Uveitis Flashcards
Primary care statistics 5
- Anterior uveitis: 57.4% most common
- Panuveitis: 2nd most common but unlikely to report due to severity
- Posterior uveitis: 10.6% common due to changes in vision
- Intermediate uveitis: 9.5%
- Diffuse uveitis: 22.4%
Signs 8 and treatment (treated and untreated) 4 of acute anterior uveitis
- ciliary flush
- posterior synechiae
- spill over
- hypopyon
- acute hydrops
- cells and flares in AC –> endo cel dusting
- decrease IOP from defective CB
- pupil miosis
- treated:
1. inflammation tends to respond to treatment and complete resolve within 5-6wks
2. excellent visual prognosis - untreated:
1. 360 degrees permanent posterior synechiae, iris atrophy, unreactive pupil
2. poor vision related to treatment delay
Course of intermediate uveitis
- benign, may not require treatment
- some cases repeat episodes over years
Characteristic signs of intermediate uveitis 3
- inferior snowballs
- snowbanking at pars plana and ora serrata
- 30% cystoid macular oedema
Work up of posterior uveitis 3
- OCT to look at layers
- Fl angiography to see veins
- Indocyanine green angiography to see choroidal vessels
Symptoms 3 of vasculitis
- symptomatic: retinal vascular changes with vitreous involvement –> cells and flares –> floaters –> decreased VA
- blocked vessels –> avascular areas –> ischaemia –> scotomas –> large enough then noticeable but usually compensated as it is unilateral
- asymptomatic: retinal vascular changes with no vitreous involvement
HLA-B27 positive related inflammatory diseases 5
- ankylosing spondylitis
- reactive arthritis
- psoriatic arthritis
- Behcet syndrome
- inflammatory bowel disease
Identify 8 clinical features that differentiates between a HLA-B27 positive vs negative anterior uveitis person
- male
- acute
- unilateral
- frequent recurrences
- no mutton fat KPs
- fibrin
- hypopyon
- systemic associations
Prevalence, signs 4, prognosis (degree and duration) 4 of JIA
- most common childhood disease
- 30-150/100,000 children
- cells and flares - dusting in acute phase - small to medium KPs
- NO hypopyon, or marked redness
- band keratopathy
- cataract
- 10% mild uveitis, +1 aqueous cells, <12wks
- 15% one attack, lasts <4mths +2 and +4 cells
- 50% moderate - severe, >4mths
- 25% very severe, several years
Systemic involvement of sarcoidosis 3
- facial palsy
- enlarged salivary gland
- arthritis
Characteristics of sarcoidosis 8
- non-cessating granulomatous disorder
- mutton fat KPs
- Busacca iris nodules
- candle wax drippings
- multifocal choroiditis
- vitritis: snowballs
- persistent disc oedema and atrophy leading to VF defects in advanced cases
- enlarged hilar
What 4 and characteristics 2 of Behcet syndrome
- rare autoimmune disease
- recurrent episodes of urogenital ulcers and vasculitis
- follows the silk road
- bilateral
- M>F, 3rd to 4th decade but peaks at 30yo
- flare
- recurrent hypopyon
What 8, characteristic 1 and chronic uveitic phase 4 of VKH
- rare
- affects melanocytes
- bilateral
- chronic
- diffuse granulomatous uveitis
- poliosis, alopecia, vitiligo, auditory hair cells
characteristic: retinal detachment
- retina detachment disappears after corticosteroid use
- decrease AC cells
- depigmentation of fundus –> sunset-glow appearance
- depigmentation at limbus –> Sugiuras sign, noticed after a month
Gender and signs 7 of Fuch’s heterochromic iridocyclitis
- females
- stellate KPs
- affected eye is the lighter eye but depends on atrophy of iris stroma and posterior pigment epithelium
- Koeppes and Busacca iris nodules
- iris atrophy - loss of crypts
- mydriasis from atrophy of sphincter muscles
- low level flare and cells –> floaters
- PSC
Complications 2 of lens induced uveitis
- phacoanaphylactic endophthalmitis: abrupt loss of vision and pain days to wks after rupture
- phacogenic non granulamotous uveitis: less severe, develops 2-3wks after rupture
Different symptoms 4 in granulomatous (chronic 3) and non-granulomatous (acute 5, chronic 2) uveitis
gran
- mild pain
- mild sensitivity to light
- tearing
- blurred vision
- chronic: syphillis, tb, sarcoidosis
non-gran
- acute onset
- sensitivity to light
- pain
- better recovery than gran
- acute: HZ, HS, HLA-B27, lyme disease, trauma
- chronic: fuchs, JIA
What 4, anterior signs 3 and posterior signs 4 of sympathetic ophthalmia
- rare
- bilateral
- granulamotous
- panuveitis
- mutton fat KP
- posterior synechiae
- chronic increase IOP
- Dalen fuchs nodules - yellow white choroidal lesions
- retinal detachment
- vasculitis
- OD swelling
Pathophysiology and risk factors 2 of endophthalmitis
- blood bourne infection can pass through uvea causing uveitis without scleral involvement
- immunosuppression
- risky procedures eg organ transplant
Course 1 and work up 2 of Tb
- 6-9months
- Tb skin test: injecting Tb protein into skin to observe allergic rxn (wheal) after 24 hrs
- <5mm = generally negative
- >10mm = intermediate rxn
- >15mm = strong rxn - chest x ray: performed if tb skin test is positive, hyper-reflective areas indicate presence of active tb or scar
Signs 3 (characteristic 1) of syphillis
- chronic granulomatous anterior uveitis
- chorioretinitis with vitritis
- 1/2 - 1 ODD lesions that can coalesce to form confluent lesions
Sign 1 of HS anterior uveitis
- patchy iris atrophy
Sign 1 of HZ anterior uveitis
- iris atrophy in 25%
Sign of congenital rubella
- anterior uveitis can lead to iris atrophy
Signs and symptoms 5, severity grading, ddx 2, treatment 5 of ARN
- can present without viral prodrome
- moderate main +/- AC inflammation
- hazy vision from increased floaters
- severe vasculitis
- OD oedema
- sa defines severity: mild 25%, moderate 25-50%, severe >50%
- rate of progression is a key differential
- eg behcet’s disease
- emergency
- identify underlying cause
- 65% chance of affecting second eye
- high doses of antiviral therapies
- also depends on how many retinal quadrants are affected
