Uveitis Flashcards
Aan wat moet je denken bei iris Atrophie im Rahmen einer Uveitis (2)
- Fuchs heterochromic iridocyclitis
- Uveitis due to herpes virus
Hoe kan de Pupille eruit zien bij een Uveitis (3 opties)
- in Miosis (Reizmiosis bij inflammatie, due to spasm of sphincter pupillae)
- irregular in shape (segmental posterior synechiae)
- sluggish in reaction (due to irisedema)
Give 2 differential diagnosises of acute iridocyclitis
- acute conjunctivitis
- acute angle closure glaucoma
Name 2 short-acting and 2 long-acting cycloplegics and mydriatics
- short-acting:
- Tropicamide 0,5%
- cyclopentolate 1% - long-acting:
- Homatropine 2%
- Atropine 1%
Which Mydriaticum/Cycloplegic is used once synechiae have formed?
Atropine 1%
Name the potent steroid preparations (3)
- betamethasone
- dexamethasone
- prednisolone
Name the weak steroid preparations (2)
- fluorometholone
- loteprednol
when do we use weak steroid preparations in uveitis?
mild uveitis in patients who are steroid responders
Complications of topical steroids (4)
- IOP elevation
- cataract
- corneal melting (inhibition of collagen synthesis)
- secondary infection with bacteria and fungi
name the short acting (1 day) corticosteroids and the long-acting (several weeks) corticosteroids used for subconjunctival or anterior subtenon injections
- short acting: betamthasone and dexamethasone
- long acting: triamcinolone acetonide and methylprednisolone acetate
after how many weeks of systemic administration of corticosteroids do you have to reduce the dose gradually?
after two weeks of systemic corticosteroid therapy
name the short term side effects of systemic corticosteroid therapy (2)
dyspepsia
peptic ulceration
Name the side effects with a long term systemic corticosteroid therapy (6)
- posterior sub capsular cataract
- worsening of diabetes
- cushingoid state
- osteoporosis
- electrolyte imbalance
- reactivation of infections such as TB
How long do you have to wait before you operate cataract after uveitis
2 to 3 months after a quiescent interval of acute iritis
Name 4 complications of uveitis and their specific treatment
- glaucoma (control inflammation with steroids and atropine, lowering IOP with systemic acetazolamide and 0,5% Timolol eye drops, Laseriridotmie or surgical iridectomy by secondary glaucoma after ring synechiae)
- cataract ( cataract operation after 2 to 3 months after a quiescent interval of acute iritis)
- band keratopathy (PTK)
- cystoid macular edema (intravitreal triamcinolone)
How can recurrent uveitis lead to phtisis bulbi?
chronic and recurrent uveitis can lead to degenerative changes in ciliary body with reduced aqueous secretion
What tissues does an intermediate uveitis involve? (2)
- pars plana of ciliary body
- periphery of choroid
How is intermediate uveitis also called?
pars planitis
what is known about the “Verlauf” of intermediate Uveitis? (3)
it is an insidious, chronic and relapsing disease
Is intermediate Uveitis normally unilateral or bilatereal?
It is typically bilateral (80%) but involvement is frequently asymmetrical
What is the etiology of intermediate uveitis
usually unknown
What are the clinical signs of intermediate uveitis? (4)
- cells in the anterior vitreous
- white snowball-like exudates
- snow bank
- absent or minimal anterior uveitis
according to the site of primary involvement, posterior uveitis can be classified in (2)
- chorioretinitis (the primary focus is in the choroid)
- retinochoroiditis ( the primary focus is in the retina)
according to the number and location of areas involved, choroiditis can be classified as (3)
- focal choroiditis
- multifocal choroiditis
- dissiminated or diffuse choroiditis
in focal choroiditis which 2 areas can be involved?
- central: posterior pole or macular region
- juxtapapillary
what do you see clinically by a disseminated or diffuse choroiditis?
multiple, small areas of inflammation are scattered all over the fundus behind the equator
What is the etiology of disseminated or diffuse choroiditis? (2)
- Syphilis
- Tuberculosis
what can the symptoms be a of posterior uveitis? (5)
- blurring of vision (due to floaters, macular involvement)
- scotoma (location of the inflammatory lesion)
- photopsia (retinal irritability)
- metamorphosien (inflamed are can be raised)
- micropsia (separation of rods and cones)
- macropsia (crowding of rods and cones)
what are the retinal sings of a posterior uveitis? (4)
- exsudates in retina
- edema of overlying retina
- retinal vaskulitis
- periphlebitis( involvement of the retinal veins)
what is the possible treatment of posterior uveitis (3)
- posterior subtenon injection or intravitreal injection of triamcinolone
- systemic steroids
- intravenös methylprednisolone 1g/day for 3 days
- 1-2 mg/kg body weight/ day and tapered gradually over several weeks - specific treatment of underlying cause
what is tubercular uveitis
a chronic granulomatous anterior and/or posterior uveitis
what is typical for a anterior tubercular uveitis?
granulatous miliary form: yellowish white nodule surrounded by multiple satellites
what is clinically tipical for a posterior tubercular uveitis? (3)
- choroidal tubercules (multiple, miliary, tubercles in choroid)
- disseminated choroiditis
- choroidal tuberculoma (large, solitary choroidal granuloma)
what is the antitubercular treatment
4-drug regimen: isoniazid + rifampicin + ethambutol + pyrazinamide for 2 months
followed by isoniazid + rifampicin for 6 months
what is a possible ocular complication of ethambutol
optic neuropathy
which organs are involved by Leprosy (3)
- the skin
- peripheral nerves
- the anterior segment of the eye
how is Leprosy caused?
Mycobacterium Leprae
what are the ocular manifestations of leprosy
Anterior uveitis
involvement of the facial nerve -> neuroparalytic lagophtalmos -> exposure keratopathy
involvement of the trigeminal nerve -> loss of corneal sensation -> neurothropic keratopathy
damage to sympathetic innervation of the dilator muscle -> miois
what is a pathognomonic sign of granulomatous anterior uveitis in leprosy
Iris pearls ( small, glistening nodules composed of dead bacilli within histiocytes, located at the pupillary margin, resembling a necklace)
what is the treatment of leprosy?
Dapsone for 1-2 years is the drug of choice
other drugs: clofazimine and rifampicin
what happens in sarkoidosis?
the formation of noncaseating granuloma in affected tissues
which tissues can be affected in sarkoidosis
lungs
skin
joints
eyes
central nervous system
liver
spleen
what are the possible ocular manifestions within sarkoidosis
anterior or posterior uveitis, involvement of the lacrimal and salivary glands
what are the clinical signs of a peripheral retinal periphlebitis
- perivenous sheathing
- peripheral retinal hemorrhages (due to increased vascular permeability)
- perivenous exudates (candle wax drippings)
what is a uveoparotid fever
simulaneous involvement bilateral of the uveal tract, parotid gland and cranial nerves causing
granulomatous anterior uveitis + swelling of the parotid + fever + facial palsy + diplopia
which investigations should be done when sarkoidosis is suspected
- ACE
- serum lysozyme
- X-ray of the lungs
- skin test (Kveim test, injection of sarcoid tissue suspension in the skin of sarcoidosis patient)
Treatment of sarcoidosis
steroids
which herpes viruses are there
- Herpes simplex Virus
- Varicella Zoster Virus (Herpes Zoster)
wich subtypes does the herpes simplex virus have and wicht tissues gets affected by it
- HSV 1 (affects the trigeminal or sacral ganglia)
- HSV 2 (affects genitals)
which tissue does the varicella zoster virus affects?
involves the first division (ophtalmic) of the trigeminal nerve causing herpes zoster ophtalmicus
what are the ocular manifestations of herpes viren?
- granulomatous chronic anterior uveitis
- acute retinal necrosis (ARN)
- progressive outer retinal necrosis (PORN)
when does the anterior uveitis usually occurs due to VZV?
usually 10 to 25 days after the onset of herpetic rashes
what is the cause of sectoral Iris Atrophy due to herpes viren?
occlusive vasculitis
what are the clinical signs of an acute retinal necrosis due to herpes viren?
- anterior granulomatous uveitis
- vitritis
- peripheral periarteritis -> retinal necrosis -> rhegmatogenous retinal detachment
what is the treatment of acute retinal necrosis due to herpes viren
- iv acyclovir for 10 - 14 days
- followed by oral acyclovir for 6 - 12 weeks
what are the possible complications of acute retinal necrosis? (2)
- retinal detachment
- ischemic optic neuropathy
wich virus causes progressive outer retinal necrosis?
VZV
in which patients is progressive outer retinal necrosis seen?
VZV- Infektion in patients with immunosuppression due to AIDS or immunosuppressive drugs
what are the clinical signs of progressive outer retinal necrosis?
- multifocal, yellow white retinal infiltrates with minimal vitritis
- early macular involvement
- minimal anterior uveitis
what can be said about the progression of progressive outer retinal necrosis?
- rapid progression due to immunosuppression
- full thickness retinal necrosis
- rapidly progressive visual loss
how is progressive outer retinal necrosis diagnosted?
vitreous samples of PCR and diagnostic assay of VZV DNA
what is the treatment of progressive outer retinal necrosis?
IV ganciclovir
Wann gibt man Steroiden bei einer Herpes Zoster Ophtalmicus (3)
- disciforme Keratitis
- Endotheliitis
- Uveitis anterior
Was gibt man als Schmerztherapie bei einer Herpes zoster Ophtalmicus?
- Akutschmerztherapie
- Pregabalin oder Gabapentin
- Duloxetin oder Amitriptylin
