post uveitis Flashcards
Different types of unifocal chorioretinitis
Toxoplasmosis, Candida, Sarcoid, TB
Name the multifocal chorioretinitis
POHS, birdshot, AMPPPE, MEWS, PIC, Sarcoid, lymphoma, TB
Name the diffuse chorioretinitis
CMV, acute retinal necrosis, progressive outer retina necrosis, Serpig
Name the non-specific panuveitis diseases
Sympathetic, sarcoid, lymphoma, syphilis, Behcet’s, idiopathic
Features of toxoplasmosis
- Protozoan: toxoplasma gondii
- origin: cats
- Congenital: pregnant female –> transplacental to foetus
- atrophic scar, possible recurrence, satellite lesion (cystic rupture), can be bilateral - Acquired: child or adult in environment
- benign, self-limiting, 20% develop systemic infection (flu-like)
Features of toxocariasis
- Parasite: toxocariasis (dogs)
- systemic infection - fever, pulmonary effects, neurological effects
- children (80% <16years)
- granuloma - cause dragged disc, unilateral, white elevated lesion
- vitritis
peripheral retinitis
endophthalmitis
Features of Sarcoidosis
- vitritis - vitreous ‘snowballs’ = clumps of cells and protein
Retina: granuloma, CMO, periphlebitis, peripheral neovasc, candle wax exudate (peri-venous sheathing), disc swelling/ optic atrophy
Features of Behcet’s disease
- Diffuse vascular leakage, retinal vasculitis (periphlebitis)
- Retinitis: white necrotic infiltrates, haemorrhage, poor visual prognosis
Features of ocular histoplasmosis
- Fungus infection (mainly lung disease)
- multifocal choroiditis - punctate atrophic lesions = histo-spots
- macula lesion - stimulate CSR –> neovasc, disciform-like scar
Features of cytomegalovirus (CMV)
- Herpes virus type 5
- untreated CMV retinitis –> retinal necrosis & RD
- bilateral (10-20%) , macula involvement (50%)
- vasculitis (ketchup on cottage cheese), mild vitritis, RD, optic atrophy
- MX: gancyclovir (IV)
Features of HIV retinopathy
- Microangiography (NFL occlusions)
- CWPs (w/o evidence of hypertension or diabetes)
Features of acute retinal necrosis (ARN)
- necrotising retinitis
- HSV1 (younger)
- HSV2 + VZV (older)
Features of progressive outer retinal necrosis (P ORN) = viral
- aggressive reaction to VZV
Features of kaposi’s sarcoma
Vascular tumours in HIV
Herpes virus type 8
Features of syphilis
= STD, subsides
- untreated –> spreads via blood to organs –> inflammation
- Tertiary: neuro-syphilis (cranial, visual pathway, oculomotor pathway)
- cardiovascular: aneurysm, vessels
- Localised granulomas
- congenital syphilis: interstitial keratitis, salt & pepper fundus
- Anterior uveitis: granulomatous mainly
Posterior uveitis: retinal vasculitis, chorioretinitis
- optic disc swelling (papiiloedema or papillitis)
Features of TB
- choroidal granuloma +/- active pulmonary TB (lung symptoms)
Features of cat scratch disease
- bacterial infection via infected cats
systemic effects: malaise, fever, lymphadenopathy, anorexia
Ocular effects: Parinaud’s oculoglandular syndrome, neuro-retinitis, vasculitis, choroidal granuloma, intermediate uveitis, sensory RD, associated ant uveitis
Features of sympathetic ophthalmia
- bilateral granulomatous uveitis
Due to trauma in 1 eye – excites inflammation in other eye - anterior uveitis (mutton fat KP, granulomatous)
- posterior: accumulations b/w RPE and BM, papilitis, choroidal lesions
What are the white dot syndromes
- Acute multifocal posterior pigment placoid epitheliopathy (AMPPPE)
- Multiple evanescent white dot syndrome (MEWDS)
- Birdshot retinochoroidopathy
- Acute retinal pigment epithelitis
- Punctate inner choroidopathy
- Serpiginous choroidopathy
- Ophthalmomyasis
Features of acute multifocal posterior pigment placoid epitheliopathy (AMPPPE)
- Bilateral, <30 years
- Choroidal vasculitis –> secondary RPE dysfunction
- many large plaque-like lesions (RPE level)
- symptoms: temporary vision loss, central/paracentral scotoma, sudden blurred vision, photopsia
- Angio: dark hypofluorescence –> slow hyperfluorescence
- Spontaneous recovery
Features of multiple evanescent white dot syndrome (MEWDS)
- Young women, unilateral
- Signs: many white small lesions - deep retina/RPE, cells in vitreous
- symptoms: sudden VA drop, possible RAPD
- self-limiting +/- chorioretinal scar
Features of birdshot retinochoroidopathy
- Bilateral, chronic inflamm disease
- older white female, uncommon
- Signs: scattered lesions, diffuse vitritis
- Symptoms: blurred vision, disturbed CV, night vision difficulty, floaters, no pain, photopsia
20% - self-limiting
80% - exacerbates - poor VA
Features of acute retinal pigment epithelitis
- presumed viral aetiology
- young px
- symptoms: acute VA decrease/ metamorphopsia
- signs: RPE changes, CSR occassionally, abnormal EOG
Features of acute retinal pigment epithelitis
- presumed viral aetiology
- young px
- symptoms: acute VA decrease/ metamorphopsia
- signs: RPE changes, CSR occassionally, abnormal EOG
Features of punctate inner choroidopathy
- Young myopic women
- no intraocular inflammation (AC cells)
Lesions: deep, yellow, resolves few weeks - CNV risk, atrophic/ pigmented
- blurred vision, light flashes, paracentral scotoma
Features of
Features of serpiginous choroidopathy
- idiopathic bilateral progressive inflammation
- 4-6th decade
- lesions begin near disc
- white subretinal infiltrates - spread outwards like snake (often to macula)
- Vitritis/ mild anterior uveitis
- remission/reactivation - satellites
Features of ophthalmomyasis
- Interna (penetrate eye) vs. externa (infest cornea, conj)
- Intraocular infestation of fly larvae
- Ant and post segment
- subretinal space tracking
How to manage posterior uveitis
Infectious: antibiotic therapy (+ steroid?)
Non-infectious: immunosuppression, steroid, cyclosporin, methotrexate
Systemic tx
Discuss intermediate uveitis / Pars Planitis
- Chronic, bilateral (95%)
- Limited CB inflammation, few systemic assoc.
- Floaters, blurred vision, dx of exclusion
- Signs: exudation into vitreous, cells in vitreous
- “Snowball/ cottonball” - inferior vitreous
- “Snow banking”
