Uveaitis Flashcards
What is the Blood Aqueous barrier made of?
- Ciliary body Non pigment epithelial cells
- Iris blood vessel Endothelial cells
- Trabecular Meshwork Blood vessels
- Canal of Schlem endothelial cells
What does the Vascular uveal tract comprise of?
Iris, ciliary body and choroid
What is the function of the Vascular uveal tract?
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)
What creates an autoimmune disease?
A chronic or recurrent uncontrolled immune response or a pathological immune response
What 2 structures of the eye cannot regenerate if damaged?
Neurosensory layers
Retinal Ganglion cells
What are cytokines?
Proteins which signals other leukocytes that amplify or suppress immune response
What do anti inflammatory cytokines do?
Create an immunosuppressive environment
Is immunosuppressive environment present in Uveitis?
No. This environment prevents the intraocular inflammation which is the hallmark of uveitis
When does uveitis arise?
When the balance between inflammatory and anti inflammatory cytokines shifts towards inflammatory cytokines
What are self antigens?
Substances that healthy immune system learns to ignore as the hosts own body produces these
How can self antigens cause an inflammatory response?
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.
What are the causes of uveitis?
- High choroid blood flow (a systemic association)
- Infectious agents in the vascular system (Ample exposure to the uvea)
- Presumed Autoimmune Origin
- Idiopathic by 50%
Definition of uveitis?
Inflammation of the uvea tract (retina, optic nerve, iris, sclera)
Intraocular inflammation compromises the blood ocular barrier.
What is the prevelance of uveitis?
Worldwide= 10%
Developed countries= 10-20%
Anterior more common
Age onset 20-60 year olds
Anterior uveitis signs?
- Conjunctival hypereamia
- Episcleral/scleral vessels dilation
- Ciliary Flush (bulbar Limbal region)
- Keratitic precipitates
- A/C cells or flare
- Hypopyon
- Posterior synachiae- iris bombe
- Anterior synachiae
- Complications- Cataract and SACG
Anterior Uveitis sxs?
- SUDDEN/ACUTE
- Redness (Sclera/conj/episcleral
- Pain
- Photophobia
- Lacrimation
- Blurred vision
What is flare a result of?
Protein leaking from blood vessels during active inflammation
Where are the cells and flare located?
Anterior chamber
What is hypopyon associated with aside from uveitis?
Endophthalmitis
If a posterior synachiae was present, what assessment would be required?
Gonioscopy
Where are KPs found?
Corneal endothelium
Where is the 1st sight of inflamm activity in anterior uveitis?
Iris and ciliary body
What does aqueous flare cause?
Light scatter
What happens to the cells and flare when inflammation activity stops
Flare may continue to leak
Cells stops as inflammations stops
What are the primary complications of uveitis?
Secondary glaucoma
Cataracts
What causes the pain in ant uveitis?
Induced spasm of the ciliary muscle
What would cause the IOPs to increase in any uveitis?
Secondary glaucoma and steroids
Where is the pain innervation from in ant uveitis?
Trigeminal nerve
Conditions of Posterior uveitis?
- Vitritis
- Cystoid Macula Oedema
- Retinal vasculitis
- Inflamm of Uvea- serous RD
- Retinitis/Choroiditis (Chorioretinitis)
- Active Retinitis
- Inactive retinitis
- ONH inflammation
What is the 2nd most common vision loss in post uveitis?
Vitritis
Vitritis signs?
Vitreous haze (cells and proteins) Clumps- 'snowballs'
What are the signs of active choroiditis?
Circular lesions and elevated
Creamy/yellow/grey
What is the hallmark for Inactive retinitis?
Pigement margins on chorioretinal scarring
Pigement is caused by hypoplasia of RPE
What condition is associated with ONH inflammation?
Optic neuritis
What are the retinal vasculitis signs?
Vascular sheathing
Retinal infiltrates- can lead to haemm, Cotton wool spots, retinal neovasc
Active retinitis signs?
Fluffy indistinct margins
Pale yellow colour
Inflamm activitiy in vitreous and A/C
Obscured underlying retinal tissue and BV
Sxs of post uveitis?
Depends on severity and location
Vitritis and MO= Blurred vision, sudden onset, bilateral, floaters, constant flashing lights
What are less common sxs in post uveitis?
Pain and photophobia
The different sxs with their conditions…
What signs are being shown and what condition is this?
Sign- Snowball
Condition- Vitritis
What condition is being shown and what key feature suggests this?
Inactive chorioretinal scarring
Dark marginal regions of hypoplasia
Anterior Uveitis- what are the non infectious causes?
- Systemic Rheumatic disorders
- Inflammatory bowel syndrome
- Sarcoidosis
- Behcets Syndrome
Anterior Uveaitis- what are the infectious causes?
- HSV
- HZV
- Tuberculosis
- Syphilis
Posterior Uveitis- What are the non infectious causes?
- Sarcoidosis
- Multiple Sclerosis
- Behcets syndrome
Posterior Uveitis- What are the infectious causes?
- Toxoplasmosis
- Tuberculosis
- Cytomegalovirus
- Syphilis
- Toxocariasis
- HSV
- HZV
What are the potential infectious causes for posterior and anterior uveitis?
- HSV
- HZV
- Tubercolosis
- Syphilis
What are the potential non infectious causes for posterior and anterior uveitis?
- Sarcoidosis
2. Behcets disease
How to refer for ACUTE uveitis?
Same day phone call as risk of complications
When is a referral non urgent in uveitis?
Longstanding hx of recurrent inflamm and doubts if active inflamm
How is uveitis managed by ophthalmologists?
Topical ocular corticosteroids
POMs only
Name the medication used to treat?
Prednisolone
Dexamethasone
Fluoromethalone
Betamethasone
How to treat Anterior uveitis?
Mydriatics- relieve pain and prevent posterior synachiae
How to treat posterior Uveitis?
Intravitreal steroid injections on tendon/orbital floor
Risk of cat and glaucoma
