Uveitis Flashcards
What is uveitis?
-Inflammation of the uveal tract (the iris, ciliary body, and choroid under the retina- middle layer) and neighbouring structures (e.g. retina, vitreous, optic nerve)
-Pas planitis the place where intermediate overlaps with choroid: chronic intermediate inflammation
-Idiopathic or due to systemic disease.
-Iritis used interchangeably
Endophthalmitis = most feared complications of cataract surgery, infection of vitreous, bacterial
Causes of anterior uveitis
-Iris of ciliary body (anterior chamber)- most common form
-Idiopathic (50%)- reactive
-Infectious (HSV, VZV, TB, syphilis)
-Non infectious (ankylosing Spondyloarthritis, IBD, sarcoidosis, MS, trauma)
-Lens-induced inflammation (retained fragments post cataract surgery)
Causes of panuveitis
-All uveal structures
-Sarcoidosis, Bechet’s
Causes of intermediate uveitis
-Vitreous (includes pars plantitis)
=Snowballs (whitish focal collections of inflammatory exudate in inferior vitreous) see at the back of the eye
=More systemic treatment
-MS, sarcoidosis, IBD
Causes of posterior uveitis
-Choroid or retina
-CMV retinitis, toxoplasmosis
Risk factors of uveitis
-Inflammatory diseases of the joints, bowel, or skin
-HLA-B27 positive
-Ocular trauma
-Age 30-40yrs
Symptoms of uveitis
-Acute onset ocular pain (posterior may not be painful, worse when contracting ciliary muscle/ reading)
-Photophobia!!!
-Watering/ lacrimation
-Pupil small and irregular due to sphincter muscle contraction
-Non reactive pupils
-Vision blurring (VA dependent on severity, usually only mildly reduced)
-Red eye
-Flare and keratin precipitates (leukocytes floating in aqueous humour, sedimentation= hypopyon)
-Systemic symptoms (respiratory, skin, joints, bowels, infection)
-Usually unilateral
Investigations of uveitis
-Bloods (FBC for inflammatory markers, U&Es, LFTs, ESR, CRP, serum ACE for granulomatous disease, ANA, ANCA, RF, HLAB27)
-Find underlying cause (VDRL, Lyme, Bartonella, toxoplasma titres, CXR for TB and sarcoidosis, treponemal antibodies for syphilis, quantiferon gold for TB, vitreous biopsy for suspicion of endophthalmitis post cataract surgery)
USUALLY FOR BILATERAL/ SEVERE/ RECURRENT CASES/ POSTERIOR SEGMENT/SUGGESTIVE OF RHEUM
Management of uveitis
-Topical (corticosteroids like dexamethasone or subconjunctival injections/ orbital floor injections/ systemic if drops ineffective, cyclopentolate)
=Anterior drops, intermediate + injections, posterior oral
-Cycloplegics to prevent and break formed synechiae
-Treat underlying cause, REFER
Complications of uveitis
-Ciliary injection (inflammation around the limbus)
-Keratic precipitates (inflammatory deposits on corneal endothelium)
-Hypopyon (inflammatory exudate in anterior chamber)
-Posterior synechiae (adhesions between pupil margin and lens capsule)
Cataract
Raised IOP
Signs of uveitis
-Injection (red eye)
-Anterior chamber cells (starry sky)
-Aqueous flare (haziness)
-Miosis (constriction of pupil as irritated iris)
-Posterior synechiae (inflammatory adhesions between pupil margin and anterior lens capsule)
-Hypopyon (whitish purulent exudate)
-Keratic precipitates (inflammatory cell deposits, pigmented dots in iris)
-Fibrinous exudate
-Iris atrophy
-Heterochromia (difference in iris colour)
Describe Fuch’s heterochromic iridocyclitis
-Chronic non-granulomatous condition, doesn’t respond to uveitis treatment (low grade grumbling, can get swelling at back of eye)
-40 yrs average
-Possible implication Rubella virus
-Blood aqueous barrier breakdown- posterior pigment epithelium
-Affected eye is lighter, can be hyperchromic if blue eyes (usually affects one eye)
Features of hitsory of uveitis
-Onset
-Rheumatological history
-How many episodes if recurrent, how frequently, how was it treated, syphilis
