Unit 6 - Uveitis Flashcards
What is the incidence of uveitis?
1 in 1000
What is the commonest cause of uveitis?
idiopathic
How can uveitis be classified?
Anatomy based: anterior, int, posterior or panuvietis
Pathology based: infection, masquerade or non-infectious
Sign based: granulomatous
Course based: Chronic (less than 3months between episodes), acute, persistent (>3mths) , recurrent (more than 3 months between episodes).
When taking the history of a uveitis patient what should you be asking (6) ?
- TB exposure
- Walking in forests with ticks
- Musculoskeletal pain, childhood arthritis or HLA B27 related morning back stifness
- Weakness/numbness episodes, MS
- Chronic cough or shortness of breath, sarcoid
- Sexual history, HIV/Syphilis
How do you grade A/C activity?
- Measure cells in 1mm X 1mm slit beam:
- 0 = <1cell
- 0.5 = 1-5
- 1 = 6-15
- 2 = 16-25
- 3 = 26-50
- 4 = >50
What are the clinical signs to look for in uveitis (7)?
- Posterior syncehiae
- KPs
- Iris granulomas
- CMO
- Retinal/choroidal lesions
- Vitreous haze
- Red eye, circumcorneal or entire eye.
What are the two objetives when treating acute and chronic uveitis?
Chronic: prevent and treat complications
Acute: suppress inflammation and alleviate symptoms
What topical treatments can be used in the treatment of uveitis?
- Steroids (hourly, then down to 6/day in two days then taper)
- NSAID (can be used in addition esp with CMO)
- Glaucoma drops (to prevent steoid induced glaucoma)
What local treatments can be used in Uveitis?
- Triamcinolone either orbital floor injection or sub-tenon injection or intravitreal
- Dexamethasone intra-vitreal e.g. ozurdex
What systemic treatment can be used in uveitis?
In order of use:
- Steroids
- Steroid sparing immunosuppressants e.g. mycopheolate, motefil
- Biologics, anti-TNF antibodies e.g Humira, effective but expensive
What are the indications to consider systemic meds in uveitis?
- Moderate to severe disease
- Bilateral
- Underlying systemic disease
- Risk of sight loss
What is HLA-B27 and how is associated with HLA-B27 disease?
- HLA-B27 is a genetic variant of an immune system protein
- 10% of white europeans have it
- HLA-B27 is an association not a cause
What are the clinical features of HLA-B27 related uveitis?
- Non-granulomatous
- Acute, recurrent attacks
- Hypopyon and fibrin
- Maybe associated with:
- Ankylosing spondylitis
- Psoriatic arthritis
- Crohn’s disease
What are the ocular and systemic signs and symptoms of Behcets disease?
- Anterior uveitis
- Retinal vasculitis
- Erythema nodosum
- Mouth and genical ulcers
- Vasculitic multisystem disease
What pattern will be shown on FFA in Behcets disease?
Ferning
What are the risk factors of developing Behcet’s disease?
- HLA- B51 in 50% of cases
- Found in groups along the silk route, less likely if those people are no longer living in their native homes.
What population is most affected by sarcoidosis?
Young afro-caribean women or older caucasian women.
What is sarcoidosis?
Multisystem inflammatory disorder
What sort of ocular disease does sarcoid produce?
Anterior, granulomatous uveitis
+ conjunctival granulomas
What are the systemic clinical features of sarcoid?
Sarcoid granuloma can appear anywerhe in the body but the lungs affected in 90%.
Skin lesions:
- lupus pernio, raised purple patches on face that look like rosacea++
- erythema nodosum, raised lumps on lower legs
What does APMPPE stand for?
Acute posterior multifocal placoid pigment epitheliopathy.
What are the ocular signs and symptoms of APMPPE?
- Painless central vision loss
- Bilateral but asymmetric
- Well defined scotomas
- Very mild or no anterior uveitis
- Creamy, yellow pale retinal lesions which are dark on ICG
What systemic symptoms are there in APMPPE?
Flue-like viral illness a few days before presentation.
What population is most affected by APMPPE?
- M=F
- Young adults
