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Clinical Opthalmology > Uvea > Flashcards

Uvea Flashcards

1
Q

Anterior Uveitis

A

Inflammation involving anterior uveal tract (iris and/or ciliary body)

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2
Q

Intermediate uveitis

A

Vitreous inflammation including pars planitis

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3
Q

Posterior uveitis

A

Inflammation involving the retina and/or choroid

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4
Q

Panuveitis

A

All uveal structures involved

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5
Q

Types of Infectious uveitis

A

Bacterial, viral, fungal, parasitic

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6
Q

Iritis

A
  • Inflammation of the iris and iridocyclitis
  • can involve involve the anterior ciliary body
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7
Q

Uveitis Classification, in terms of location, cause and onset

A

Location
- anterior
- intermediate
- posterior
- panuveitis

Cause
- infectious
- non-infectious
- masquerade (neoplastic or non-neoplastic)

Onset
- acute
- recurrent
- chronic
- persistent

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8
Q

Acute Anterior Uveitis (AAU) and aetiology

A
  • most common presentation
  • may be caused by cross reactivity with selective microbial antigens in predisposed individuals
  • can be caused by trauma
  • can be secondary to bacterial keratitis and scleritis
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9
Q

Chronic Anterior Uveitis (CAU)

A
  • less common
  • commonly bilateral and associated with systemic disease
  • variable prognosis
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10
Q

Anterior Uveitis Clinical Features

A
  • pain
  • vision loss
  • photophobia
  • redness
  • watery discharge
  • circumlimbal flush
  • miosis
  • AC cells - suggest inflammatory response
  • aqueous flare - amines of of clear fluid
  • hypopyon - whitish exudate of inflammatory cells in the inferior AC
  • keratic precipitates - deposits on corneal endothelium
  • iris nodules
  • posterior synechiae
  • iris atrophy
  • iris neovasc - esp in chronic
  • reduced IOP
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11
Q

Anterior Chamber Grading for cells

A

0 = <1
0.5+ = 1-5
1+ = 6-15
2+= 16-25
3+ = 26-50
4+ = >50

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12
Q

Vitreous Grading of Haze

A

0 = good view of NFL
1+ = Clear disc and vessels but hazy NFL
2+ = disc and vessels hazy
3+ = only disc visible
4+ = disc not visible

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13
Q

Anterior Chamber Grading for Flare

A

0 = none
1+ = faint
2+ = moderate
3+ = marked
4+ = intense

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14
Q

Anterior Uveitis Management

A
  • single episode AAU doesn’t require investigation
  • recurrent/bilateral/chronic AAU require investigation
  • uveitis screen
    • blood tests
    • urine sample
    • chest x-ray
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15
Q

AAU Pharmacological Treatment

A

Topical
- predforte
- maxidex
- cyclopentolate
- atropine

Periocular
- subconj dexamethosone
- subconj betnosol
- subconj mydricaine

Intraocular
- Ozurdex implant

Systemic
- oral steroids
- oral second line immunosuppression

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16
Q

Intermediate Uveitis Clinical Features

A

Symptoms
- blurred vision
- floaters
- pain/redness
- photophobia

Signs
- AC cells
- high or low IOP
- cataract
- vitreous cells
- snowballs/snowbanking
- CMO

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17
Q

IU investigation

A
  • uveitis screen
  • flourescein angiography
  • AC or vitreous trap
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18
Q

IU - viral causes

A
  • herpes simplex virus
  • varicella zoster virus
  • cytomegalovirus
  • Epstein Barr virus
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19
Q

IU treatment

A
  • topical predforte
  • maxidex
  • cyclopentolate
  • atropine
  • intraretinal ocular steroid
  • antibiotic/antiviral/anti fungal
  • systemic steroids
  • 2nd line immunosuppression
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20
Q

Types of Posterior Uveitis

A
  • Retinitis - whitish retinal opacities with indistinct borders
  • Choroiditis - round yellow nodule
  • Vasculitis - may affect arteries and veins
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21
Q

What is Aniridia

A
  • bilateral hypoplasia
  • ranges from small defect on iris to total loss of iris
  • associated with foveal hypoplasia
  • glaucoma in 75%
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22
Q

Aniridia - Treatment

A
  • treat glaucoma
  • painted contact lens
  • prosthetic iris implant
  • cataract surgery
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23
Q

What is Axenfield-Reiger syndrome

A

Umbrella term for a group of disorders involving iris and angle malformations

24
Q

Axenfield anomaly

A
  • posterior embrytoxon
  • peripheraliris strands attached to cornea
  • ocular defect caused by abnormal development of anterior segment
  • anteriorly placed schwalbes line and iris bands extending to the cornea
25
Q

What is reigers anomaly

A
  • posterior embryotoxon
  • iris stromal hypoplasia
  • ectropion uvea (iris pigment on anterior eye surface)
  • corectopia
  • full thickness iris defects
26
Q

Axenfield-Reiger Management

A
  • glaucoma develops in 50%
  • surgical interventions for iris abnormalities
  • supportive
27
Q

What is Coloboma

A
  • defect resulting from failure of closure of embryologic
  • can affect any layer from disc to eyelids
  • typically inferonasal Portion of iris
  • associated with CHARGE syndrome
    • Coloboma
    • Heart defects
    • choanal Atresia
    • Retardation of growth
    • Genital abnormalities
    • Ear abnormalities
28
Q

Fuchs Hetereocromic Cyclitis (FHC)

A
  • Chronic Non-glaucomtous uveitis
  • often asymptomatic - low grade grumbling uveitis
  • 90% unilateral
29
Q

Fuchs Heterocromic Cyclitis signs

A
  • iris heterochromia
  • Stellate KPs
  • mild flare
  • iris atrophy
  • iris nodules
  • cataract
  • raised IOP
30
Q

Fuchs Heterochromic Cyclitis Treatment

A
  • observation
  • topical steroids for exacerbations
  • topical treatment for glaucoma - may need laser/surgery
  • cataract surgery
31
Q

Juvenile Idiopathic Arthritis (JIA)

A
  • Most common condition associated with childhood uveitis
  • asymptomatic therefore children with arthritis are screened
  • uveitis may not be presenting feature of the disease
32
Q

Juvenile Idiopathic arthritis signs

A
  • band keratopathy
  • uveitis
  • cataract
  • glaucoma
33
Q

Juvenile Idiopathic arthritis treatment

A
  • topical treatments often insufficient
  • joint treatment with paediatricians and rheumatology
  • require immunosuppression
34
Q

CMV retinitis

A
  • usually immunosuppressed pateients
  • most commonly seen in HIV patients
  • treatment is for the eye but also to prevent infection elsewhere
  • HAART therapy
35
Q

What are Acute retinal Necrosis (ARN) and progressive outer retinal necrosis (PORN )

A
  • necrosis of retinal tissue
36
Q

Acute retinal necrosis diagnostic criteria

A
  • one or more foci of full thickness
  • peripheral retina location
  • rapid progression
  • circumferential direction
  • occlusive vasculopathy
  • prominent AC and vitreous inflammation
  • optic neuropathy/atrophy
37
Q

Progressive outer retinal necrosis diagnostic criteria

A
  • multiple foci of deep retinal pacification which may be confluent
  • peripheral retina - macular involvement
  • extremely rapid progression
  • no consistent direction
  • no vascular inflammation
  • perivenular clearing of retinal opacification
38
Q

Acute retinal necrosis treatment

A
  • intravitreal foscarnet
  • IV aciclovir
  • Oral Valaciclovir
  • Famciclovir
  • systemic corticosteroids
  • topical corticosteroids
39
Q

Chorioretinitis types

A

White dot syndromes
- multiple evanescent white dot syndrome
- acute posterior multi focal placoid pigment epitheliopathy
- birdshot chorioretinopathy
- multi focal choroiditis
- serpiginous choroidopathy

40
Q

Uveal Tumours

A
  • iris lesions
  • iris nodules
  • iris melanomas
  • ciliary body melanomas
  • choroidal tumours
  • choroidal Naevus
41
Q

What are iris lesions

A
  • pigmented usually flat iris lesion
  • 15% risk of malignancy
  • pupil architecture may be affected
42
Q

What are isis nodules

A
  • can be present in inflammatory conditions and systemic disease
  • busacca and koeppe nodules
43
Q

What is iris melanoma, and its risk factors

A
  • similar appearance to melanoma
  • can distort iris architecture And pupil margin
  • may invade into angle

Risk Factors
- fair skin
- iris naevi
- numerous cutaneous
- sunlight exposure

44
Q

Ciliary Body Melanoma, and its treatment

A
  • difficult to diagnose
  • present late with visual symptoms
  • same risk factors as iris melanoma

Treatment
- radiotherapy
- enucleation
- chemotherapy if metastasis

45
Q

What is a choroidal Naevus

A
  • incidental finding
  • present in 5/10% of population
  • change is suspicious
  • usually flat
  • life long monitoring
46
Q

Choroidal Naevus Signs

A
  • pigmented retina lesion
  • over lying drusen
  • flat
  • depigmented halo

Suspicious signs
- lipofuscin
- symptomatic
- within 3mm of optic disc
- >2mm in height and 5mm in diameter

47
Q

Choroidal Naevus Treatment

A
  • monitor with photography
  • 6 months intially then annually
  • if concerned then refer to HES
48
Q

What is a Choroidal Melanoma

A
  • most common intraocular malignancy
  • same risk factors as iris melanoma
  • usually asymptomatic
  • metastasis can occur to liver
  • mortality at 50% over 10 years
49
Q

Choroidal Melanoma signs

A
  • solitary elevated pigment mass
  • collar stud appearance
  • lipofuscin
  • localised retinal detachment
  • Vitiris
  • sentinal vessels, rubeosis, choroidal folds
  • possibly symptomatic -> suspicious
50
Q

What are Choroidal Dystrophies

A
  • group of inherited disorders affecting choroidal function
  • RPE, choriocappilaris and photoreceptors with progressive involvement of larg choroidal vessels
  • chorioderemia
  • gyrate atrophy
  • progressive bifocal chorioretinal atrophy
51
Q

What is Choroideremia, and its signs and symptoms

A
  • progressive, diffuse degeneration of choroid, RPE and photoreceptors
  • very poor prognosis

Symptoms
- usually diagnosed in adolescence
- nyctalopia
- reduced peripheral vision
- eventually loss of central vision

Signs
- RPE mottling
- mid-peripheral RPE changes, which spread centrally and peripherally
- end stage
- choroidal vessels run over bare sclera
- retinal arteriolar attenuation
- optic atrophy

52
Q

Choroideraemia - Treatment

A
  • supportive
  • LVA
  • Blind registration
  • gene therapy
53
Q

Gyrate Atrophy

A
  • rare autosomal recessive condition
  • enzyme deficiency leads to choroidal atrophy
  • legal blindness by age 50
54
Q

Gyrate atrophy signs and symptoms

A

Symptoms
- nyctalopia
- peripheral field loss
- central field loss

Signs
- Mid peripheral de-pigment spots
- well defined peripheral atrophic patches with scalloped edges
- atrophic lesions eventually coalesce
- fovea lost in later stages
- may develop ER or CMO

55
Q

Gyrate Atrophy Treatment

A
  • Arginine restricted diet
  • pyridoxine supplements
  • gene therapy research

Clinical Opthalmology (7 decks)

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