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0V2022 Introduction to eye diseases > uveitis > Flashcards

uveitis Flashcards

1
Q

what is uveitis ?

A

. inflammation of uveal tract

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2
Q

what is the anatomical classification of uveitis?

A
  1. anterior ( 75%)- classified into
    . iritis
    . iridocyclitis
  2. intermediate
    . posterior ciliary body ( pars plana), extreme periphery or retina and choroid are affected
  3. posterior
    . where retina and choroid are affected
  4. panuveitis
    . where all parts of the eye anterior, intermediate and posterior are affected
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3
Q

what is iritis ?

A

inflammation predominantly affects iris

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4
Q

what is iridocyclitis ( more common) ?

A

inflammation predominantly affects iris and anterior part of the ciliary body ( pars plicata )

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5
Q

what are the standards of classifying uveitis?

A
  1. onset: sudden or insidious
  2. duration : limited, if it is < 3months or persistent , i.e.> 3 months in duration
  3. recurrent: describes repeated episodes of uveitis separated by periods of inactivity without treatment of > 3 months in duration
  4. chronic : describes persistent uveitis characterised by prompt relapse in < 3 months after discontinuation of therapy
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6
Q

what is endogenous aetiology of uveitis ?

A

associated with internal diseases
1. majority of cases assumed to be autoimmune and may be associated with systemic disease ( e.g. inflammatory bowel disease )

  1. prior infection ( e.g. herpes simplex, herpes zoster )
  2. idiopathic ( not associated with an underlying systemic disease )
    - specific uveitis entities with distinct characteristics
    . fuchs heterochromic iridocyclitis
    . posner-schlossman syndrome
    . anterior segment ischaemia
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7
Q

what is exogenous aetiology ?

A

. external injury or infection that results in uveitis

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8
Q

how is anterior uveitis classified ?

A

. anterior uveitis is traditionally classified as ‘ non-granulomatous’ or ‘granulomatous ‘ based on the nature of the keratic precipitates ( KPs)
-most common duvets

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9
Q

what is non-granulomatous uveitis ?

A

. typically has an acute onset
. fine KP on slit lamp
. more likely to be idiopathic - not have a known cause
-can see spikes on endothelium in slit lamp

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10
Q

what is granulomatous uveitis ?

A

. typically presents as a chronic condition
. with large ‘mutton fat’ KP and iris nodules
. more likely to be associated with systemic conditions

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11
Q

what are the predisposing factors for Uveitis ?

A

. age over 20 years in 90% of cases ( mean age at onset = 40 years )

. major histocompatibility complex antigen HLA-B27 is positive in 8% of the general population, but in approximately 50% of all patients with this condition

. systemic disease as above: it is important to take a comprehensive medical history

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12
Q

what are the symptoms of anterior uveitis ?

A
  1. red eye
  2. unilateral ( usually in acute)
    - may be bilateral or change eye if chronic
  3. rapid onset if acute
    - but more gradual at recurrent episodes
  4. moderate-severe dull pain
    - usually reported as ‘behind the eye’
    - more severe if chronic
  5. vision reduced
    - px complains hazy vision
    - more sever if chronic
  6. photophobia
    - milder if chronic
  7. epiphora
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13
Q

what are the signs of anterior uveitis ?

What is the investigation to detect this?

A
  1. hyperaemia: ciliary flush
  2. keratic precipitates
  3. cells and aqueous flare
  4. iris nodules

sometimes
. miosis
. raised IOP- check pressure

. must check fundus in both eye to check if it actually just anterior uveitis or intermediate or posterior uveitis
-check IOP as they may be raised

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14
Q

what are the signs of keratic precipitates ( KPs) ?

A

. endothelial dusting
- acute anterior uveitis

. medium
- acute and chronic anterior uveitis

. large
‘mutton fat’
chronic anterior uveitis - big blobs on endothelium

. old KPs
. pigmented
. chronic anterior uveitis

. kruckenberg’s spindle
. melanin pigment forming a vertical line on the posterior central cornea- can be diff patterns depending on aqueous but usually aqueous

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15
Q

explain cells as a sign of anterior uveitis ?

A

cells represent

. active inflammation
. WBC
. number of cells can be graded-
e.g hypopyon- classed as grade 5- pooling effect on the bottom of eye- check pic

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16
Q

explain flare as a sign of anterior uveitis?

A

. proteins leaked from damaged iris bv’s

. tyndall effect- light scattering by particles in a colloid very fine suspension

. with cells= active inflammation
. without cells = no active inflammation

17
Q

explain iris nodules as a sign of anterior uveitis?

A
  1. bussaca -
    . whitish-yellow lumps away from pupil border
    . internal iris stroma
    . always associated with granulomatous uveitis
  2. koeppe
    . cellular aggregates at pupil border
    . may accumulate pigment over time
18
Q

what are the complications of anterior uveitis?

A

. anterior synechiae-
between iris and posterior cornea - iris stuck to cornea

. posterior synechiae - between iris and lens capsule- iris and lens capsule stuck together

19
Q

what is the management of first episode of anterior uveitis ?

A

. refer to ophthalmologist ‘urgent’ ( within 1 week )

. if reduced VA, severe pain or raised IOP= same day referral to ophthalmologist

. sunglasses for photophobia

. topical cycloplegic
- first check for possibility of angle closure

. analgesics

20
Q

what is the management of subsequent episodes of anterior uveitis ?

A

. refer back to HES
. monitor for ocular complications
. IOP check
. consider near add for cycloplegia

21
Q

what is the management by ophthalmologist for anterior uveitis?

A

. cycloplegia

. topical steroid

  • treat secondary glaucoma
    . sub-tenon’s steroid injection may be required
    . possible systemic immunosuppression
    . referral for investigation of associations
22
Q

what are the differential diagnosis for uveitis , scleritis and episcleritis?

A
  • uveitis
    . moderate pain
    . circumcorneal flush
    . corneal involvement
    Other causes of red eye e.g. endophthalmitis
    Other forms of uveitis e.g intermediate, posterior, panuveitis
  • scleritis
    . severe pain
    . deep injection
  • episcleritis
    . no pain
    . superficial injection

. other causes or red eye
- closed angle gluacoma

23
Q

what is intermediate uveitis ?

A

. least common type of uveitis
- 1.5 per 100,000 population per year

. mostly idiopathic

  • recently recognised association with human T-cell lymphotropic virus type 1 ( HTLV-1) - type of virus
    . high prevalence in japan and brazil
  • strong association between pars planitis ( snowball) and MS
  • most common in children and young adults
    . onset after age 40 is rare
24
Q

what is intermediate uveitis classified as?

A

. chronic cyclitis: peripheral uveitis: pars planitis; vitritis

. chronic inflammation of peripheral retina
- vitreous involvement

. unknown aetiology
- autoimmune/MS linked

25
Q

what are the symptoms of intermediate uveitis?

A

. bilateral ( 60-80%)

. eye may be quiet

. hazy vision

  • corneal involvement
  • band keratopathy

. floaters
. reduced VA

26
Q

what are the signs of intermediate uveitis?

A

. yellow exudates in peripheral retina
- scleral indentation

. exudates may break off to form snowbanks
-99% inferior retina

. exudates may break off and float about in the vitreous

27
Q

what is the management of intermediate uveitis ?

A

. refer to HES for soon appointment

. steroid drops
. steroid injections
. immunosuppressives
. vitrectomy

28
Q

what are the complications associated with intermediate uveitis?

A 
. secondary glaucoma
. posterior subcapsular cataract
. vitreous detachment/ haemorrhage
. retinal breaks/ tears/ detachment 
. optic disc oedema
. macular oedema- snowabank
29
Q

what is the epidemiology of posterior uveitis?

A

. 1 to 3% of uveitis cases
. most common cause is toxoplasmosis
. idiopathic

. most common in developing world

30
Q

what are the signs of posterior uveitis ?

A

. retinitis
. choroiditis
. vasculitis ( inflammation of blood vessels)

31
Q

what is the management of posterior uveitis ?

A

. refer to HES

. to be seen soon

32
Q

what is panuveitis ?

A

affects all layers of the uvea ( iris, ciliary body and choroid) and can include retina and vitreous humour

33
Q

what is the epidemiology of panuveitis?

A

. most common type of uveitis in south america. africa and asia
. mostly idiopathic

0V2022 Introduction to eye diseases (22 decks)

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