Uvea Flashcards
What are Persistent Pupillary Membranes (PPMs)
- PPMs:
- Iris to iris
- Iris to cornea
- Iris to lens
- Cause corneal or lenticular opacity where contact occurs
What is iris atrophy
- Progressive thinning of the iris
- scalloped pupil, transillumination defects due to stromal thinning, full-thickness holes
- Common finding in old dogs
define iridocyclitis
anterior uveitis
define chorioditis
posterior uveitis
Define panuveitis
Anterior + posterior uveitis
Define Endophthalmitis
inflammation inside the eye
define Panophthalmitis
endophthalmitis + inflammation of the cornea and scler
What causes uveitis
- Endogenous causes:
- Infectious
- neoplastic
- toxic
- metabolic
- autoimmune
- Exogenous causes:
- Trauma
- perforating corneal wouds
- corneal surgery
- corneal ulceration
What is Iridocyclitis? signs??
- Inflammation of the Iris and ciliary body
- Clinical signs:
- Aqueous flare (Pathognomonic)
- Fibrin or cells (WBCs, RBCs) in anterior chamber
- Miosis
- Hypotony - lower than normal IOP
- decreased production of aqueous humor by the ciliary body
- Keratic precipitates
- accumulations of WBCs adhering to corneal endothelium
- Rubeosis iridis
- neovascularization of iris
What is Posterior uveitis? signs?
- Choroid (Choroiditis)
- Active or Inactive lesions
What are the signs of Active posterior uveitis
- Active lesions:
- indistinct lesion margins
- Retinal blood vessels are distorted as they course over the lesion
- Tapetal Hypo-reflectivity
- subretinal edema or exudate that obscures tapetum
- Retinal Hemorrhages
- Retinal detachment
- Non-tapetal lesions
- Grayish/white areas
- Chorioretinal edema/exudates
- Retinal perivascular cuffing
What are the signs of Inactive Posterior Uveitis
- Chorioretinal scars
- Tapetal Hyper-reflectivity
What is the most common cause of uveitis?
idiopathic
What are Infectious causes of Uveitis?
- Ocular manifestations of systemic disease
- Bacterial:
- Rickettsia rickettsii
- Borrelia burgdorgeri
- Erlichia canis
- Brucella canis
- Leptospirosis
- Bartonella spp
- Fungal
- Blastomyces dermatidis
- Cryptococcus neoformans
- Histoplasma capsulatum
- Coccidioides immitis
- Algal
- Prototheca spp
- Protozoal
- Toxoplasma gondii
- Leishmania spp
- Parasitic
- ocular larval migrans (toxocara canis & Baylisascaris procyonis)
- Dirofilaria immitis
- Onchocerciasis
- Ophthalmomyiasis interna (cuterebra)
- Viral:
- Feline infectious peritonitis
- Feline leukemia virus
- Feline immunodeficiency virus
- Canine Adenovirus “Blue eye”
- Canine distemper virus
- Rabies
Bold = commonly performed infectious disease tests
What are non-infectious causes of systemic disease with ocular manifestation of Uveitis?
- Hyperlipidemia
- Coagulopathy
- Vasculitis
- Diabetes mellitus (Via LIU)
- Hyperviscosity syndromes
- Histiocytic proliferative syndromes
- Granulomatous meningoencephalitis
- Metastatic neoplasia
What are causes of primary uveitis?
- Immune mediated:
- lens-induced uveitis (LIU)
- cataract (phacolytic)
- Lens capsue rupture (phacoclastic)
- Lens subluxation/luxation
- Uveodermatologic syndrome
- Ocular and skin lesions
- Feline lymphocytic-plasmacytic (chronic idiopathic uveitis)
- lens-induced uveitis (LIU)
- Neoplasia
- primary ocular neoplasia
- Misc:
- Idiopathic
- Pirgmentary uveitis of Golden Retrievers
- Keratitis associated reflex uveitis
- Scleritis
- Radiation therapy trauma
What is the diagnostic approach to Uveitis?
- Thorough medical history
- Complete physical exam
- temperature, thoracic auscultation, abdominal palpation
- peripheral lymph node assessment
- thorough cutaneous examination
- Minimum database (CBC, Chem, UA)
- Selected infectious disease screening
- Aspirates/impression smears
- Enucleation w/ histopathology
- Diagnostic and therapeutic in blind eye
How is Uveitis treated?
- Treat cause if known
- Symptommatic treatment - unknown causer
- Therapy Goals:
- Decrease inflammation
- relieve pain
- Prevent complications of uveitis
- Other Systemic Immunosuppressive medications
- Azathioprine, Cyclosporine, mycophenolate, leflunomide
- Used as steroid-sparing long term maintenance therapies in patients with immune-mediated disease
- Azathioprine, Cyclosporine, mycophenolate, leflunomide
- Antimicrobials:
- systemic antibiotics
- empirical tretment for common infectious agents
- Pending titers or if workup declined by owner
- Dogs: Doxy
- Cats: Clindamycin, Azithromycin
- Topical antibiotic are NOT effective
- systemic antibiotics
- Mydriatic/Cycloplegic
- Atropine 1%
- Duration of effect is long in a normal eye
- eyes w/ uveitis are refractory to atropine effects
What are the benefits of Mydriatic/Cycloplegic medications for Uveitis?
- Eliminates ciliary m. spasm / decreases pain
- Dilates pupil/prevents synechia
- Stabilizes blood aqueous barrier
What are the contraindications for Mydriatic/cycloplegic agents as treatment for Uveitis
- Ocular hypertension/glaucoma
- KCS
What are the possible sequelae of Uveitis?
- Peripheral anterior synechiae
- Posterior synechiae
- Cataract
- Lens luxation
- Iris bombe
- Secondary Glaucoma
- Phthisis bulbi
- Blindess
What are the primary uveal neoplasias?
- Melanoma/Melanocytoma and feline diffuse iris melanoma (FDIM)
- Iridociliary epithelial neoplasms
- adenoma, adenocarcinoma
- Other less common:
- Medulloepithelioma, glioma, astrocytoma, intraocular sarcoma (cats)
What are the secondary/metastatic uveal neoplasms?
- Lymphoma
- Pulmonary carcinoma, mammary carcinoma, TVT
- Other Less common:
- hemangiosarcoma
- osteosarcoma
- any tumor can metastasize from a distant site to the eye
What is the treatment for Uveal Tumors?
- Thorough physical examination
- Thoracic radiographs and abdominal radiographs/ultrasound
- Especially in cats with FDIM
- Local treatment
- Excision or laser (focal lesions)
- Enucleation & histopathology
- Extensive primary tumors
- Inflamed or glaucomatous eyes
- Chemotherapy
- Ocular metastasis from distant site
