Uveitis

Question 1

Ddx of diffuse KP

Answer 1

FUSST

Fuchs, HSV uveitis, sarcoidosis, syphilis, toxo (rarely)

Question 2

Incidence of uveitis in IBD

Answer 2

Uc- 10%

Crohns- 3%

Question 3

Pars planitis HLA association

Answer 3

HLA-DR15

Question 4

Pars planitis DDX

Answer 4

Sarcoidosis
Toxoplasma
Toxocara
MS
Lyme
Senile vitritis
Syph (very rare)
Whipples
Bartonella

Question 5

Ganciclovir toxicity

Answer 5

Neutropenia and thrombocytopenia;

Needs central line

Question 6

Foscarnet toxicity

Answer 6

Renal

Needs central line

Question 7

Cidofovir toxicity

Answer 7

Renal, uveitis, hypotony (2/2 CB atrophy)

Iritis in 20-50% (occurs about 5 days p last infusion)

Question 8

ARN vs. PORN

Answer 8

ARN: injection, iritis, KP, vitritis, patches of necrotizing retinitis with demarcation line; obliterative arteritis c periph vasoocclusion –> resolves c peri vascular clearing
-tx: iv ACV x 5-10 d, then po x 6 wks, (alt: ganciclovir); ASA, po steroids
PORN: 70% bilateral, vasculitis not prominent, minimal vitritis, multiple discrete peripheral/central areas of retinal opacification/infiltrates.
-Tx c foscarnet AND ganciclovir

Question 9

DDX pale sub retinal mass

Answer 9

Mets, amelanotic melanoma, choroidal osteoma, old SRH, granuloma

Question 10

PCP manifestation in eye

Answer 10

Choroiditis c multimodal orange nummular lesions (cysts)

A/w inhaled pentamidine use

Question 11

DUSN

Answer 11

Ancylostoma caninum or baylisascaris procyonis
Sx: gray white retinal lesions, onh swelling, vit cells, rep changes, unilateral wipeout

Treatment: laser worm

Question 12

P acnes endophthalmitis

Answer 12

Chronic Granulomatous uveitis

Tx c intravit vanco/cephalos, usually bag/IOL removal

Question 13

POHS HLA association

Answer 13

HLA-B7 and DR-2

Question 14

Pars planitis:

a) uni or bilateral?
b) sign that is a/w MS

Answer 14

a) bilateral in 80%, but may be asymmetricb) Periphlebitis

Question 15

DDX leopard spots

Answer 15

Lymphoma, idiopathic uveal effusion syndrome, onchocerciasis

Question 16

Most effective tx for Bechet’s

Answer 16

chlorambucil

Question 17

HLA associations for:
A. birdshot
B. VKH
C. Pars planitis
D. Bechet's
E. sarcoidosis 
F. POHS
G. JRA
H. MS

Answer 17

a. HLA-A29
b. HLA-DR4
c. HLA-DR2, B7 (most sources say sub-allele DR-15; also HLA DR-51, DR-17)
d. HLA-B51
e. B8
f. B7, DR2
G. DR4 (same as VKH)
H. HLA-DR15 (like PP-see MEEI 63 & 120)

Question 18

Class I vs class II MHC

Answer 18

Class I: Include HLA A, B, C. Present on almost all nucleated cells; Used by CD8 T lymphocyte

Class II: Included HLA-DR, DP, DQ; Used by CD4 T lymphocytes

MHA/HLA SYSTEM ENCODED ON CHROMOSOME 6

Question 19

DDX Dalen-Fuchs nodules

Answer 19

VKH/SO, TB, Sarcoidosis (Not Bechets)

MEEI 37

Question 20

Vasculitides primarily involving veins

Answer 20

Sarcoidosis, birdshot, multiple sclerosis, Eales’

Toxo can affect both arteries and veins

Question 21

Medication-related uveitis

Answer 21

Bisphosphonates: scleritis, uveitis
Bactrim, other abx: bilateral acute Iridocyclitis
Moxifloxacin: uveitis like syndrome with TIDs
Cidofovir

Question 22

Heerfordt syndrome

Answer 22

Sarcoid syndrome (uveoparotid fever): granulomatous uveitis, constitutional symptoms, parotid swelling, Bell’s palsy

Question 23

Lofgren syndrome

Answer 23

Form of systemic sarcoidosis defined by bilateral hilar LAD, arthropathy, fever, and erythema nodosum

(Don’t confuse with Loeffler syndrome, which is eos PNA)

Question 24

Mikulicz syndrome

Answer 24

Lacrimal and parotid gland swelling, sicca syndrome

Question 25

Vasculitides primarily involving arterioles

Answer 25

ARN, PAN, Bechet’s

Question 26

What medications are associated with uveitis?

Answer 26

Rifabutin, OCP, bisphosphonates, sulfonamide CAUSE uveitis
Metipranolol and travoprost are associated with uveitis.

Also associated: bcg vaccine, flu, ppd