uveitis

Question 1

def uveitis

Answer 1

uvea is the pigmented part of the eye (iris, ciliary body, choroid)

anterior uvea - iris and ciliary body, thus anterior uveitis = inflammation of the iris and the ciliary body (iritis or iridocyclitis)

posterior uvea = choroid - inflamm of choroid = posterior uveitis

Intermediate uveitis affects the vitrous and panuveitis is as the name suggests

Question 2

aetiology uveitis

Answer 2

underlying systemic disease including autoimmune causes, HLA plays a role

used to be thought to be idiopathic - now we know autoimmune plays a role

Question 3

aetiology anterior uveitis

Answer 3

HLA B27-related spondyloarthritides: ankylosing spondylitis, reactive arthritis, inflammatory bowel disease

sarcoid, Behcets

IBD,

reactive arthritis, juvenile chronic arthritis

herpes simplex/zoster, TB, syphilis, HIV

Question 4

aeitiology posterior and panuveitis

Answer 4

• Herpes simplex and zoster toxoplasmosis
• TB
• CMV
• endophthalmitis
• lymphoma
• sarcoidosis
• behcet’s

Question 5

aetiology intermediate uveitis

Answer 5

MS

lymphoma

sarcoid

Question 6

Sympathetic ophthalmia

Answer 6

Inflammation of the contralateral eye weeks/months after penetrating injury (rare).

Question 7

epi uveitis

Answer 7

incidence - 15 in 100000 people (75% are anterior uveitis)

Uveitis associated with spondyloarthritis is twice as common in males as in females.

Anterior uveitis is the most common form of uveitis in the UK

affects adults of working age

Question 8

sx uveitis

Answer 8

pain (ciliary spasm and inflammation, pain increased on accomodation)

photophobia

red eyes

• starts with conjuctival injection around the junction of the cornea and sclera
• increased lacrimation (no sticky discharge, unlike in conjunctivitis).

lacrimation

blurred vision

pupil may be small - initially from iris spasm; later it may be irregular or dilate irregularly due to adhesions between lens and iris (synechiae)

May rarely be associated with tubulointerstitial nephritis

• flank pain
• haematuria
• proteinuria
• sterile pyuria
• acute renal failure

Onset is over hours/days.

Ask about associated headaches and features of systemic disease.

Question 9

signs of uveitis

Answer 9

reduced acuity

ciliary flush (redness may be confined to corneoscleral margin)

hypopyon (proteinaceous exudate and inflammatory cells in the inferior of the anterior chamber)

small irregular pupil due to posterior synechiae - adhesions of the iris to the lens

slit lamp - Keratic precipitates (deposits of leucocytes on the corneal endothelium, if not consider posterior uveitis)

fundoscopy - To exclude retinal detachment, posterior inflammation or a tumour that may give rise to anterior uveitis.

Signs of complications: raised Intraocular pressure, cataract.

Signs of the underlying aetiology.

Question 10

Ix uveitis

Answer 10

Investigate for associated systemic conditions depending on associated symptoms:

• U&Es,
• spondyloarthritides (sacroiliac joint X-ray, HLA typing),
• sarcoidosis (CXR, serumcalcium, serum ACE),
• syphilis serology.

Ocular imaging such as fundus fluorescein and indocyanide green-angiography are used to further examine for retinal and choroidal disease