UVEITIS Flashcards
What is uveitis?
It is inflammation which can then go on to cause damage in the eye
What is the uvea and why is it susceptible to insult?
The pigmented layer in the eye. Consists of iris, ciliary body and choroid.
Most vascular tissue in the body so exposed to all vascular insult
What are the types of uveitis?
Anterior–> affects the iris
Intermediate–> affects ciliary body
Posterior–> affects the choroid
What is the pathophysiology of anterior uveitis?
Inflammation of anterior portion of the uvea - iris and ciliary body–> leaky WBC into aqueous humour in anterior chamber of the eye
What are the causes of anterior uveitis?
Autoimmune- HLA-B27 associated - ankylosing spondylitits, psoriatic arthritis. SLE, sarcoidosis, MS, IBD - Chron’s / UC
Infections- toxoplasmosis (most common) CMV, HSV, HIV, TB, candida, syphillis,
Drug induced- bisphosphonates, rifabutin, antivirals
Traumatic- sympathetic ophthalmia
What is aqueous flare in anterior uveitis?
When you shine light into the eye, see a beam–> these are the cells that have moved into the ant chamber
Which gene is anterior uveitis associated with?
HLAB27
Ank spond
IBD
Reactive arthritis
Presentation of anterior uveitis?
Present spontaneously
Unilateral
Dull, aching red eye
Floaters
blurred vision
ciliary flush
photophobia
abnormally shaped pupils (due to posterior synechiae pulling iris into abnormal shape)
Hypopyon
What is a hypopyon
collection of white blood cells in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level
What are synechiae?
Adhesions
Posteriorly the iris sticks to the lens
Peripherally the iris sticks to the cornea
These may block the corneal angle and increase the pressure in the eye. Need to make a hole to drain the aqueous humour
You can break th synechiae when the eye is not inflamed by dilating the pupil
What are the symptoms of intermediate uveitis?
Blurring of vision
Floaters
What are the signs of intermediate uveitis?
Cells in vitreous humous
Snow balls- clumps of cells
Snow banking-clumps of cell on retina
Macular oedema- seen on fundoscopy/ OCT
What are the non-ophthalmological investigations for uveitis?
Distinguish whether is it infectious or not.
FBC- is WCC high
U&Es
LFT
Q-Gold- do they have TB? either granulomas in the eye or can cause immune reaction to protein
Treatment of anterior uveitis?
Topical steroids/ sub conjunctival steroids
Cycloplegics–> dilate the eye–> break syncheniae and help reduce pain by stopping ciliary muscle spasm
Antibiotics if infectious
Immunosuppressants
Treatment of intermediate + posterior uveitis?
Periocular steroids
Intravitreal steroid implants
Systemic treatment e.g. pulse therapy, oral steroids, immunosupression
Side effects of topical eye steroids?
Increase intraocular pressure
cataracts
Complications of uveitis?
Posterior synechiae
macular oedema
cataracts
pupillary membrane
glaucoma (due to acute rise in intraocular pressure)
Posterior uveitis
Choro-retinal scars
retinal detachment
What is sympathetic ophthalmitis?
Due to trauma, presents as deafness, white skin patches, inflammation of eye and meningism
What is Behcets syndrome?
Multisystem disorder
autoimmune mediated inflammation of arteries and veins
Behcets triad of symptoms?
1)Oral ulcers
2) genital ulcers
3) anterior uveitis
Associations of Behcets syndrome?
More common East mediterranean
More common in men
20-40 y/o
Associated with HLAb51
30% of pts have +ve fhx
Symptoms of Behcets
Oral ulcers, genital ulcers, ant uveitis
Thrombophlebitis + DVT
Arthritis
Neuro involvement e.g aseptic meningitis
GI- also pain, diarrhoea, colitis
Erythema nodosum
Diagnosis of Behcets?
Diagnosis based on clinical findings
Positive pathergy test is suggestive
Classical presentation of ant uveitis?
(bilateral in maybe systemic conditions) red, painful eyes around the corneal limbus, watering, blurry vision, and small, fixed, oval-shaped pupil
