Uveitis

Question 1

What is uveitis?

Answer 1

broad term for inflammation of one or all parts of uvea, or vascular area between the retina and sclera of the eye

Question 2

What is included in uvea?

Answer 2

choroid, ciliary body and iris

Question 3

What is anterior uveitis?

Answer 3

involves inflammation of the iris and ciliary body

Question 4

What is intermediate uveitis?

Answer 4

involves the posterior ciliary body and pars plana

Question 5

What is posterior uveitis?

Answer 5

Inflammation of:

1. Retina
2. Choroid
3. Retinal vasculature
4. Optic nerve

Question 6

What is acute uveitis?

Answer 6

sudden onset (hours or days)

Question 7

What is recurrent uveitis?

Answer 7

repeated episodes separated by disease inactivity ≥3 months, whether on or off treatment

Question 8

What is chronic uveitis?

Answer 8

persistent uveitis (>3 months’ duration) characterised by relapse within 3 months of therapy termination.

Question 9

What are causes for uveitis?

Answer 9

1. idiopathic
2. associated with human leukocyte antigen-B27-related disease
3. viral eye disease

Question 10

What are RF for uveitis?

Answer 10

1. Inflammatory disease
2. HLA-B27 positivity
3. Ocular trauma
4. Immunosuppresion

Question 11

What type of uveitis is most common?

Answer 11

1. Anterior uveitis most common

2. Infectious uveitis common in developing countries

Question 12

What are symptoms and signs of uveitis?

Answer 12

1. Pain (anterior uveitis)
2. Decreased vision (intermediate and posterior)
3. Synechiae
4. Flare: hallmark of anterior uveitis
5. Keratic precipitate
6. Tearing
7. Photophobia
8. Eye redness without discharge

Question 13

What are classic anterior uveitis signs?

Answer 13

1. Pain
2. Flare
3. redness
4. photophobia
5. tearing

Question 14

What are possible DDx for uveitis?

Answer 14

1. Ocular lymphoma
2. Leukaemia
3. Intra-ocular solid tumours
4. Intra-ocular foreign body
5. Ocular ischaemia syndrome

Question 15

What are investigations for uveitis?

Answer 15

clinical diagnosis

Question 16

What is the management plan for uveitis?

Answer 16

• Potentially blinding conditions so refer to ophthalmologist
• Corticosteroid eye drops + management of any underlying disease e.g. prednisolone

Question 17

What are possible complications of uveitis?

Answer 17

1. Synechia
2. Retinal scarring
3. Cataract
4. Band keratopathy
5. Macular oedema
6. Glaucoma
7. Choroidal neovascularisation
8. Retinal detachement

Question 18

What are symptoms of posterior uveitis?

Answer 18

1. floaters
2. decreased vision
3. photophobia
4. often asymptomatic

Question 19

What are some common causes for anterior uveitis?

Answer 19

1. Ankylosing spondylitis
2. Crohn’s disease
3. Juvenile idiopathic arthritis
4. Psoriatic arthritis

Question 20

What are some common cause of posterior uveitis?

Answer 20

1. HSV
2. Herpes Zoster
3. TB

Question 21

What are 4 types of uveitis?

Answer 21

anterior, posterior, complete, intermediate

Question 22

What are causes of anterior uveitis?

Answer 22

1. Idiopthic

2. Associated with non-infectious, autoimmune systemic disease

Question 23

What non-infectious, autoimmune systemic disease is anterior uveitis associated with?

Answer 23

1. seronegative spondyloarthropathies
2. RA
3. Sarcoidosis
4. IBD
5. HLA-B27 associated conditions-SLE
6. Reactive arthritis
7. Behcet’s disease

Question 24

What are symptoms of anterior uveitis?

Answer 24

1. Pain: dull and progressive
2. Flares
3. Photophobia
4. Lacrimation
5. Decreased visual acuity
6. Eye redness

Question 25

What is hypopyon?

Answer 25

medical condition involving inflammatory cells in the anterior chamber of the eye – one key thing to look out for during flares

Question 26

What investigations are done for uveitis?

Answer 26

- slit lamp - other than slit lamp examination, mostly clinical Dx (don’t need Ix) – can do smear and cytology if infectious cause suspected

Question 27

What would be found on a slit lamp for anterior uvetitis?

Answer 27

1. Keratic precipitates (leukocytes) in anterior chamber 2. Protein in aqueous humour 3. General signs of inflammation of iris (red eye, hypopyon)

Question 28

What would be found on posterior uveitis slit lamp?

Answer 28

1. Leukocytes in vitreous humour | 2. Inflammation of choroid and retina

Question 29

What is management for uveitis?

Answer 29

1. Corticosteroids (drops) 2. Cycloplegic eye drops 3. Simple analgesia for anterior 4. Antibiotic or antiviral therapy if infectious cause

Question 30

When would you use corticosteroid drops?

Answer 30

1. Can use systemic/oral steroids if symptoms persist | 2. Treats the underlying inflammatio

Question 31

When would you use cycloplegic eye drops?

Answer 31

1. Relieves pain caused by the spasm of muscles | 2. Prevents formation of synechiae

Question 32

What is synchiea?

Answer 32

Synechiae are at pupil margin where iris is adherent to the anterior lens capsule which prevents dilation and makes cataract surgery harder