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Uveitis > Panuveitis > Flashcards

Panuveitis Flashcards

1
Q

Vogt–Koyanagi disease

A

skin changes and anterior uveitis

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2
Q

Harada disease

A

neurological features and exudative retinal detachments

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3
Q

VOGT–KOYANAGI–HARADA - phases

A

Prodromal (CNS, auditory), Acute uveitic (Bilateral granulomatous anterior and multifocal posterior uveitis), Convalescent (skin, depigmented fundus)

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4
Q

sunset glow

A

depigmented fundus in Convalescent phase VKH. Also residual chorioretinal scarring in Sympathetic ophthalmitis

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5
Q

Diagnostic criteria for VKH

A
  1. Absence of a history of penetrating ocular trauma 2. Absence of other ocular disease entities 3. Bilateral uveitis 4. Neurological and auditory manifestations 5. Integumentary findings, not preceding
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6
Q

CSF in VKH

A

transient lymphocytic pleocytosis and melanin-containing macrophages

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7
Q

secondary Frosted branch angiitis

A

cytomegalovirus retinitis, lymphoma, leukaemia

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8
Q

primary Frosted branch angiitis

A

idiopathic, children and young adults. bilateral

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9
Q

Multifocal choroiditis and panuveitis

A

bi, asymmetrical, chronic/recurrent, young and middle females, anterior 50%, vitritis, Multiple discrete, ovoid, yellowish-grey. CNV 25-35%, CMO. VF large defects

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10
Q

Punctate inner choroidopathy

A

myopic women, bi sequentially, small yellow–white macular spots, CNV 40%, serous RD

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11
Q

Lyme disease

A
  • Uveitis is relatively uncommon but can be anterior (granulomatous or non-granulomatous), intermediate (the most common), or posterior including multifocal choroiditis, vasculitis and neuroretinitis.
  • Other manifestations include early (stage 1) transient conjunctivitis, bilateral stromal keratitis, episcleritis, scleritis, orbital myositis, optic neuritis, papilloedema and ocular motor and facial nerve palsy (up to 25% of facial nerve palsy in endemic areas).
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12
Q

Acquired syphilis

A

• Anterior may be granulomatous or non-granulomatous and is bilateral in 50%. Roseolae are dilated iris capillaries • Chorioretinitis is often multifocal, bilateral and associated with vitritis • Acute syphilitic posterior placoid chorioretinopathy • Retinitis • Optic neuritis and neuroretinitis

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13
Q

Tuberculosis

A

• Anterior uveitis granulomatous; iris nodules may be present. • Vitritis • Choroidal granuloma • Choroiditis typically multifocal and in a centrifugally spreading serpiginous • Retinal vasculitis is preferentially venous

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14
Q

fluffy ‘cotton ball’ or ‘string of pearls’ colonies

A

Endogenous Candida endophthalmitis

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15
Q

Sympathetic ophthalmitis - what time

A

between 2 weeks and 3 months after initial injury in 65%.

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16
Q

Dalen–Fuchs nodules

A

granulomas located between Bruch membrane and the RPE

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17
Q

Sympathetic ophthalmitis - how often relapse

A

50%

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18
Q

Sympathetic ophthalmitis - FA

A

multiple foci of leakage at the level of the RPE, with subretinal pooling in the presence of exudative retinal detachment

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19
Q

Sympathetic ophthalmitis - ICGA

A

hypofluorescent spots in active disease, which resolve with treatment

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20
Q

LENS-INDUCED UVEITIS - other names

A

phacogenic (previously phacoanaphylactic)

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21
Q

LENS-INDUCED UVEITIS - features

A

• Anterior uveitis is granulomatous • Corneal oedema is common adjacent to an anterior chamber lens fragment • IOP is frequently elevated. • Vitritis of variable severity is usually present if lens fragments lie within the vitreous cavity

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22
Q

Sarcoidosis - most common presentation

A

granulomatous anterior uveitis

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23
Q

Sarcoidosis - ocular inflammation features

A
  1. ‘Mutton fat’ KPs and/or small granulomatous KPs and/or iris nodules 2. Trabecular meshwork (TM) nodules and/or tent-shaped PAS 3. Vitreous opacities: snowballs and/or ‘strings (sznury) of pearls’. 4. Multiple chorioretinal peripheral lesions - uncommon 5. Nodular and/or segmental periphlebitis (± ‘candle wax drippings’ - Perivenous exudates) and/or retinal macroaneurysm 6. Optic disc nodule(s)/granuloma(s) and/or solitary choroidal nodule. 7. Bilaterality. 8. conjunctival nodules, lacrimal gland infiltration, dry eye, eyelid skin nodules, orbital and scleral lesions
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24
Q

Sarcoidosis - 5 significant investigations

A
  1. Negative tuberculin skin test in a BCG-vaccinated patient or in a patient having had a positive tuberculin skin test previously. 2. Elevated serum ACE levels and/or elevated serum lysozyme 3. Chest X-ray showing bilateral hilar lymphadenopathy (chest abnormal in 90%), 4. Abnormal liver enzyme tests. 5. Chest CT scan in patients with a negative chest X-ray result
25
Q

Definite ocular sarcoidosis

A

biopsy-supported diagnosis in the presence of a compatible uveitis

26
Q

Presumed ocular sarcoidosis

A

biopsy not done but chest X-ray shows BHL (bilateral hilar lymphadenopathy) with a compatible uveitis

27
Q

Probable ocular sarcoidosis

A

biopsy not done, no BHL on chest X-ray but >3/7 of the intraocular signs above and >2/5 positive laboratory tests

28
Q

Possible ocular sarcoidosis

A

lung biopsy negative but >4/7 signs and >2/5 positive laboratory tests

29
Q

BEHÇET DISEASE - age

A

third decade

30
Q

BEHÇET DISEASE - which vessels

A

Vasculitis (small, medium and large veins and arteries)

31
Q

BEHÇET DISEASE - criteria

A

recurrent oral ulceration (at least three times in a 12-month period plus at least two of genital ulceration), ocular inflammation, characteristic skin lesions (erythema nodosum, pseudofolliculitis, acneiform nodules, papulopustular lesions) and a pathergy reaction: pustule 24–48 hours after a sterile needle prick (>95% specific). Other: aneurysms, arthritis

32
Q

BEHÇET DISEASE - uveitis features

A

AAU, often bilateral, is typical. It is not granulomatous. A transient mobile hypopyon in a relatively white eye • Vitritis • Retinitis. Transient superficial white infiltrates that heal without scarring may be seen

33
Q

Toxoplasmosis - definitive host

A

cat

34
Q

Toxoplasmosis - intermediate hosts

A

mice, livestock, birds and humans

35
Q

Toxoplasmosis - the average age of presentation

A

29 years

36
Q

Toxoplasmosis - pregnancy

A

may provoke the recurrence

37
Q

Toxoplasmosis - uveitis features

A

• ‘Spill-over’ (rozprzestrzeniający się) anterior uveitis (granulomatous or resemble Fuchs) • A single inflammatory focus - Lesions tend to involve the posterior pole • Vitritis - ‘Headlight in the fog’ • Vasculitis may be arterial, but is more commonly venous • Optic disc oedema is common • Neuroretinitis - acutely acquired rather than reactivated infection

38
Q

average number of recurrent attacks of Toxoplasmosis

A

2.7

39
Q

Toxoplasmosis - Serology

A

Toxoplasma IgG antibodies are detectable in the serum within 1–2 weeks of initial infection. Positivity to IgM antibodies usually means that infection has been acquired within the last year

40
Q

Goldmann–Witmer coefficient

A

Ocular fluid antibody assessment. Calculating the ratio (Goldmann–Witmer coefficient) of specific IgG in aqueous humour to that in serum

41
Q

Toxoplasmosis - treatment

A

Prednisolone (1 mg/kg) is given initially and tapered according to clinical response, but should always be used in conjunction with a specific anti-Toxoplasma agent, most frequently pyrimethamine combined with sulfadiazine (‘classic’ or ‘triple’ therapy, sometimes supplemented with clindamycin). Some authorities start steroids only after 24–48 hours of antimicrobial therapy.

42
Q

Toxocariasis - how infestation

A

ingestion of soil or food contaminated with ova shed in canine faeces

43
Q

Toxocariasis - forms

A

○ Chronic endophthalmitis (include anterior uveitis, vitritis, chorioretinitis, papillitis and a fundus granuloma) ○ Posterior pole or peripheral granuloma without inflammation - older child or adult

44
Q

Onchocerciasis - forms

A

• Anterior uveitis • Keratitis • Chorioretinitis • Optic neuritis

45
Q

VKH - what ethnic groups

A

Asian-Indians, Hispanics, Native Americans, Middle Easterners

46
Q

Chronic recurrent stage of VKH

A

granulomatous anterior uveitis, KPs, iris nodules, posterior synechiae, iris atrophy

47
Q

Owl’s eye

A

inclusion bodies in CMV

48
Q

Langerhans giant cell

A

mostly tuberculosis, may also sarcoidosis

49
Q

IBD

A

sclerouveuitis HLA B-B27 (-). B27(+) sacroilitis. intermediate uveitis B27(-)

50
Q

Measles (rubeola) - basic

A

3 C’s: cough, coryza, conjunctivitis

51
Q

Measles (rubeola) - ophthalmic

A

conjunctivitis, retinopathy (edema, macular star, optic disc swelling, narrowed arterioles, intraretinal hemor). When subsides: bone spicules, salt-and-pepper

52
Q

Which organisms are associated with the best prognosis in endophthalmitis

A

coagulase-negative staphylococci

53
Q

Which organisms are associated with the worst prognosis in endophthalmitis

A

Enterococci

54
Q

Primary intraocular lymphoma - diagnosis

A

IL10:IL6 >1,0 . Myeloid Differentiation Primary Gene 88 (MYD88) mutation. kappa:lambda light-chain ratio of >3 or <0.6 - marker of monoclonality

55
Q

Can present with hypopyon

A

Behcet, HLA-B27, Rifabutin, lymphoma, TASS

56
Q

candle-wax drippings

A

peri-venous exudates in sarcoidosis

57
Q

best screening test for sarcoidosis

A

Chest X-Ray

58
Q

IBD

A

sclerouveuitis HLA B-B27 (-). B27(+) sacroilitis. intermediate uveitis B27(-)

Uveitis (7 decks)

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