uveitis Flashcards
what are the components of the uveal tract ?
iris
the ciliary bodies
the choroid
what arethe types of the uveitis ?
anterior uveitis - iris and ciliary body
intermediate uveitis - the ciliary body
posterior uveitis - choroid +/- retina
panuveitis - all of the uveal tract
what is thee most common cause of non-infectious uveitis ?
idiopathic
what are the non infectious causes of uveitis ?
juvenile idiopathic arthritis
sero negative arthritis
IBD
Sarcoidosis
Behcet
VKH
what are the infectious causes of uveitis ?
syphillus
HSV
TB
leprosy
Lyme diseasee
Rubella
what are the symptoms of anterior uveitis or iridocyclitis ?
severe pain
drop in vision
photophobia
what are the signs associated with anterior uveitis ?
aqueous flares
keratic precipitates
posterior synechiae / festooned pupil
fibrinous reactions
hypopyon
what is the initial treatment for anterior uveitis ?
cycloplegia : to alleviate the pain along with prevention of posterior synchaecia - atropine
topical corticosteroids : dexamethasone or prednisolone
what is thee triad associated with behcets disease ?
aphthous oral ulcers
genital ulcers
uveitis
what is the genetic association in behcet’s disease ?
HLA-B51
associated with people originating from the “silk road” route
what are the ocular features associated with Behcet’s ?
retinal vasculitis
vitritis
optic neuropathy
Acute anterior uveitis
transient hypopyon
what type of disease is VKH ?
idiopathic multi-system autoimmune disease
thought to be autoimmune against melanocytes
what type of uveitis is associatedd with VKH ?
granulomatous panuveitis
that is bilateral and shows exudative Retinal detachement and disc oedema
sunset glow fundus
what are the accompanying signs associated with VKH ?
neurological symptoms - headache and neck sttiffness
skin manifestations - vitiligo , alopecia, poliosis
auditory disturbances - deafness and tiinnitus
what is JIA ?
juvenile idiopathic arthritis is arthritis of unknown aetiology that takes place before the onset of 16 years of age for at least 6 weeks
what is the commonest systemic disease associated with anterior uveitis in children ?
JIA
what is the most common form of JIA ?
oligoarticular form
affecting 4 joints or less
most commonly the knees followed by the ankles and wrists
whatare the occular manifestayions in JIA ?
iritis develops first but is asymptomatic
ocular complications which happen afterward include band keratopathy, cataract and glaucoma if iritis is not recognized
what is the management for patients diagnosed with JIA ?
need 3 monthly regular follow up by the ophthalmologist
especially those with oligoarticular form ( same as pacuiarticular form)
what are the characteristics of Ankylosing spondylitis ?
characterized by : inflammation , then calcification and finally ossification of the ligaments and capsules of the bonees of thee axial skeleton
what age group is associated with AS ?
middle aged men
what is the genetic association with ankylosing spondylitis ?
HLA-B27
what are the bony deformities associated with AS ?
sclerosis of the sacroiliac joint
fixed flexion deformity
what are the features of psoriatic arthritis ?
scaly skin lesions
also HLA-B27 positive
anterior non granulomatous uveitis
recurrent attacks
immune mediated scleritis ?
think rheumatoid arthritis
what are the features of rheumatoid arthritis ?
autoimmune joint diseases
affecting small joints of the hand ( hand deformities )
more common in females
what are the ocular manifestations associated with RA ?
keratoconjunctivitis sicca
marginal corneal ulcers ( collagen affection )
scleritis
episclerits
what are the hand deformities associated with RA ?
swan neck deformity - PIP flexed
Boutonniere deformity- DIP flexed
what type of disease is sarcoidosis ?
multisystem non-caseating granulomatous disease
what are the systemic manifestations in sarcoidosis ?
bilateral hilar lymphadenopathy
lung infiltrates
ereythema nodosum
thoracic lymphadenopathy
occular manifestations
what are the occular manifestation in sarcoidosis ?
granulomatous anterior uveitis
KP mutton fat
iris nodules
lacrimal gland involvement ( enlargement )- dry eyes
patchy venous sheaths
chorioretinal granuloma
vitritis - vitreous opacities called snowball or pearls on a string
what is seen on FFA in cases of sarcoidosis ?
sheathing of the retinal veins
leakage and staining at the site of sheathing
what are thee findings on chest x ray in sarcoidosis ?
pulmonary mottling
bilateral hilar lymphadenopathy
what other iinveestigations should be performed in cases of suspected sarcoidosis ?
serum ACE levels - elevated
Mantoux test - but may be negative in patients with BCG vaccine
Lung function test
Gallium Scan - increased uptake in the parotid, lacrimal and pulmonary regions
what is the treatment for sarcoidosis ?
systemic steroids especially in posterior segment disease where vision is threatened
what is endophthalmitis ?
ocular inflammatory responsee caused by the invasion of intraocular structures by replicating organisms
what are the types of acute endophthalmitis ?
endogenous - hematogenous spread from the body
exogenous - post-op or blunt/peenetrating occular trauma
what is the most common cause of acute endophthalmitis ?
post-operative
followed by bleb related causes
what is a bleb ?
surgically made “door” that allows drainage of fluid from the eye to treat glaucoma
what is the most common causative organism associated with endophthalmitis ?
staph. epidermidis
what is the presentation of acute post operative endophthalmitis ?
1-7 days after the surgery
rapid drop in vision
corneal oedema
flare and severe exudation
what does ocular adnexa mean ?
all the orbital contents except the globe and optic nerve
what are the risk factors associated with acute post operative endophthalmitis ?
complicated surgery
diabetics
sutureless surgery
suturless dead temporal wounds
what is the treatment for acute post operative endophthalmis ?
immediate intra-vitreal antibiotics
( vancomycin and ceftazidime)
after a vitreous sample has been taken
vitrectomy in severe cases with vision of hand movement or less
