uveitis

Question 1

what are the components of the uveal tract ?

Answer 1

iris
the ciliary bodies
the choroid

Question 2

what arethe types of the uveitis ?

Answer 2

anterior uveitis - iris and ciliary body
intermediate uveitis - the ciliary body
posterior uveitis - choroid +/- retina
panuveitis - all of the uveal tract

Question 3

what is thee most common cause of non-infectious uveitis ?

Answer 3

idiopathic

Question 4

what are the non infectious causes of uveitis ?

Answer 4

juvenile idiopathic arthritis
sero negative arthritis
IBD
Sarcoidosis
Behcet
VKH

Question 5

what are the infectious causes of uveitis ?

Answer 5

syphillus
HSV
TB
leprosy
Lyme diseasee
Rubella

Question 6

what are the symptoms of anterior uveitis or iridocyclitis ?

Answer 6

severe pain
drop in vision
photophobia

Question 7

what are the signs associated with anterior uveitis ?

Answer 7

aqueous flares
keratic precipitates
posterior synechiae / festooned pupil
fibrinous reactions
hypopyon

Question 8

what is the initial treatment for anterior uveitis ?

Answer 8

cycloplegia : to alleviate the pain along with prevention of posterior synchaecia - atropine
topical corticosteroids : dexamethasone or prednisolone

Question 9

what is thee triad associated with behcets disease ?

Answer 9

aphthous oral ulcers
genital ulcers
uveitis

Question 10

what is the genetic association in behcet’s disease ?

Answer 10

HLA-B51
associated with people originating from the “silk road” route

Question 11

what are the ocular features associated with Behcet’s ?

Answer 11

retinal vasculitis
vitritis
optic neuropathy
Acute anterior uveitis
transient hypopyon

Question 12

what type of disease is VKH ?

Answer 12

idiopathic multi-system autoimmune disease
thought to be autoimmune against melanocytes

Question 13

what type of uveitis is associatedd with VKH ?

Answer 13

granulomatous panuveitis
that is bilateral and shows exudative Retinal detachement and disc oedema
sunset glow fundus

Question 14

what are the accompanying signs associated with VKH ?

Answer 14

neurological symptoms - headache and neck sttiffness
skin manifestations - vitiligo , alopecia, poliosis
auditory disturbances - deafness and tiinnitus

Question 15

what is JIA ?

Answer 15

juvenile idiopathic arthritis is arthritis of unknown aetiology that takes place before the onset of 16 years of age for at least 6 weeks

Question 16

what is the commonest systemic disease associated with anterior uveitis in children ?

Answer 16

JIA

Question 17

what is the most common form of JIA ?

Answer 17

oligoarticular form
affecting 4 joints or less
most commonly the knees followed by the ankles and wrists

Question 18

whatare the occular manifestayions in JIA ?

Answer 18

iritis develops first but is asymptomatic
ocular complications which happen afterward include band keratopathy, cataract and glaucoma if iritis is not recognized

Question 19

what is the management for patients diagnosed with JIA ?

Answer 19

need 3 monthly regular follow up by the ophthalmologist
especially those with oligoarticular form ( same as pacuiarticular form)

Question 20

what are the characteristics of Ankylosing spondylitis ?

Answer 20

characterized by : inflammation , then calcification and finally ossification of the ligaments and capsules of the bonees of thee axial skeleton

Question 21

what age group is associated with AS ?

Answer 21

middle aged men

Question 22

what is the genetic association with ankylosing spondylitis ?

Answer 22

HLA-B27

Question 23

what are the bony deformities associated with AS ?

Answer 23

sclerosis of the sacroiliac joint
fixed flexion deformity

Question 24

what are the features of psoriatic arthritis ?

Answer 24

scaly skin lesions
also HLA-B27 positive
anterior non granulomatous uveitis
recurrent attacks

Question 25

immune mediated scleritis ?

Answer 25

think rheumatoid arthritis

Question 26

what are the features of rheumatoid arthritis ?

Answer 26

autoimmune joint diseases affecting small joints of the hand ( hand deformities ) more common in females

Question 27

what are the ocular manifestations associated with RA ?

Answer 27

keratoconjunctivitis sicca marginal corneal ulcers ( collagen affection ) scleritis episclerits

Question 28

what are the hand deformities associated with RA ?

Answer 28

swan neck deformity - PIP flexed Boutonniere deformity- DIP flexed

Question 29

what type of disease is sarcoidosis ?

Answer 29

multisystem non-caseating granulomatous disease

Question 30

what are the systemic manifestations in sarcoidosis ?

Answer 30

bilateral hilar lymphadenopathy lung infiltrates ereythema nodosum thoracic lymphadenopathy occular manifestations

Question 31

what are the occular manifestation in sarcoidosis ?

Answer 31

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

Question 32

what is seen on FFA in cases of sarcoidosis ?

Answer 32

sheathing of the retinal veins leakage and staining at the site of sheathing

Question 33

what are thee findings on chest x ray in sarcoidosis ?

Answer 33

pulmonary mottling bilateral hilar lymphadenopathy

Question 34

what other iinveestigations should be performed in cases of suspected sarcoidosis ?

Answer 34

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

Question 35

what is the treatment for sarcoidosis ?

Answer 35

systemic steroids especially in posterior segment disease where vision is threatened

Question 36

what is endophthalmitis ?

Answer 36

ocular inflammatory responsee caused by the invasion of intraocular structures by replicating organisms

Question 37

what are the types of acute endophthalmitis ?

Answer 37

endogenous - hematogenous spread from the body exogenous - post-op or blunt/peenetrating occular trauma

Question 38

what is the most common cause of acute endophthalmitis ?

Answer 38

post-operative followed by bleb related causes

Question 39

what is a bleb ?

Answer 39

surgically made "door" that allows drainage of fluid from the eye to treat glaucoma

Question 40

what is the most common causative organism associated with endophthalmitis ?

Answer 40

staph. epidermidis

Question 41

what is the presentation of acute post operative endophthalmitis ?

Answer 41

1-7 days after the surgery rapid drop in vision corneal oedema flare and severe exudation

Question 42

what does ocular adnexa mean ?

Answer 42

all the orbital contents except the globe and optic nerve

Question 43

what are the risk factors associated with acute post operative endophthalmitis ?

Answer 43

complicated surgery diabetics sutureless surgery suturless dead temporal wounds

Question 44

what is the treatment for acute post operative endophthalmis ?

Answer 44

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