appearance

A

AZOOR

61
Q

white dot syndrome with FAF showing lesion of hypoautofluoresence speckled with and bordered by hyperautofluorescence

A

AZOOR

62
Q

ERG findings in AZOOR

A

delayed 30-Hz-flicker ERG and reduction in EOG light rise (localizing pathology to RPE)

63
Q

differential for panuveitis

A

VKH, SO, sarcoid, toxoplasma, toxocara, syphilis, Behcet’s

64
Q

% ocular involvement in sarcoid? what is most common ocular finding?

A

50%. anterior uveitis

65
Q

acute presentation of erythema nodosum, febrile arthropathy, bilateral hilar adenopathy, and acute iritis

A

Lofgren syndrome (subset of acute sarcoid)

66
Q

acute presentation of uveitis, parotitis, fever, facial nerve palsy

A

Herrfordt syndrome (subset of acute sarcoid)

67
Q

major cause of morbidity in sarcoid

A

pulmonary disease

68
Q

slit lamp findings in sarcoidosis

A

anterior cell, mutton fat KP, iris nodules (Berlin at angle, Busacca midstromal, Koeppe at pupil margin), snowballs in vitreous

69
Q

candlewax drippings along retinal venules

A

sarcoid

70
Q

strong family history of granulomatous disease presenting in childhood?

A

Blau syndrome: familial juvenile systemic granulomatosis

71
Q

best initial test to screen for sarcoid in suspected patients

A

CXR

72
Q

classic histology of sarcoid

A

noncaseating granulomas

73
Q

most common risk factor for sympathetic ophthalmia

A 
intraocular surgery (especially vitreoretinal surgery).
trauma has higher risk but is less common
74
Q

yellowish-white, midequatorial lesions in sympathetic ophthalmia. diagnosis and histology

A

Dalen-Fuchs nodules (clusters of epithelioid cells between RPE and Bruchs)

75
Q

pattern of inflammation in sympathetic ophthalmia

A

bilateral, diffuse, non-necrotizing granulomatous panuveitis that classically spares the choriocapillaris in the early stage

76
Q

FA pattern for sympathetic ophthalmia

A

chorioretinal lesions that block early and stain late

77
Q

definitive prevention of sympathetic ophthalmia, and indications

A

enucleation (not evisceration), generally within 2 weeks of initial trauma or surgery. indicated with grossly deformed or painful eye with no vision

78
Q

HLA association for sympathetic ophthalmia and VKH

A

HLA-DR4

79
Q

ethnicities with higher prevalence of VKH

A

Asian, Asian Indian, Native American, Hispanic, MIddle Eastern. (Rare in whites and sub-Saharan Africans)

80
Q

what are the four stages of VKH

A

prodromal, acute uveitic, convalescent, and chronic recurrent

81
Q

classic retinal finding in acute uveitic phase of VKH

A

multiple serous retinal detachments

82
Q

In what stage of VKH does skin and hair depigmentation occur?

A

convalescent

83
Q

perilimbal vitilligo in VKH

A

Sugiura sign

84
Q

pale disc in background of bright red-orange choroid

A

sunset-glow fundus appearance in VKH (appears in convalescent stage)

85
Q

extraocular findings in VKH

A

hearing loss, vitiligo, allopecia, poliosis

86
Q

chronic recurrent stage of VKH

A

repeated bouts of anterior uveitis

87
Q

major criteria for Behcet’s

A

ocular inflammation, oral ulcers, genital ulcers, characteristic skin lesions (erythema nodosum, acbe, folliculitis)

88
Q

most frequent finding in Behctet’s

A

oral aphthous ulcers

89
Q

what is cutaneous pathergy

A

sterile ulcer formed at the site of venipuncture. 40% occurrence in Behcet’s but not specific

90
Q

most serious manifestations of Behcet’s?

A

neurologic involvement

91
Q

pattern of ocular inflammation in Behcet’s

A

bilateral, necrotizing, diffuse, nongranulomatous obliterative vasculitis or arteries and veins in any uveal tissue

92
Q

explosive onset eye pain with hypopyon in eye with previous bouts of inflammation

A

Behcet’s

93
Q

HLA association with Behcet’s

A

HLA-B51

94
Q

Matching: Birdshot/Serpiginous v CNV/CME

A

Birdshot: CME
Serpiginous: CNV

Intraocular Inflammation and Uveitis (7 decks)

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