Red Eye 2 Flashcards
1
Q
uveitis
A
general term used to describe inflammation of the uvea, which is comprised of the choroid, ciliary body, and iris
2
Q
classifications of uveitis
A
- anterior: iritis, iridocyclitis
- posterior: retinitis, choroiditis
- intermediate: cyclitis, vitritis, pars planitis
- panuveitis
3
Q
uveitis symptoms
A
- redness
- blurry vision
- pupillary abnormalities
- photophobia
- pain
4
Q
uveitis symptoms: cause of redness
A
- ciliary flush/circumlimbal flush
- anterior ciliary arteries anastomose with limbal vasculariation and originate from long posterior ciliary arteries; therefore, anything causing inflammation of the ciliary body causes associated inflammation seen around the limbal region
5
Q
uveitis symptoms: cause of blurred vision
A
- cloudy media: cornea, AC, lens, vitreous
- ciliary body spasm
- macular edema
6
Q
uveitis symptoms: cause of pupillary abnormalities
A
- typically associated with miosis secondary to prostaglandin release from inflammation
- pay close attention to anterior lens capsule and any signs of previous posterior synechiae; strongly consider cycloplegics to prevent recurrence, or initial occurrence
7
Q
uveitis symptoms: cause of photophobia
A
- pain caused by light exposure, anterior chamber reaction and ciliary body spasm
- tx options: cycloplegia and sunglasses
8
Q
uveitis symptoms: cause of pain
A
- primarily related to ciliary body spasm/inflammation, irritating uveal nerves
- referred pain: periorbital pain associated with the trigeminal nerve branch
- tx options: cycloplegia reduces pain secondary to stabilization of ciliary body muscle spasm, which also reduces “spill-over” of inflammatory materials; may also use oral analgesics
9
Q
uveitis signs
A
- cells and flare
- keratic precipitates
- IOP changes
- iris nodules, atrophy, synehciae
- band keratopathy
- posterior subcapsular cataract
- vitreous cells, haze, snowballs
- posterior signs: pars planitis, chorioretinal lesions, vasculitis, hemorrhages, optic nerve edema, neovascularization, retinal detachment
10
Q
cells and flare
A
- origin: vascular leakage from iris or ciliary body
- cells predominantly are lymphocytes and monocytes
- pigmented cells may be uveal cells, macrophages containing pigment, or erythrocytes, or can get free anterior chamber pigment from normal iris depigmentation
- leukocytes may precipitate out to form hypopyon
- flare: protein, mainly albumin; can also look like longer white strands as fibrin material collects clumped cells
11
Q
cells and flare grading
A
- 0: complete absence, no cells
- 1+: faint flare (barely detectable), 5-10 cells per field
- 2+: moderate flare (iris and lens details clear), 10-20 cells per field
- 3+: marked flare (iris and lens details hazy), 20-50 cells per field
- 4+: intense flare (fixed, coagulated aqueous with considerable fibrin), 50+ cells per field
12
Q
keratic precipitates
A
- Mutton fat are larger (1 mm or greater), mostly on inferior cornea and greasy appearing, usually indicative of: granulomatous inflammation and likely and underlying systemic condition (sarcoidosis, syphilis, TB)
- finer, stellate, diffuse KPs usually cover entire corneal endothelium
13
Q
IOP changes in uveitis
A
- needs to be checked, no matter how much pain patient is in
- lower more commonly seen, however can have elevated IOP; higher more common in herpes- usually associated with trabeculitis; FHIC, Posner-Schlossman
14
Q
iris nodules
A
- some represent collection of inflammatory cells similar to KPs
- Koeppe: pupillary border
- Busacca: anterior iris mid-periphery
- sarcoid, syphilis, TB
15
Q
iris atrophy
A
resulting from chronicity of condition
