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Medicine I > Uvea > Flashcards

Uvea Flashcards

1
Q

What are Persistent Pupillary Membranes (PPMs)

A
  • PPMs:
    • Iris to iris
    • Iris to cornea
    • Iris to lens
  • Cause corneal or lenticular opacity where contact occurs
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2
Q

What is iris atrophy

A
  • Progressive thinning of the iris
  • scalloped pupil, transillumination defects due to stromal thinning, full-thickness holes
  • Common finding in old dogs
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3
Q

define iridocyclitis

A

anterior uveitis

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4
Q

define chorioditis

A

posterior uveitis

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5
Q

Define panuveitis

A

Anterior + posterior uveitis

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6
Q

Define Endophthalmitis

A

inflammation inside the eye

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7
Q

define Panophthalmitis

A

endophthalmitis + inflammation of the cornea and scler

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8
Q

What causes uveitis

A
  • Endogenous causes:
    • Infectious
    • neoplastic
    • toxic
    • metabolic
    • autoimmune
  • Exogenous causes:
    • Trauma
    • perforating corneal wouds
    • corneal surgery
    • corneal ulceration
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9
Q

What is Iridocyclitis? signs??

A
  • 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
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10
Q

What is Posterior uveitis? signs?

A
  • Choroid (Choroiditis)
  • Active or Inactive lesions
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11
Q

What are the signs of Active posterior uveitis

A
  • 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
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12
Q

What are the signs of Inactive Posterior Uveitis

A
  • Chorioretinal scars
  • Tapetal Hyper-reflectivity
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13
Q

What is the most common cause of uveitis?

A

idiopathic

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14
Q

What are Infectious causes of Uveitis?

A
  • 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

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15
Q

What are non-infectious causes of systemic disease with ocular manifestation of Uveitis?

A
  • Hyperlipidemia
  • Coagulopathy
  • Vasculitis
  • Diabetes mellitus (Via LIU)
  • Hyperviscosity syndromes
  • Histiocytic proliferative syndromes
  • Granulomatous meningoencephalitis
  • Metastatic neoplasia
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16
Q

What are causes of primary uveitis?

A
  • 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)
  • Neoplasia
    • primary ocular neoplasia
  • Misc:
    • Idiopathic
    • Pirgmentary uveitis of Golden Retrievers
    • Keratitis associated reflex uveitis
    • Scleritis
    • Radiation therapy trauma
17
Q

What is the diagnostic approach to Uveitis?

A
  • 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
18
Q

How is Uveitis treated?

A
  • 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
  • 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
  • Mydriatic/Cycloplegic
    • Atropine 1%
    • Duration of effect is long in a normal eye
      • eyes w/ uveitis are refractory to atropine effects
19
Q

What are the benefits of Mydriatic/Cycloplegic medications for Uveitis?

A
  • Eliminates ciliary m. spasm / decreases pain
  • Dilates pupil/prevents synechia
  • Stabilizes blood aqueous barrier
20
Q

What are the contraindications for Mydriatic/cycloplegic agents as treatment for Uveitis

A
  • Ocular hypertension/glaucoma
  • KCS
21
Q

What are the possible sequelae of Uveitis?

A
  • Peripheral anterior synechiae
  • Posterior synechiae
  • Cataract
  • Lens luxation
  • Iris bombe
  • Secondary Glaucoma
  • Phthisis bulbi
  • Blindess
22
Q

What are the primary uveal neoplasias?

A
  • Melanoma/Melanocytoma and feline diffuse iris melanoma (FDIM)
  • Iridociliary epithelial neoplasms
    • adenoma, adenocarcinoma
  • Other less common:
    • Medulloepithelioma, glioma, astrocytoma, intraocular sarcoma (cats)
23
Q

What are the secondary/metastatic uveal neoplasms?

A
  • Lymphoma
  • Pulmonary carcinoma, mammary carcinoma, TVT
  • Other Less common:
    • hemangiosarcoma
    • osteosarcoma
    • any tumor can metastasize from a distant site to the eye
24
Q

What is the treatment for Uveal Tumors?

A
  • 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

Medicine I (43 decks)

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