Uveitis

Question 1

Type of uveitis in JIA

Answer 1

Chronic, predominantly anterior, nongranulomatous inflammation affecting the iris and ciliary body (iridocyclitis) of insidious onset

Question 2

Anterior Uveitis

Answer 2

Anterior chamber

Includes Iritis, Iridocyclitis, anterior cyclitis

Question 3

Intermediate Uveitis

Answer 3

Vitreous humor

Pars Planitis, posterior cyclitis, Hyalitis

Question 4

Posterior Uveitis

Answer 4

Retina or Choroid
Focal, multifocal or diffuse choroiditis
Chorioretinitis, Retinochoroiditis, Retinitis, Neuroretinitis

Question 5

Risk factors for JIA associated Uveitis

Answer 5

Age of onset (young)
Sex (female)
JIA subtype (Psoriatic, oligo, RF negative poly)
ANA positivity
HLA B27 positivity
*anti histone antibodies were also a significant predictor of uveitis only in girls
Elevated ESR at time of diagnosis

Question 6

Posterior synechiae

Answer 6

Adhesions between iris and anterior lens capsule capsule

Question 7

Anterior Synechiae

Answer 7

Adhesions between iris and the cornea

Question 8

Band Keratopathy

Answer 8

Deposition of calcium in the corneal epithelium as can occur from chronic anterior uveitis in JIA

Question 9

Iris Bombe

Answer 9

Synechiae that are circumferential prevent free flow of aqueous humor between posterior and anterior chambers, resulting in bulging of the iris and increased intraocular pressure

Question 10

Sudden, bilateral, anterior uveitis with eye redness and photophobia with renal Disease

Child is typically systemically ill with fever, arthralgia, fatigue and abdominal pain (renal disease manifested by sterile pyuria may be transient

Answer 10

TINU

Question 11

Common infections causing uveitis

Answer 11

HIV
Bartonella (neuroretinitis characterized by exudates in the retina (macular star))
Lyme disease (anterior and intermediate)
EBV (anterior)
Toxoplasma gondii (pan uveitis)
Toxocara (focal chorioretinitis)
TB (granulomatous uveitis affecting both the anterior and posterior uvea

Question 12

Defect in Vogt Koyanagi Harada syndrome

Answer 12

Tyrosinase

Question 13

Clinical features of Vogt- Koyanagi Harada

Answer 13

vitiligo, aseptic meningitis, encephalitis, uveitis, hearing loss, changes in the retinal pigment epithelium, poliosis (patchy loss of pigment of eyelashes, eyebrows or hair ) is a characteristic finding

Question 14

Clinical features of pars planitis

Answer 14

Blurred vision, visual floaters, macular edema is common
Bilateral
Usually not associated with systemic disease in children, but associated with MS in adulthood

Question 15

Investigations for all patients with uveitis of uncertain etiology

Answer 15

ANA
UA
HLA b27 
Lyme, Bartonella, Toxacara, Toxoplasma, Syphilis
Urine beta 2, BUN, CR, ESR and CBC

Question 16

Investigations for patients with granulomatous uveitis

Answer 16

Quant or PPD

Chest x ray if suspicious for TB and Sarcoid

Question 17

Investigations for posterior uveitis

Answer 17

CMV, Herpes, HIV

For focal choroidal lesion, both Toxos

Question 18

Risk factors for poor prognosis

Answer 18

Male gender
young age at onset of uveitis
Short duration between onset of arthritis and uveitis
presence of synechie

Question 19

Percentage of uveitis in different JIA subtypes

Answer 19

Oligo 30%
RF negative JIA 15%
Psoriatic 10%
RF positive JIA
sJIA
ERA  less than 1 percent

Question 20

Most common cause of anterior uveitis

Answer 20

• JIA

Question 21

Most common cause of intermediate uveitis

Answer 21

• Pars planitis

Question 22

Most common cause of posterior uveitis

Answer 22

• Infections (TB, CMV, herpes, Varicella, syphilis)

Question 23

Most common cause of Panuveitis

Answer 23

• Idiopathic followed by VKH, behcets and sarcoid