Red eye: Inflammation Flashcards
Anterior uveitis
Inflammation of uveal tract = choroid + ciliary body + iris
Iritis = inflammation confined to anterior chamber
Cyclitis = inflammation involving ciliary body
Keratouveitis = inflammation involving corona and uveal tract
Sclerauveitis = inflammation involving sclera and uveal tract
Causes of anterior uveitis
- Idiopathic (70%)
- Infection (TB, syphilis, HSV, Herpes zoster)
- Lens-induced
- Tumours
- Trauma
- Systemic diseases (HLA-B27 vs non)
Primary site of inflammation in anterior uveitis
Anterior chamber
Systemic diseases associated with anterior uveitis
HLA-B27:
Psoriatic arthritis
Ankylosing spondylitis
IBD
Reiter’s syndrome
Non-HLA-B27:
Juvenile idiopathic arthritis
Sarcoidosis
Symptoms of anterior uveitis
Pain
Photophobia
Red eye - Circumcillary injection
Blurred vision
Pupil miotic (Small)
Poor reaction to light
Signs of anterior uveitis
Conjunctiva
- Perilimbal injection
- Diffused conjunctival injection
Cornea
- Keratic precipitates
Anterior chamber:
- Flare and cells
- Fibrin overlying pupil
- Hypopyon
Pupil
- Irregular (due to posterior synechiae)
Iris
- Nodules
- Posterior synechia
- Atrophy
- Heterochromia
Intraocular pressure
- Hypotony
- Secondary glaucoma – open or closed angle
Complications of anterior uveitis
Irregular pupil (due to posterior synechia)
Secondary angle closure glaucoma (due to iris adhering to cornea at filtration angle)
Treatment for anterior uveitis
- Mydriatics
- Analgesia
- Topical/PO steroids
- Unilateral: Topical steroids + Cycloplegics (Prednisolone + Cyclopentolate)
- Bilateral/ Resistant to Tx: PO steroids
If anterior uveitis recurs, what should be screened for?
Screen for HLAB27, ANA, RF, ESR, CRP, dsDNA
+ TRO TB and syphilis
Episcleritis
Inflammation of the superficial episcleral vessels of the eye
Types of episcleritis
- Diffuse
- Sectoral
- Nodular
Symptoms of episcleritis
- Often asymptomatic
- Mild tearing/ irritation
- Tender to touch
Signs of episcleritis
- Vessels blanch with phenylephrine
- Diffuse, sectoral or nodular injection
- Episcleral vessels seen mobile over underlying scleral
Treatment for episcleritis
Self-limiting
Eye lubricants, topical NSAIDs/steroids
Scleritis
Inflammation of the deeper scleral vessels with maximal congestion
Cause of scleritis
Immune > infectious
- a/w systemic disease most commonly rheumatoid arthritis
Symptoms of scleritis
Pain++ (Wakes patient up from sleep)
Worse with eye movements
Red eye
Watery eyes
Photophobia
Signs of scleritis
- Bluish-red violaceous hue (Distributed in concordance with its subtypes)
- Vessels DON’T blanch with phenylephrine
What is the clinical test to differentiate between episcleritis and scleritis?
Phenylephrine is used to blanch the overlying conjunctival and episcleral vessels
- Absence of blanching of the deep scleral vessels is seen in scleritis
Complications of scleritis
- Scleral thinning and perforation
- Raised intraocular pressure
- Retinal detachment
Investigations for scleritis
Bloods:
- FBC
- UFEME/ Urinalysis
- ESR/ CRP
- RF/ Anti-CCP/ ANA
- ANCA
CXR and CT scan for systemic diseases
B scan ultrasonography
Treatment for scleritis
Tx underlying condition
Systemic:
NSAIDs
Steroids
Immunosuppression
Which is more severe, episcleritis vs scleritis?
Scleritis is more severe, potentially sight-threatening
