Unit 7 - Uveitis Flashcards
Which conditions are termed intermediate uveitis?
Pars planitis
Posterior cyclitis
Hyalitis
What are the symptoms of intermediate uveitis?
Floaters,
Flashes
Blurred vision
+/- pain
what conditions make up posterior uveitis?
Chorioretinitis
Retinitis
Neuroretinitis
Retinal vasculitis
What are the symptoms of posterior uveitis?
Floaters
Flashes
Blurred vision
+/- pain
What is panuveitis?
Inflammation of A/C, vitreous, retina and choroid
what time course is termed persistent under the SUN classifications?
greater than 3 months
What is considered “recurrent” under the SUN classification?
Repeated episodes separated by periods of inactivity > 3 months
Why is it difficult to look for RAPD in uveitis?
posterior synechiae
What can cause high IOP in uveitis?
Possner-Schlossman syndrome
Herpetic kerato-uveitis
Steroid reponder
In which conditions would you expect to see interstitial keratitis?
syphilis
Cogan’s syndrome
If the iris details were very hazy what level of A/C flare would you have?
3+
If the iris details were visible but there was some flare what grade of flare would that be?
2+
What are cells grades in a/c
Grade Cells
0.5+ 1-5
1+ 6-15
2+ 16-25
3+ 26-50
4+ 50+
How is vitreous flare graded?
Grade
1+ Clear view
2+ Disc/vessels hazy
3+ Disc/vessels very hazy
4+ Posterior pole barely visible
5+ No fundal view
How are vitreous cells graded?
Grade Cells
Trace 2-20
1 21-50
2 51-100
3 101-250
4 >251
What retinal changes should you look for in a uveitis examination?
Vascular sheathing
Macular oedema
Retinal haems
CWS
Retinal infiltrates
Exudative RD
Retinal necrosis
What signs are we looking for at the optic disc in a uveitis clinical exam?
Disc hyperaemia
Papillitis
Papilloedema
Atrophy
Neuroretinitis
Optic neuritis
Optic disc granuloma
What are the common causes of AAU?
Idiopathic
HLAB27
JIA
Fuch’s
Ankylosing spondylitis
Inflammatory bowel disease
Syphilis
What are the common causes of granulomatous AAU?
Microbial infecton e.g. syphilis, TB, herpes, toxoplasmosis
Sarcoid, VKT
What is the treatment regime for uveitis?
Antibiotics if bacterial
Antiviral treatment
Cycloplegic
Topical steroids
Topical anti-inflammatory
If uveitis treatment needs to be escalated what would you try next?
Systemic treatment
Oral steroids
Oral anti-inflammatory
Antimetabolites
T-cell inhibitors (cyclosporine)
Biologics: anti-TNF
What is considered remission in uveitis treatment?
Inactive disease > 3 months after treatment stopped
Are men or women more commonly affected by episcleritis?
Women
What types of episcleritis are there?
Simple (75%)
Nodular (25%)
what tests can you use to differential between episclertitis and scleritis?
Phenylephrine
Cotton wool bud - moving vessels
What is the differential diagnosis in episcleritis (beyond scleritis)?
Phlyctenular conj - nodular inflammation of conj in response to a foreign antigen
Conj
What types of scleritis are there?
Posterior (10%)
Anterior (80-85%)
What two types of anterior scleritis are there?
Necrotising
Non-necrotising
What percentage of patients with anterior scleritis will have a systemic association?
50%
What signs would you get with posterior scleritis?
Disc oedema
Myositis (inflamation of muscle causing diplopia/proptosis)
Eye tender to palpation
Choroidal folds due to oedema pushing them up
Why should we perform further blood tests in uveitis?
Confirm diagnosis
Exclude
Baseline before treatment may impact on them
In Retinal vasculitis, which conditions will primarily affect arteries?
ARN
LSE
In Retinal vasculitis, which conditions will primarily affect veins?
Sarcoid
IRN
MS
In retinal vasculities which conditions can affect both arteries and veins?
Behcet’s
Toxoplasmosis
Chorioretintis
What can cause any combination of retinal vasculitis?
TB
Syphilis
In patients presenting with uveitis and a headache what should we suspect?
AMPPE
MS
Behcet’s
Encephalitis
Systemic vasculitis
Syphilis
In patients with hypopyon what conditions should you suspec if not infectious?
Behcet’s (eye may be otherwise quiet)
Lymphoproliferative disease
AAU with HLAB27 positive
In a hot eye with uveitis what are the main disease suspects?
Bacterial (most common)
Fungal (rare)
How soon after an IVI or cataract surgery would you expect symptoms of enodphthalmitis?
2-5 days
What treatment is required in toxoplasmosis?
Antibiotics make no difference to course of attack
Inflammation is the things that causes vision loss
What two types of test are used to test for syphilis and why do you need two?
Non-treponemal test - positive in acute disease but also with other diseases
Treponemal test, specific to syphilis (detects antibodies specifci syphilis but not if disease active)
What % of sarcoid patients present with ocular symptoms?
5-10%
What tests should be used in sarcoid?
CXR
sACE but not very specific
