Ocular Inflammation

Question 1

what is Iritis/Anterior Uveitis?

Answer 1

Inflammation of the uveal tract (the iris, ciliary body and choroid)

Question 2

what is the main cause of Anterior Uveitis?

Answer 2

Idiopathic

Question 3

what are the seronegative arthropathic causes of Anterior Uveitis?

Answer 3

Ankylosing spondylitis, Inflammatory bowel disease, Psoriatic arthritis, Reiter’s syndrome

Question 4

what are the infective causes of Anterior Uveitis?

Answer 4

TB, Syphilis, HIV, Herpes zoster, Toxoplasmosis, Toxocariasis

Question 5

what are the autoimmune causes of Anterior Uveitis?

Answer 5

Sarcoidosis, Behcets

Question 6

what are the malignant causes of Anterior Uveitis?

Answer 6

Non-Hodgkin’s lymphoma, Leukaemia, Retinoblastoma, Ocular melanoma

Question 7

what are the clinical features of anterior uveitis?

Answer 7

• Ocular pain
• Photophobia
• Blurring of vision
• Redness –
• Cells/flare in anterior chamber
• Hypopyon
• Reduced visual acuity
• Small pupil – iris spasms and adhesions
• Posterior synechiae – pupil stuck to lens surface
• Posterior Uveitis – floaters, scotomas

Question 8

what are the systemic symptoms associated with anterior uveitis?

Answer 8

Systemic symptoms depending on cough – respiratory symptoms, skin problems, joint disease, bowel disease, infectious disease

Question 9

how is anterior uveitis diagnosed?

Answer 9

• Positive Talbots test – pain increases as eyes converge

* Investigate for underlying cause if bilateral or highly recurrent

Question 10

what is management of anterior uveitis?

Answer 10

• Topical Steroids

* Topical Mydriatic

Question 11

what is the cause of episcleritis?

Answer 11

Idiopathic
• Underlying systemic vascular disease – polyarteritis nodosa, granulomatosis
• Connective tissue disease – RA, rosacesa, atopy, GOUT, UC

Question 12

what is episcleritis?

Answer 12

Benign engorgement of blood vessels

Question 13

what are clinical features of episcleritis?

Answer 13

• Red eyes
• Nodules may occur/diffuse
• No discharge, less photophobia, then uveitis, gritty feeling
• Localised patch of injected sclera which blanches on application of phenylephrine

Question 14

what is the management of episcleritis?

Answer 14

• Self limiting
• Topical lubricants or NSAIDs
• Topical prednisolone acetate

Question 15

what are the causes of scleritis?

Answer 15

• Idiopathic
• Inflammatory
• Infectious - Herpes Zoster, syphilis, varicella
• Gout
• Other – surgery/trauma

Question 16

what are the inflammatory causes of scleritits?

Answer 16

Collagen vascular disease (Rheumatoid Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematosus, Wegener’s granulomatosis, Polyarteritis nodosa), IBD, sarcoidosis

Question 17

what is scleritis?

Answer 17

Inflammation of the sclera

Question 18

what is the pathophysiology of scleritis?

Answer 18

• T cell driven inflammation
• Granulomatous disorder – fibroid necrosis with infiltration from macrophages
• Both inflammatory and ischaemic scleral lesions occur

Question 19

what are the macroscopic features of scleritis?

Answer 19

Anteriorly the sclera may show diffuse or nodular swelling bt less commony a necrotising form occurs with full thickness tissue loss, uveal exposure and the risk of perforation

Question 20

what are the two types of scleritis?

Answer 20

• Anterior – diffuse, nodular or necrotising

* Posterior

Question 21

what are the clinical features of scleritis?

Answer 21

• Red eye
• Painful!!! – wake patient up at night, deep boring, radiate to jaw
• Lacrimation
• Photophobia
• Reduced visual acquity
• Injection of deep vascular plexus – vidaceous hue – blue/purple
• Posterior –

Question 22

what are the complications of scleritis?

Answer 22

• Scleromalacia perforans
• Keratitis
• Uveitis
• Cataract Formation
• Glaucoma

Question 23

what is the management of scleritis?

Answer 23

• NSAID

* Corticosteroids – oral prednisolone (if severe)