Uveitis Flashcards
uvea parts
Choroid, iris, ciliary body
Choroid location
from ora serrata to optic disc
Choroid job
vascular supply + absorb reflecting light
Choroid layers
external to interna:
- Hallers layer (large vessels)
- Sattler’s layer (medium vessels)
- Choriocapillaries (capillaries)
- Bruch’s membrane
Iris zones
Pupillary zone - inner most from pupillary margin to collarette. sphincter pupillae (CN3)
Ciliary zone - outer part from collarette to iris origin. dillator pupillae (sympathetic via ciliary nerve)
Ciliary body parts
Pars plicata - anterior, finger like projection. function: accommodation, aqueous humour production and drainage
Pars plana - avascular, between ora serrata and ciliary processes. no function. used for intravitreal injections or pars plana vitrectomy
Parasympathetic nerve supply to ciliary body
Edinger westphal nucleus of CN3 - ciliary ganglion - short ciliary nerve - contraction of ciliary body and laxing of zonular fibres (thick lens)
Sympathetic nerve supply to ciliary body
Hypothalamus - sympathetic chain - superior cervical ganglion - nerves tagging along with ICA or CNV1 - long ciliary nerve - relaxation of ciliary body, tight zonular fibres (lens flat)
Uveitis classification
Anterior - iris and pars plicata
Intermediate - pars plana to vitreus
Posterior - chorioretinitis
Pan uveitis - all
Anterior uveitis
HLA B27 (psoriasis, ankylosing spondylitis etc), sarcoid or infection (TB, syphilis, lyme disease, VZV)
risk of angle closure glaucoma, posterior synechchiea
Fx: acute painful red eye, photophobia, irregularly meiosed pupil.
Anterior uveitis
Granulomatous vs non-granulomatous
Granulomatous - chronic > 3months, mutton fat KP
Non- granulomatous - acute, stellate KP
Intermediate uveitis (pars palan)
painless blurry vision and floaters
Fx:
- snowballs floaters in inferior vitreous
- snowbanking exduates on ora serrata (seen on indirect ophthalmoscopy with scleral depression)
Onchocerciasis (onchocerca volvulous)
- Africa, river blindness
Vectro : simulium black fly
Fx: maculopapular rash, panuveitis, keratitis
Dx: nematodes on retroillumination
Mx: ivermectin
Toxocariasis (toxocara cani)
- Most common cause of childhood leukocoria
host: dog
Fx: endophthalmitis
Diagnosis: ELISA, calcification on CT differentiates from retinoblastoma
Mx: steroids
Toxoplasmosis
Most common cause of childhood chorioretinitis
Host: cats
Fx: congenital toxoplasmosis: hydrocephalus, intraretinal calcium deposits, chorioretinitis
In AIDS - anterior uveitis
mx: Pyrimethamine
Histoplasma capsulatum
dimorphic fungi
in AIDS patients.
Chorioretinal scars
Sarcoidosis
black woman.
hilar lymphadenopathy, parotid gland enlargement, CN7 palsy
periretinal granuloma (Lander sign)
raised ACE and hypercalcaemia
TB
anterior uveitis
posterior uveitis
keratitis, scleritis, conjunctivitis
dacryoadenitis
Reactive arthritis
Reiter syndrome
urethritis, arthritis, conjunctivitis
Vogt koyanagi harada syndrome
Multisystem inflammation.
Bilateral pan-uveitis
prodorme of tinnitus, meningism, hearing loss
also vitiligo
(japanese)
Birdshot choroidopathy
HLA-A29, middle aged women
Chronic bilateral posterior uveitis
Hypopigmented fundus lesions
Sickle cell retinopathy non-proliferative
Sickle cell retinopathy proliferative
sea fan neovascularisation
vitreous haemorrhage, retinal detachment
Goldberg classification!!
Eales disease
Idiopathic retinal vasculitis
Young indian males
inflammation, occlusion, vitreous haemorrhage
Coates disease
Unknown aetiology, young boys
↓ VA, strabismus, telangiectasia, exudates, retinal detachment, leukocoria
