Uveitis Flashcards
What does ACAID stand for?
Anterior Chamber- Associated Immune Deviation
-Affords the immune privilege of the internal eye
First identified association between HLA genes and human disease?
HLA-B27 and Anterior Uveitis
STRONGEST association between HLA genes and human disease ever described (224x risk)
HLA-A29 and Birdshot Chorioretinopathy
Birdshot Chorioretinopathy: associated HLA subtype?
HLA-A29 (âABI the birdâ)
HLA-B27: associated ophtha disease?
Acute Anterior Uveitis: Ankylosing Spondylitis and Reiterâs Syndrome (âBinugBoG na Reiterâ)
HLA-B51/B5: associated ophtha disease?
Behçetâs Disease (âBEA Behçetâ)
Vogt-Koyanagi-Harada Syndrome, Sympathetic Ophthalmia: associated HLA subtype?
HLA-DR4: (âDR. 4 Vicky Soâ)
Specialized dendritic cells in the Conjunctiva
Langerhans Cells
Hypersensitivity Type 1: Immediate/IgE-mediated diseases
Seasonal Allergic Conjunctivitis, Giant Papillary Conjunctivitis, Vernal Keratoconjunctivitis, Atopic Keratoconjunctivitis
Hypersensitivity Type 2: Cytotoxic diseases
Moorenâs Ulcer, Mucous Membrane Pemphigoid
Hypersensitivity Type 3: Immune Complex-mediated diseases
Stevens-Johnson Syndrome, Sjogrenâs Syndrome, Peripheral Ulcerative Keratitis, Scleritis
(Triple S PUK)
Hypersensitivity Type 4: Delayed Hypersensitivity diseases
Giant Papillary Conjunctivitis, Vernal Keratoconjunctivitis, Atopic Keratoconjunctivitis, Sympathetic Ophthalmia, Phlyctenulosis, Contact Dermatoblepharitis, Graft Rejection
Hypersensitivity Type 5: Stimulatory diseases
Thyroid-related Eye Disease
Acute course
Sudden-onset and limited duration
Recurrent course
Repeated episodes separated by periods of inactivity WITHOUT treatment ⼠3 months in duration
Chronic course
Persistent Uveitis with relapse in < 3 months after DISCONTINUING treatment
Worsening activity
2-step increase in level of inflammation OR
increase from Grade 3+ to 4+
Improved activity
2-step decrease in level of inflammation OR decrease from Grade 1+ to 0
Anterior Chamber Cells Classification
Marker of activity
0: <1
0.5+/trace: 1-5
1+: 6-15
2+: 16-25
3+: 26-50
4+: >50
Anterior Chamber Flare Classification
- Not a marker of activity
- Protein transudation due to breakdown of the B-O-B
0: None 1+: Faint 2+: Moderate (Iris and Lens details CLEAR) 3+: Marked (Iris and Lens details HAZY) 4+: Intense (Fibrin or Plasmoid Aqueous)
Vitreous Flare Classification
0: None
1+: Hazy RNFL details (Clear details of the Optic Disc and Vessels)
2+: Hazy details of the Optic Disc and Vessels
3+: Only the Optic Disc is visible
4+: Optic Disc NOT visible
Granulomatous Morphology
What size of KP?
Nodules?
Severity?
- Large mutton fat KPs
- With Busacca, Koeppe and Berlin nodules
- Usually chronic and severe
Large and mutton-fat keratic precipitates are made up of what?
Macrophages and Giant Cells
Infectious etiologies of granulomatous uveitis
TTT Fudge Lasang Herpes Siya
TB, Syphilis, Toxoplasma, Toxocara, Herpes, Fungal, Leprosy
Non-Infectious etiologies of granulomatous uveitis
(Very sterile sterile man)
VKH, SO, Sarcoidosis, Masquerade
Non-Granulomatous morphology size?
Small to medium-sized Keratic Precipitates
Small to medium-sized Keratic Precipitates are made up of what?
PMNs (Neutrophils) & Lymphocytes
Diseases with red eyes
JIA-associated Uveitis, Fuchs Heterochromic Iridocyclitis, Posner-Schlossman Syndrome, Intermediate, Posterior uveitis
Uveitic diseases with hypopyon
Behçetâs Disease, HLA-B27-associated Uveitis, Herpes Zoster/Herpes Simplex Keratouveitis, Toxoplasmosis, Toxocariasis, Masquerade (Endophthalmitis, Retained IOFB)
(TT HHMB)
Differential of broad based posterior synechiae
Tuberculous uveitis
Occlusio Pupillae
membrane covering the entire pupil
Iris BombĂŠ
Anterior bowing of the Iris due to a pupillary block from either an occlusio or seclusio pupillae
Seclusio Pupillae
360-degree posterior synechiae
Location of Busacca nodules
Iris stroma
Location of Koeppe nodules
Pupillary border
Location of Berlin nodules
Angle
What are keratic precipitates?
Collection of inflammatory cells at the Corneal Endothelium
Stellate KP differentials
âHITâ
Intraocular Viral Infections (i.e. Herpes)
Toxoplasmosis
Fuchs Heterochromic Iridocyclitis
Etiologies of Band Keratopathy and Treatment
Chronic Inflammation (i.e. Childhood Chronic Iridocyclitis) Silicone Oil in Aphakic patients Hypercalcemia Hyperphosphatemia Hereditary Exposure to Mercurial vapors
Tx: EDTA
What is a band keratopathy and where is it located?
Deposits of calcium in Bowmanâs layer
What comprises snowballs?
Epithelioid Cells and Giant Cells
What is a snowbank?
Accumulation of a FIBROGLIAL MASS over the Pars Plana and adjacent Retina; can have vessels crossing over it
MOST COMMON cause of decreased vision in Intermediate Uveitis in adults
Cystoid Macular Edema
MOST COMMON cause of decreased vision in Intermediate Uveitis in children
Optic disc edema
Diseases causing perivascular sheathing of arterioles
ARN, Toxoplasmosis
Diseases causing perivascular sheathing of venules
CMV
Entity causing candlewax drippings
Sarcoidosis
4 entities causing Retinitis + Vasculitis
Behçetâs, HSV, VZV, CMV
Disease causing geographic choroiditis + retinitis
TB
Diseases causing choroiditis + exudative RD
VKH, SO, CSCR
Give baseline uveitic workup
CBC w/ Platelet & Differential Count ESR, CRP Chest X-Ray, PPD, Quantiferon Gold, GeneXpert VDRL/RPR, FTA-ABS Urinalysis FBS, AST, ALT, Crea
Special test to request for ankylosing spondylitis?
Sacroiliac Joint X-Ray
Special test to request for Granulomatosis with Polyangiitis?
c-ANCA (Proteinase 3)
Special test to request for Polyarteritis Nodosa?
p-ANCA (Myeloperoxidase)
Special tests to request for Viruses, Toxoplasma, Toxocara?
PCR of Intraocular Fluid/serum antigenemia
Special tests to request for Sarcoidosis?
Serum Angiotensin Converting Enzyme (ACE), Lysozyme, Kveim Test, Gallium scan, Chest CT-Scan
Why should steroids be given in the morning between 6-10AM?
To mimic the normal diurnal cycle and reduce the risk of adrenal suppression
What is the ideal glucocorticoid?
No mineralocorticoid activity