Unit 7 - Uveitis

Question 1

Which conditions are termed intermediate uveitis?

Answer 1

Pars planitis
Posterior cyclitis
Hyalitis

Question 2

What are the symptoms of intermediate uveitis?

Answer 2

Floaters,
Flashes
Blurred vision
+/- pain

Question 3

what conditions make up posterior uveitis?

Answer 3

Chorioretinitis
Retinitis
Neuroretinitis
Retinal vasculitis

Question 4

What are the symptoms of posterior uveitis?

Answer 4

Floaters
Flashes
Blurred vision
+/- pain

Question 5

What is panuveitis?

Answer 5

Inflammation of A/C, vitreous, retina and choroid

Question 6

what time course is termed persistent under the SUN classifications?

Answer 6

greater than 3 months

Question 7

What is considered “recurrent” under the SUN classification?

Answer 7

Repeated episodes separated by periods of inactivity > 3 months

Question 8

Why is it difficult to look for RAPD in uveitis?

Answer 8

posterior synechiae

Question 9

What can cause high IOP in uveitis?

Answer 9

Possner-Schlossman syndrome
Herpetic kerato-uveitis
Steroid reponder

Question 10

In which conditions would you expect to see interstitial keratitis?

Answer 10

syphilis
Cogan’s syndrome

Question 11

If the iris details were very hazy what level of A/C flare would you have?

Answer 11

3+

Question 12

If the iris details were visible but there was some flare what grade of flare would that be?

Answer 12

2+

Question 13

What are cells grades in a/c

Answer 13

Grade Cells
0.5+ 1-5
1+ 6-15
2+ 16-25
3+ 26-50
4+ 50+

Question 14

How is vitreous flare graded?

Answer 14

Grade
1+ Clear view
2+ Disc/vessels hazy
3+ Disc/vessels very hazy
4+ Posterior pole barely visible
5+ No fundal view

Question 15

How are vitreous cells graded?

Answer 15

Grade Cells
Trace 2-20
1 21-50
2 51-100
3 101-250
4 >251

Question 16

What retinal changes should you look for in a uveitis examination?

Answer 16

Vascular sheathing
Macular oedema
Retinal haems
CWS
Retinal infiltrates
Exudative RD
Retinal necrosis

Question 17

What signs are we looking for at the optic disc in a uveitis clinical exam?

Answer 17

Disc hyperaemia
Papillitis
Papilloedema
Atrophy
Neuroretinitis
Optic neuritis
Optic disc granuloma

Question 18

What are the common causes of AAU?

Answer 18

Idiopathic
HLAB27
JIA
Fuch’s
Ankylosing spondylitis
Inflammatory bowel disease
Syphilis

Question 19

What are the common causes of granulomatous AAU?

Answer 19

Microbial infecton e.g. syphilis, TB, herpes, toxoplasmosis
Sarcoid, VKT

Question 20

What is the treatment regime for uveitis?

Answer 20

Antibiotics if bacterial
Antiviral treatment
Cycloplegic
Topical steroids
Topical anti-inflammatory

Question 21

If uveitis treatment needs to be escalated what would you try next?

Answer 21

Systemic treatment
Oral steroids
Oral anti-inflammatory
Antimetabolites
T-cell inhibitors (cyclosporine)
Biologics: anti-TNF

Question 22

What is considered remission in uveitis treatment?

Answer 22

Inactive disease > 3 months after treatment stopped

Question 23

Are men or women more commonly affected by episcleritis?

Answer 23

Women

Question 24

What types of episcleritis are there?

Answer 24

Simple (75%)
Nodular (25%)

Question 25

what tests can you use to differential between episclertitis and scleritis?

Answer 25

Phenylephrine Cotton wool bud - moving vessels

Question 26

What is the differential diagnosis in episcleritis (beyond scleritis)?

Answer 26

Phlyctenular conj - nodular inflammation of conj in response to a foreign antigen Conj

Question 27

What types of scleritis are there?

Answer 27

Posterior (10%) Anterior (80-85%)

Question 28

What two types of anterior scleritis are there?

Answer 28

Necrotising Non-necrotising

Question 29

What percentage of patients with anterior scleritis will have a systemic association?

Answer 29

50%

Question 30

What signs would you get with posterior scleritis?

Answer 30

Disc oedema Myositis (inflamation of muscle causing diplopia/proptosis) Eye tender to palpation Choroidal folds due to oedema pushing them up

Question 31

Why should we perform further blood tests in uveitis?

Answer 31

Confirm diagnosis Exclude Baseline before treatment may impact on them

Question 32

In Retinal vasculitis, which conditions will primarily affect arteries?

Answer 32

ARN LSE

Question 33

In Retinal vasculitis, which conditions will primarily affect veins?

Answer 33

Sarcoid IRN MS

Question 34

In retinal vasculities which conditions can affect both arteries and veins?

Answer 34

Behcet's Toxoplasmosis Chorioretintis

Question 35

What can cause any combination of retinal vasculitis?

Answer 35

TB Syphilis

Question 36

In patients presenting with uveitis and a headache what should we suspect?

Answer 36

AMPPE MS Behcet's Encephalitis Systemic vasculitis Syphilis

Question 37

In patients with hypopyon what conditions should you suspec if not infectious?

Answer 37

Behcet's (eye may be otherwise quiet) Lymphoproliferative disease AAU with HLAB27 positive

Question 38

In a hot eye with uveitis what are the main disease suspects?

Answer 38

Bacterial (most common) Fungal (rare)

Question 39

How soon after an IVI or cataract surgery would you expect symptoms of enodphthalmitis?

Answer 39

2-5 days

Question 40

What treatment is required in toxoplasmosis?

Answer 40

Antibiotics make no difference to course of attack Inflammation is the things that causes vision loss

Question 41

What two types of test are used to test for syphilis and why do you need two?

Answer 41

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)

Question 42

What % of sarcoid patients present with ocular symptoms?

Answer 42

5-10%

Question 43

What tests should be used in sarcoid?

Answer 43

CXR sACE but not very specific