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OPM > Uveitis and Metabolic Diseases > Flashcards

Uveitis and Metabolic Diseases Flashcards

1
Q

Types of Uveitis

A
  1. Anterior
  2. Intermediate
  3. Posterior Uveitis
  4. Panuveitis
  5. Endophthalmitis
  6. Panophthalmitis
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2
Q

Uveitis Definition

A

Inflammation of Uveal tract ( May involves retina and vessels)

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3
Q

Acute Uveitis

A

Sudden onset Limited duration

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4
Q

Recurrent Uveitis

A

Repeated seperated by inactivity w/o tx 3 or >3/12

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5
Q

Chronic Uveitis

A

Persistent Prompt Relapse ( if tx stopped)

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6
Q

Remission Uveitis

A

Inactive for at least 3/12 after tx stops

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7
Q

Patient history factors

A
  1. Age 2. Race 3. Geo location 4. Past ocular history ( POH) 5. Past medical history 6. Hygiene & Diet 7. Sexual practice 8. Recreation drug use 9. Pets
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8
Q
  1. Age
A

Certain age groups prone to certain types of uveitis

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9
Q
  1. Race
A

Genetics

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10
Q
  1. Geographic location
A

Endemic spread over the world

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11
Q
  1. Past ocular history
A

Uveitis as a result of ocular trauma/ surgery ( Infection/ Inflammation)

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12
Q
  1. Past medical history
A

Infectious agents: TB, Syphilis Systemic Diseases Rx ( Prescriptions) eg. Corticosteroids

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13
Q
  1. Hygiene & Diet
A

Infection: Toxocariasis Taxoplasmosis

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14
Q
  1. Sexual practice
A

Sexual transmitted diseases Syphilis HIV

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15
Q
  1. Recreational drug use
A

Eg. Needles HIV infection Fungal Endophthalmitis

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16
Q
  1. Pets
A

Cats: toxoplasmosis & Cat-scratch diseases Dogs: Taxocariasis

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17
Q

ACUTE ANTERIOR UVEITIS ( AAU) Characteristics

A

Most common Sudden onset Duration of 3/12 or less Easy to recognise ( Severe symptoms)

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18
Q

AAU Symptoms:

A

Unilateral pain Photophobia Redness Lacrimation

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19
Q

AAU Signs:

A
  • Good at presentation
  • Ciliary Injection: Vessels from EOMs may present through ophthalmic arteries 
  • Miosis ( Sphincter spasm) = Involuntary sudden contraction of sphincter papillae ==> Pupil constric
  • Endothelial dusting
  • Aqueous flare ( Protein in AC)
  • Hypopyon ( Pus- WBCs accumulated)
  • Posterior Synechiae ( Adhesion of Iris into lens)
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20
Q

Sign?

A

Ciliary Injection

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21
Q

Sign?

A

AAU
Miosis

( Sphincter Spasm)

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22
Q

Sign?

A

AAU
Endothelial Dusting

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23
Q

Sign?

A

AAU
Aqueous cells in AC

Show disease severity ( No. of cells)

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24
Q

AAU

Grading of cells ?

A

No. of cells within slit beam

( 2mm long & 1mm wide )

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25
Q

Signs?

A

AAU

Aqueous flare

( Protein leaking in AC)
Grading

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26
Q

Sign?

A

AAU Hypopyon

( Pus - WBCs in AC inferiorly forming horizontal level)

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27
Q

Signs

A

AAU
Posterior Synechiae

( adhesion of Iris to Lens)

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28
Q

AAU
Course and Prognosis ?

A
  • If treated, inflammation ⇒ completely resolve (5-6 weeks)

► Excellent visual prognosis

  • Complications and poor visual prognosis are related to delayed or inadequate management
  • Steroid-induced in IOP may occur but glaucomatous damage is uncommon
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29
Q

CHRONIC ANTERIOR UVEITIS

CAU

A
  • Less common than AAU
  • Persistent inflammation- promptly relapses < 3/12, after discontinuation of tx
  • Gradual presentation:
    many patients are asymptomatic until the development of complications (e.g., cataract, band keratopathy)
30
Q

CAU

Signs

A
  • Aqueous cells & aqueous flare
  • Iris nodules
  • Keratic precipitates (KP) ⇔ Clusters of cellular deposits on the cornea
31
Q

Sign?

A

CAU
Keratic Precipitate on Cornea

32
Q

CAU

Causes and Prognosis ?

A
  • Inflammation persists for >3/12 (sometimes years)
  • Remissions and exacerbations are common
  • Prognosis is guarded
  • Complications can ensue (e.g., cataract, glaucoma)
  • Further towards back → Harder to treat
33
Q

Posterior Uveitis

A
  • Includes retinitis, choroiditis and retinal vasculitis
  • Often both retina & choroid involved
  • Symptoms: vary according to inflammation location
    Floaters
    Impaired central vision
34
Q

RETINITIS

( Posterior Uveitis)

A
  • Focal (solitary) or multifocal
  • Active lesions - whitish retinal opacities with indistinct borders due to surrounding oedema
35
Q

CHOROIDITIS

( Posterior Uveitis)

A
  • Focal, multifocal or geographic
  • Active choroiditis is characterised by a round, yellow nodule
36
Q

VASCULITIS

( Posterior Uveitis)

A
  • Can occur as a 1˚ condition or 2˚ to retinitis
  • Affects Veins > Arteries
  • Active: Yellowish or grey-white, patchy, perivascular cuffing
  • Quiet: Perivascular scarring
37
Q

SPONDELOARTHRIPATHIES

( Ankylosing Spondylitis)

A
  • Strong rlts with Uveitis
  • Inflammatory joint diseases of the vertebral column, associated with human leukocyte antigen HLA-B27
  • Patients with spondyloarthropathies often test +ve for HLA-B27
  • Prevalence of HLA-B27 varies markedly in the general population

6-8%: Caucasian

4%: North African

2-9%: Chinese
0.1- 0.5%: Japanese

24%: North Scandinavia

38
Q

Ankylosing Spondylitis

(AS)

A
  • Inflammation, calcification and finally ossification of ligaments and capsules of joints
  • Causes bony ankylosis of the axial skeleton
  • Typically affects males, about 95% of whom are HLA-B27 +ve
  • Early adulthood
39
Q

AS Prevalence

A
  • 25% of patients with AS develop acute anterior uveitis (AAU)
  • 25% of males with AAU have AS
  • Either eye can be affected at different times
40
Q

Uveitis in Juvenile Arthritis
[Juvanile Idiopathic Arthritis]

A
  • Inflammatory arthritis of at least 6/52 duration occurring before age 16
  • Affects girls more commonly than boys (3:2)
  • Causes childhood anterior uveitis
41
Q

Juvanile Idiopathic Arthritis + Anterior Uveitis

Symptoms ?

A
  • Usually asymptomatic ( uveitis is detected on routine slit-lamp exam)
  • Even present with 4+ aqueous cells, rarely patients complain
    Occasionally c/o vitreous floaters
42
Q

SARCOIDOSIS ?

A
  • Idiopathic granulomatous inflammatory disorder
  • Can affect one organ or many
  • Mostly affects:
    Lymph nodes
    Lungs
    Liver
    Spleen
    Skin
    Eyes
43
Q

SARCOIDOSIS
Ocular signs ?

A
  • AAU
  • Granulomatous CAU
  • Intermediate uveitis (uncommon)
  • Periphlebitis
  • Choroidal infiltrates
44
Q

SARCOIDOSIS

Ocular signs
Choroid?

Retina?
Optic nerve?

A
  • Multifocal choroiditis
  • Retinal granulomas
  • Choroidal granulomas
  • Retinal neovascularisation in the periphery
  • Optic nerve granulomas or papilloedema
45
Q

Sign?

A

Sarcoidosis

46
Q

Sign?

A

Sarcoidosis

Multifocal Choroiditis

47
Q

Sign?

A

Saccoidosis

Choroidal Granulomas

48
Q

Sign?

A

Sarcoidosis

Optic nerve granulomas or papilloedema

49
Q

Behcet syndrome ?

A
  • Idiopathic, multi-system disease
  • Recurrent episodes of orogenital ulceration & vasculitis
  • Ocular complications in 95% of men & 70% of womenEye complications occur within 2 years of oral ulcers appearing
  • Onset is usually in the 30s
  • Mostly affects people of Eastern Mediterranean & Japanese descent
50
Q

Behcet Syndrome

Ocular signs

A
  • Recurrent AAU with hypopyon
  • Retinal infiltrates
  • Retinal vasculitis
  • Vascular leakage
  • Vitritis
  • OtherConjunctivitis, episcleritis, scleritis
51
Q

Parasitic Uvetis
TOXOPLASMOSIS
Cause?

A
  • Caused by Toxoplasma gondiiAn intracellular protozoan
  • T. gondii = common cause of infectious retinitis in otherwise healthy individuals
  • Cats = definitive host of the parasite
52
Q

TOXOPLASMOSIS

Transmission?

A

Humans become infected with T. gondii:

  • By ingesting soil or infected animal faeces containing T. gondii cysts
  • Accidental contamination of hands when disposing of cat litter
  • By consuming raw or undercooked meat containing T. gondii cysts
  • mother to foetus when T. gondii is contracted during pregnancy

⇒ CNS causing inflammatory response ( treated with corticosteroid)

53
Q

TOXOPLASMOSIS

Prognosis?

A
  • Recurrent episodes of inflammation are common
    Cysts rupture ⇒ release hundreds of tachyzoites → normal retinal cells
  • Recurrences ( between the ages of 10 and 35 years)
    Average age 25 years
54
Q

Toxoplasmosis

Signs and Symptoms?

A
  • Unilateral sudden onset of floaters, vision loss & photophobia
  • Signs:
    Solitary inflammatory focus near old pigmented scar (satellite lesion)
    Sometimes multiple foci
    Vitritis: Hard to see the fundus and the inflammatory focus, although it may have a “headlight in the fog” appearance
55
Q

TOXOCARIASIS?

A
  • Infestation with intestinal roundworm of dogs (Toxocara canis)
  • Transmission : accidental ingestion of soil or food contaminated with ova shed in dog faeces
56
Q

TOXOCARIASIS

Complications?

A
  • Chronic endophthalmitisOften patient presents b/w ages of 2 & 9 years with:

Leukocoria

Strabismus

Unilateral VA loss

Anterior uveitis& vitritis

Greyish-white exudateon peripheral ret

  • Granulomas
    Posterior pole
    Peripheral
    VA affected if it affects the macula and/or optic nerve
57
Q

Complication of which disease?

A

Toxocariasis

( Granulomas)

58
Q

THYROTOXICOSIS

(Metabolic disease)

A
  • Hyperthyroidism
    = excessive secretion of thyroid hormones
  • Graves disease
    Most common subtype of hyperthyroidise
    ⇒ Autoimmune disorder (over-secretion of thyroid hormones)
    More common females
59
Q

THYROTOXICOSIS

(Metabolic disease)

Symptoms?

A
  • Onset: in 30s or 40s
  • Weight loss despite good appetite
  • Increased bowel frequency
  • Sweating
  • Heat intolerance
  • Nervousness
  • Irritability
  • Palpitations
  • Weakness and fatigue
60
Q

THYROTOXICOSIS

(Metabolic disease)
General Signs?

A
  • Goitre
  • Finger clubbing
  • Raised plaques on the legs
61
Q

THYROTOXICOSIS

(Metabolic disease)

Symptoms in Eyes ?

A
  • Lid retraction & proptosis (Eye bulging forward)
  • Chemosis
    = Eye irritation, conjunctiva filled with fluild, swollen
62
Q

RHEUMATOID ARTHRITIS

( Autoimmune systemic disease)

A
  • Autoimmune systemic disease
  • More common in females than males
  • Presents in the 40s with joint swelling
63
Q

RHEUMATOID ARTHRITIS

( Autoimmune systemic disease)
Ocular signs?

A
  • Keratoconjunctivitis sicca
  • Scleritis
  • Ulcerative keratitis
64
Q

SYSTEMIC LUPUS ERYTHEMATOSUS ( SLE)

(Metabolic disease)

?

A
  • Autoimmune, non-organ specific connective tissue disease
  • Causes widespread vasculitisand tissue damage
  • Predominantly affects young females
  • Ocular signs:
    madarosis,
    keratoconjunctivitissicca,
    scleritis,
    peripheral ulcerative keratitis,
    retinal vasculitisand optic neuropathy
65
Q

SJOGREN Syndrome

( Metabolic disease)

?

A
  • Autoimmune inflammation
    and destruction of lacrimal and salivary glands
    ( dry tounge)
  • Classified as primary when it exists in isolation, and secondary when associated with other diseases such as RA, SLE etc
66
Q

SJOGREN Syndrome

( Metabolic disease)

Signs?

A
67
Q

GIANT CELL ARERITIS !!!
Symptoms ?

A
  • Inflammation of medium & large arteries
  • Patient usually presents in 70s or 80s with:
    Scalp tenderness, first noticed when combing the hair
  • Headache (frontal, occipital or temporal areas, or more generalized)
  • Jaw claudication = pain on speaking and chewing
  • Polymyalgia rheumatica
    ( Muscle pain and stiffness)
68
Q

GIANT CELL ARERITIS !!!
Signs ?

A
  • Superficial temporal arteritis is characterized by thickened, tender inflamed and nodular arteries which cannot be flattened against the skull
69
Q

GIANT CELL ARERITIS !!!
Ocular Signs ?

A
  • Arteritic anterior ischaemic optic neuropathy (AION) most common symptom
  • Transient ischaemic attacks (amaurosis fugax) may precede AION
  • Cilioretinal artery occlusion
  • Central retinal artery occlusion
  • Diplopiatransient or constant c/b ischaemia of the ocular motor nerves or extraocular muscles
70
Q

Signs?

A

Giant Cell Arteritis
[Arteritic Anterior Ischaemic Opic Neuropathy]
AION

OPM (10 decks)

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