Uveitis Flashcards
MHC
MHC gens that encode the HLA protien
MHC1 : A,B,C
MHC2:DR,DQ,DP
MHC1:a subunit + B2 migroglobulin
MHC2: a subunit+ B subunit
MEWDS
young , myopic female , 2-4th decade
unilateral, 1/3 viral prodrome
central or paracentral scotoma, photopsias
multiple white to orange small discrete retinal lesions mainly in perifovela region , granular pigmentation in the fovea =/- vitiritis, on swelling , vascular sheathing
FFA:late punctate hyperF in wreath like configeration surrounding the fovea
FAF: multiple hyperAF exceeding those in clinical finding
ICG: multiple hypoC exceeding those in clinical finding
OCT: abnormal elipsoid zone reflectivity
ERG: diminshed a wave
VF: generalized depression, central and paracentral scotoma, englared blind spot
prognosis: good, resolved in 2-10 weeks, recurrance 10-15%
Birdshot chorioretinopathy
White female , >4th decade
95% HLAb27 , 8% of general population +ve
blurry vision, floaters, dyschromatopsia
visual dysfunction not correlated with VA
multiple creamy color retinal lesions at the level of choroid mainly in postequatorial retina, nasal to the ON and radiating from it , following the choroidal vessels + vitiritis, on swelling , uveitic ME
FFA:early hypoF , late faint staining ( not good in this Disease , good in diagnosing the complication)
FAF: multiple hypoAF exceeding those in clinical finding
ICG: multiple hypoC exceeding those in clinical finding
OCT: loss of elipsoid zone , ME, MA, pachychoroid in early D and leptochoroid in late D
Ff ERG and 30-2 VF important in follow up
RX: systemic and or local steroid + early treatment with IMT
prognosis: chronic D , complicated with UME, ERM, CNVM
sarcoid
- systemic granulomatous disease
- 90% pulomonary
- 50% ocular , 10% of of causes of uveitis
- nourthern white people , african american 20x
- F>M, 20-50 age
- sibling of a patient with sarcoid have fivefold risk of developing the disease
- younger than 5y» more cutaneous and articular disease
- > 60y more risk of uveitis and less pulmonary diease
- MC manifestation of ocular disease is acute or chronic granulomatous anterior uveitis , 2/3 of ocular sarcoid
- usually acute disease will resolved after 2 years assocated with acute anterior uveitis
- 20% od ocular sarcoid presented woth posteriro uveitis
- Rx: Steroid (topical/systemic/local). cycloplegic, vision threatining posteriro uveitis needs systemic steroid +/- IMT
- poor prognosis: presented late >1y, glaucoma, chronic intermediate or posterior uveitis
APMPPE
- young adult
- M=F
- 50% prodromal viral infection
- HLAB7, HLADR2
- systemic infectious and noninfectious association one of them cerebral vascultitis» any neurological symptoms needs urgent neuro evaluation
*unilateral sudden vision loss with central pr paracentral scotoma , fellow eye will be affected within days to weeks,minimalAS involvment , mild vitritis - multiple large placoid yellow to white lesions at the level of choroid mainly in posterior pole , +/- papillitis , resloved after 2-6 weeks leaving permenant RPE changes
- FFA:early hypoF , late staining ( more than the clinical finding
- FAF: multiple hyperAF late in the disease become hypo
- ICG: multiple hypoC with hypervisualization of underlying choroidal vessels
OCT: hyperreflectivity of outer retina layers» loss of RPE and PR
RX: systemic steroid id there is cerebral vasculitis or macular involvment
prognosis is poor if it is unilateral , long duration until the fellow eye affected, macular involvment , recurrent , older age
it is acute and nonrecurrent
immune cells
TH1: intracellular infected cells, fungal infection, delayed hypersensitivity reaction,autoimmune , rejection
TH2: parasetic infection,atopic disease
cytotoxic T cells: tumor and viral infected cells
Natural killing cells: tumor and viral infected cells, no antigen presenting cells
leptospirosis
- gram -ve spirochete
- from urine of the animal
- 2 phases : leptospiremic and immunological disease (uveitis)
- MC ocular manifestation ciliary injection
- intraocular inflammation 10-44%» anterior uveitis , neuroretinitis, panuveitis
- Dx: ELISA, Igm , PCR
- Rx: IV penicillin g 1.5m QID or doxyxyclin 100 mg BID for 7 dyas
- local/topical/ systemic steroid + Cyloplegic
Cryptococcurs neoforman
Budding yeast from soil or pigeon fees
MC fungal endophthalmitis in AIDS +/- fungal meningitis
Other ocular manifestation : nystagmus or CNP
can cause granulomatous anterior uveitis, papilledema , vitritis, vascular sheathing, SRD, (multifocal choroiditis) multiple yellow white sub-retinal infiltrate
Dx India ink staining of C.N or postive culture from vitreous tap, retinal biopsy or CSF tap
Rx IV amphotericin B +/- oral flucutocin +/- IV voriconazole
Serpiginous choroiditis
1-Chronic bilateral progressive recurrent inflammation of RPE choriocapillaris and choroid
2- male =female
3- associated with. crohn disease, polyartritis nodosa and sarcoid
4- geographic or helicode choroidopathy
5-c/o DOV or painless paracdntral scotoma
6- quite AC , no vitritis, bilateral asymmetrical white to yellow infiltrate at the level of RPE in peri papillary area spreadin serpentine or pseudopodial pattern , 1/3 start in the macular area, reactivation at the margin of old lesion (SRF) , 25% complicated by CNVM
7- FAF hyperautoF at the active margin, FFA of active lesion early hypo late hyper staining with blurry margin, old lesion sharp margin with hypoF at the area of RPE hyperplasia and choriocapillaris loss and transmission hyperF at the area of RPE atrophy,ICG aerly and late hypocyanescence , with more lesion than FFA , OCT hyperreflectivity and thickening and blurring of outer retinal layer with underlying thickened choroid
8- mimicker : syphilis, Tb and herpes
9- treatment with local and or systemic steroid + IMT ( antimetabolite with calcineurin inhibitors) +/- anti VEGF or IVT for CNVM
Congenital syphilis
MC transplacetally in stage 1 and 2
MC in early congenital infection is bilateral multifocal choroiditis then retinal vasculitis which both of them will lead to salt and-paper retinopathy , On pallor, sclerosed BV which mimic RP
MC in late congenital infection is bilateral nonulcerative interstitial keratitis +/- anterior uveitis
Hutchinson triad : interstitial keratitis+ NS deafness + hutchinson teeth
Chronic IK leads to cornea scarring with ghosts BV
Other manifestation: cataract, glaucoma, lens sublaxation ,uveitis ,optic neuritis
