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Uveaitis Flashcards

1
Q

What is the Blood Aqueous barrier made of?

A
  1. Ciliary body Non pigment epithelial cells
  2. Iris blood vessel Endothelial cells
  3. Trabecular Meshwork Blood vessels
  4. Canal of Schlem endothelial cells
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2
Q

What does the Vascular uveal tract comprise of?

A

Iris, ciliary body and choroid

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3
Q

What is the function of the Vascular uveal tract?

A

a. Regulating power of the eye
b. Accommodation
c. Pupil size- controlling retinal illumination
d. Pigment absorption cells (reduce internal reflection and harmful UV radiation)

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4
Q

What creates an autoimmune disease?

A

A chronic or recurrent uncontrolled immune response or a pathological immune response

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5
Q

What 2 structures of the eye cannot regenerate if damaged?

A

Neurosensory layers

Retinal Ganglion cells

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6
Q

What are cytokines?

A

Proteins which signals other leukocytes that amplify or suppress immune response

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7
Q

What do anti inflammatory cytokines do?

A

Create an immunosuppressive environment

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8
Q

Is immunosuppressive environment present in Uveitis?

A

No. This environment prevents the intraocular inflammation which is the hallmark of uveitis

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9
Q

When does uveitis arise?

A

When the balance between inflammatory and anti inflammatory cytokines shifts towards inflammatory cytokines

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10
Q

What are self antigens?

A

Substances that healthy immune system learns to ignore as the hosts own body produces these

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11
Q

How can self antigens cause an inflammatory response?

A

If they are not recognised by the immune system, this would then be identified as a pathogenic antigen leading to reproduction of antibodies and hence an inflammatory response.

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12
Q

What are the causes of uveitis?

A
  1. High choroid blood flow (a systemic association)
  2. Infectious agents in the vascular system (Ample exposure to the uvea)
  3. Presumed Autoimmune Origin
  4. Idiopathic by 50%
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13
Q

Definition of uveitis?

A

Inflammation of the uvea tract (retina, optic nerve, iris, sclera)
Intraocular inflammation compromises the blood ocular barrier.

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14
Q

What is the prevelance of uveitis?

A

Worldwide= 10%
Developed countries= 10-20%
Anterior more common
Age onset 20-60 year olds

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15
Q

Anterior uveitis signs?

A
  1. Conjunctival hypereamia
  2. Episcleral/scleral vessels dilation
  3. Ciliary Flush (bulbar Limbal region)
  4. Keratitic precipitates
  5. A/C cells or flare
  6. Hypopyon
  7. Posterior synachiae- iris bombe
  8. Anterior synachiae
  9. Complications- Cataract and SACG
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16
Q

Anterior Uveitis sxs?

A
  1. SUDDEN/ACUTE
  2. Redness (Sclera/conj/episcleral
  3. Pain
  4. Photophobia
  5. Lacrimation
  6. Blurred vision
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17
Q

What is flare a result of?

A

Protein leaking from blood vessels during active inflammation

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18
Q

Where are the cells and flare located?

A

Anterior chamber

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19
Q

What is hypopyon associated with aside from uveitis?

A

Endophthalmitis

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20
Q

If a posterior synachiae was present, what assessment would be required?

A

Gonioscopy

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21
Q

Where are KPs found?

A

Corneal endothelium

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22
Q

Where is the 1st sight of inflamm activity in anterior uveitis?

A

Iris and ciliary body

23
Q

What does aqueous flare cause?

A

Light scatter

24
Q

What happens to the cells and flare when inflammation activity stops

A

Flare may continue to leak

Cells stops as inflammations stops

25
Q

What are the primary complications of uveitis?

A

Secondary glaucoma

Cataracts

26
Q

What causes the pain in ant uveitis?

A

Induced spasm of the ciliary muscle

27
Q

What would cause the IOPs to increase in any uveitis?

A

Secondary glaucoma and steroids

28
Q

Where is the pain innervation from in ant uveitis?

A

Trigeminal nerve

29
Q

Conditions of Posterior uveitis?

A
  1. Vitritis
  2. Cystoid Macula Oedema
  3. Retinal vasculitis
  4. Inflamm of Uvea- serous RD
  5. Retinitis/Choroiditis (Chorioretinitis)
  6. Active Retinitis
  7. Inactive retinitis
  8. ONH inflammation
30
Q

What is the 2nd most common vision loss in post uveitis?

A

Vitritis

31
Q

Vitritis signs?

A 
Vitreous haze (cells and proteins)
Clumps- 'snowballs'
32
Q

What are the signs of active choroiditis?

A

Circular lesions and elevated

Creamy/yellow/grey

33
Q

What is the hallmark for Inactive retinitis?

A

Pigement margins on chorioretinal scarring

Pigement is caused by hypoplasia of RPE

34
Q

What condition is associated with ONH inflammation?

A

Optic neuritis

35
Q

What are the retinal vasculitis signs?

A

Vascular sheathing

Retinal infiltrates- can lead to haemm, Cotton wool spots, retinal neovasc

36
Q

Active retinitis signs?

A

Fluffy indistinct margins
Pale yellow colour
Inflamm activitiy in vitreous and A/C
Obscured underlying retinal tissue and BV

37
Q

Sxs of post uveitis?

A

Depends on severity and location

Vitritis and MO= Blurred vision, sudden onset, bilateral, floaters, constant flashing lights

38
Q

What are less common sxs in post uveitis?

A

Pain and photophobia

39
Q

The different sxs with their conditions…

A
40
Q

What signs are being shown and what condition is this?

A

Sign- Snowball

Condition- Vitritis

41
Q

What condition is being shown and what key feature suggests this?

A

Inactive chorioretinal scarring

Dark marginal regions of hypoplasia

42
Q

Anterior Uveitis- what are the non infectious causes?

A
  1. Systemic Rheumatic disorders
  2. Inflammatory bowel syndrome
  3. Sarcoidosis
  4. Behcets Syndrome
43
Q

Anterior Uveaitis- what are the infectious causes?

A
  1. HSV
  2. HZV
  3. Tuberculosis
  4. Syphilis
44
Q

Posterior Uveitis- What are the non infectious causes?

A
  1. Sarcoidosis
  2. Multiple Sclerosis
  3. Behcets syndrome
45
Q

Posterior Uveitis- What are the infectious causes?

A
  1. Toxoplasmosis
  2. Tuberculosis
  3. Cytomegalovirus
  4. Syphilis
  5. Toxocariasis
  6. HSV
  7. HZV
46
Q

What are the potential infectious causes for posterior and anterior uveitis?

A
  1. HSV
  2. HZV
  3. Tubercolosis
  4. Syphilis
47
Q

What are the potential non infectious causes for posterior and anterior uveitis?

A
  1. Sarcoidosis

2. Behcets disease

48
Q

How to refer for ACUTE uveitis?

A

Same day phone call as risk of complications

49
Q

When is a referral non urgent in uveitis?

A

Longstanding hx of recurrent inflamm and doubts if active inflamm

50
Q

How is uveitis managed by ophthalmologists?

A

Topical ocular corticosteroids

POMs only

51
Q

Name the medication used to treat?

A

Prednisolone
Dexamethasone
Fluoromethalone
Betamethasone

52
Q

How to treat Anterior uveitis?

A

Mydriatics- relieve pain and prevent posterior synachiae

53
Q

How to treat posterior Uveitis?

A

Intravitreal steroid injections on tendon/orbital floor

Risk of cat and glaucoma

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