Uveitis Flashcards
Define uveitis.
Uveitis is inflammation of the uveal tract, which includes the iris, ciliary body and choroid. It is classified according to the part of the uveal tract that the inflammation affects.
How common is uveitis? Who is usually affected?
- Usually 30-40yrs
- Ant age, sex, origin
- Anterior uveitis is the most common form (75% of cases)
- Intermediate uveitis is least common
What are the different types of uveitis?
- Anterior uveitis - iris (iritis) +/-ciliary body (iridocyclitis).
- Intermediate uveitis - mainly vitreous +/- underlying retina
- Posterior uveitis - choroid, optic nerve head and retina. Includes chorioretinitis, retinitis and neuroretinitis
- Panuveitis - whole uveal tract
Best practice:
Anterior uveitis involves inflammation of the iris and ciliary body. Intermediate uveitis involves the posterior ciliary body and pars plana. Posterior uveitis involves the posterior vitreous, retina, choroid, retinal vasculature, and optic nerve. Panuveitis involves inflammation in the anterior, intermediate, and posterior segments of the eye.
What is the most common type of uveitis?
Anterior uveitis
What are the general features of uveitis?
- Acute onset
- Blurred vision
- Pain
- Redness - ciliary flush (ring of redness spreading out)
- Photophobia
- Floaters
- Small +/- irregular pupil due to sphincter muscle contraction
- Hypopyon
- Normal acuity -→ impaired
Symptoms determined by the location of inflammation e.g. photophobia and pain are more common in iritis while floaters in posterior uveitis.
What is the triad of symptoms for anterior uveitis (iritis)?
- Redness
- Pain
- Photophobia
What are the other signs/symptoms for anterior uveitis?
Vision may be normal or blurred depending on degree of inflammation
Redness throughout of injection localised to the limbus
Anterior chamber features of inflammation: cells, keratic precipitates on corneal endothelium, fibrin or hypopyons (pus) and pupil may adhere to the lens (posterior synechiae)
IOP may be raised due to cells clogging trabecular mesh or due to posterior synechiae causing aq humou to build up behing iris and force iris against trabecular meshwork and so reduce aq drainage.
What are the clinical features of intermediate uveitis?
- Painless blurred vision - most commonly associated with floaters
- BOTH eyes are affected
Unusual to experience photophobia/redness
What are the signs/symptoms of posterior uveitis?
Painless, blurred vision can progress to severe visual loss
Floaters and scotomata/blind spots in the visual field are common
What is the aetiology of anterior/posterior uveitis?
Autoimmune disease - RhA, Behcet’s disease, ankylosing spondylitis, positive HLA-B27, RA, sarcoidosis, psoriasis, IBD (Crohn’s disease and UC)
Infections (rare) - herpes simplex and zoster, toxoplasmosis, cytomegalovirus, syphilis, TB, HIV, Lyme disease
Idiopathic - sometimes no cause is found.
What are the risk factors for anterior/posterior uveitis?
- Inflammatory disease of joints, bowel, skin
- HLA-B27 positive
- Ocular trauma
- Age 30-40yrs
What investigations would you do for uveitis? What are the results?
Fundoscopy and slit lamp examination
Diagnosis is clinical - often linked to underlying conditions which may require investigation.
If aetiology still undetermined then idiopathic cause diagnosed.
Posterior uveitis is often found with systemic autoimmune diseases or infections; appropriate investigations should be performed and treatment given that is aimed at the cause.
Compare and contrast anterior and posterior uveitis (4).
But this is more of a spectrum.
What is the uvea?
The vascular area between the retina and the sclera
What is the management of anterior uveitis?
- Urgent review by ophthalmology
- Cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
- Steroid eye drops
