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Uveitis > Posterior Uveitis > Flashcards

Posterior Uveitis Flashcards

1
Q

DDx for pan uveitis

A

sarcoidosis

TB

Syphylis

VHK

SO

Behcet’s

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2
Q

CMV

A

hemorrhagic necrotizing retinitis of all retinal layers

in HIV patients when CD4 count < 50

40% bilateral

path: large owl’s eyes intranuclear inclusions in enlarged,necrotic retinal cells

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3
Q

CMV treatment

A

Ganciclovir (causes neutropenia/thrombocytopenia)

Foscarnet (renal toxic)

Cidofovir (renal toxicity, uveitis, hypotony)

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4
Q

Acute retinal necrosis

A

self limited confulent peripheral necrotising retinitis due to VZV > HSV > CMV

usually in immunocompetent people (33% bilateral - more commonly in immunocompromized)

Pain, injection, gran KP, periopheral patchest of necrotizing retinitis

focal areas of choroidal hypoperfusion on FA

Tx: acyclovir IV (5d) PO (6wks)

65-90% develop RRD usually within 3 mo

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5
Q

PORN

A

ARN in AIDS patient

painless, minimal inflammation

75% unilateral, 70% become bilateral

67% become NLP within 4 weeks

poor response ot anitvirals

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6
Q

Rubella

A

sensorineural hearing loss

Talk and pepper retinopathy

cataracts or glaucoma

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7
Q

Measles

A

pigmentary retinopathy due to infection acquired in utero

keratoconjunctivitis, retinal edema, Koplik’s spots, vascular attenuation, macular star,

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8
Q

Subacute sclerosing panencephalitis

A

measles infection involving CNS

macular or perimacular choroiretinitis, papilledema, optic atrophy, nystagmus, cortical blindness

also have seizures, myoclonus

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9
Q

pneumocystis choroiditis

A

due to pneumocystitis carinii

orange nummular lesions containing cysts of pneumocystis

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10
Q

cysteicercosis

A

pork tapeworm - Taenia Solium or Taenia Saginata

humans are definiative host

adult worms live in small intestines

larvae travel to eye - produce cystic subretinal or intravitreal lesions

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11
Q

Diffuse unilateral subacute neuroretinitis (DUSN)

A

ancylostoma caninum (dog hookworm) or Baylisascaris procyonis (racoon nematode)

deep grey/white lesions with optic nerve nerve swelling, RPE swelling

Tx: laser nematode

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12
Q

onchocerciasis

A

oncerocerca volvulus

adults live in fibrous, subcutanous nodules (in joints)

Female worm >>> male worm

live larvae = little or no inflamm, death causes severe granulomatous inflammation and scarring

Transmitted by black fly

sclerosisng keratitis, scleritis, cataract, PAS, glaucoma

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13
Q

Whipples disease

A

tropheryma whipplei - gram pos bacillus

Actinomycetes family

causes uveitis and retinal vasculitis + migratory arthritis and diarrhea

PAS positive macrophages with ‘clubbed’ microvilli in intestinal wall or vitreous

Tx: Bactrim

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14
Q

Endophthalmitis - post-operative

Risk factors

organisms

incidence

A

acute postoperative (<6 wks after surgery - 90% within 1 wk)

RF: blepharitis, wound leak, iris prolapse, vitreous loss, diabetes, alcoholism

Organisms: Staph epi, Staph Aureus, Strep, Pseudomonas

Delayed (p acnes)

ICCE/ECCE - 0.07%

PPV - 0.51%

PK - 0.11%

Glaucoma - 0.06%

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15
Q

Endophthalmitis trauma/endogenous

Risk factors

Organisms

Incidence

A

trauma: RF - retained FB, delayed surgery, soil contamination, disruption of the lens

Bacillus (30%), Staph epi (25%), Strep (13%), staph aureus (8%)

2-7% of penetrating injuries

Endogenous: RF: immunosuppression, indwelling catehter, IVDA, intra-abdominal surgery

Candida highest

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16
Q

Sarcoidosis

A

Path: noncaseating granulomas and Langhans’ multinucleated giant cells

F>M, Blacks (10:1)

25-50% have systemic manifestations

60% have uveitis (2/3 with anterior uveitis)

Systemic: Lung - hilar adenopathy

Skin - erythema nodosum, granulomas

hepatosplenomegaly

Diabetes insipidus

Hypercalcemia, parathyroid gland infiltration

17
Q

Mikulicz’s Syndrome

A

Lacrimal and parotid gland swelling

KCS

can be secondary to sarcoidosis, TB, lymphoma/leukemia

18
Q

Behcet’s Disease

Triad

HLA

A

Chronic recurrent relapsing occlusive vasculitis

Oral ulcers, genital ulcers, inflammatory eye symptoms

HLA B51

M>F - Japanese/Mediterranean

Uveitis (Post > Ant) non granulomatous,

Bilateral transient hypopyon, CME, Tractional RD, ION, retinal hemorrhages

Also erythema nodosum, folliculitis, arthritis, thrombophlebitis, GI pain, diarrhea, CNS involvement

19
Q

Vogt-Koyanagi-Harada syndrome

Harada’s disease

Presumped cause

HLA

Ethnicity

Gender

Age

A

bilateral diffuse granulomatous panuveitis

Serous RD, vitritis, disc edema, meningeal irritation, pigmentary skin chagnes, auditory disturbance

Harada’s disease: Eye findings only

presumed to be autoimmune process against melanocytes

HLA DR4

Asians > Native Americans > Hispanics

F>M, 30-50 yrs old

20
Q

Eye findings in VKH

Other findings

Sugiura’s sign

A

granulomatous panuveitis

bilateral

Serious RD

vitritis, ON edema

Dalen-Fuchs nodules

Sunset fundus (RPE distrubance with focal areas of atrophy and hyperpigmentation

Other: Poliosis, tinnitis, vertigo, meningeal irritation, alopecia, deafness

Sugiura’s sign - perilimbal vitiligo

21
Q

Stages of VKH

Prodrome

syndrome

chroinc stage

recurrent statge

A

Prodrome - flu-like, meningismus, seizures, eye pain/redness

Syndrome: Uveitis with serous RD

chronic stage: sunset fundus, Dalen fuchs nodules, perilimbal vitiligo

recurrent stage - AC reaction, pgiment changes

22
Q

Path

LP

FA

A

inflammation of Choriocapillaris (absent in SO) and retina. dalen fuches (between RPE and bruchs)

LP with pleocytosis

multiple focal ares of subretinal leakage

‘1000 points of light’

23
Q

Sympathetic Ophthalmia

Incidence

cause

A

bilateral granulomatous panuveitis following penetrating injury

  1. 1-0.3% after penetrating injury
  2. 015% after surgery

caused by immune sensitization to melanin or malanin associated proteins

= T-cell mediated - delayed hypersensitivity rxn

24
Q

SO - pathology

FA

Treatment

A

diffuse lymphocytic infiltration of choroid with epitheliod (giant) cells

Sparking of choroicapillaris

Dalen fuchs nodules

mulitple hyperfluorescent sites of leakage

Treat with enucleation of eye within 14 days if NLP, steroids or immunosuppression

25
Q

Syphilis

Acquired vs congenital

A

Uveitis (4 decks)

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