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3F: Peds Final > Uveitis In Kids > Flashcards

Uveitis In Kids Flashcards

1
Q

Treatment for chalazion

A

Compresses

Tobradex (abx/steroid combo)

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2
Q

Leukocoria

A
  • White pupil
  • Seen in infancy and early childhood
  • strab and/or nystagmus can be present (mainly sensory)
  • difference in eye size-bupthalmos, microphthalmos
  • there could also be increase IOP, cataract, or tumor
  • decreased vision
  • may have ab APD
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3
Q

Differentials for leukocoria

A
  • cataracts
  • retinoblastoma
  • ROP/PHPV
  • coats
  • toxoccariasis
  • toxoplasmosis
  • myelinated nerve fiber
  • coloboma
  • RD
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4
Q

Eval for leukocoria

A
  • complete evaluation-history, pupils, IOP, AC, lens, retinoscopy, vitreous, fundus eval
  • B scan
  • radiology
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5
Q

Treatment for leukocoria

A

Treat underlying problem

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6
Q

Prognosis of leukocoria

A

Poor to guarded prognosis (depending on the cause)

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7
Q

Phthisis bulbi

A
  • function has decompensated
  • eye shrinks after trauam, surgical truama, loss if function
  • soft, low IOP
  • intraocular disorganization
  • B scan to rule out growths
  • non painful blind eye
  • enucleation, if it becomes a painful blind eye
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8
Q

Uveitis in chidlren

A
  • more in females
  • just like in adutls
  • 62% are Caucasian
  • major etiologies: idiopathic and juvenile idiopathic arthritis
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9
Q

Classifications of uveitis

A

Based on

  • anatomical location (anterior, intermediate, posterior, or panuveiits)
  • pathology (granulomatous or non granulomatous)
  • course (acute, chronic, or recurrent)
  • etiology (traumatic, immunologic, infectious, or idiopathic)
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10
Q

Differentials for anterior uveitis

A 
JRA
Trauma
Sarcoidosis 
TB
Syphilis 
Lyme
Herpes
Fuchs heterochromia 
Iridocyclitis
Kawasaki disease
Idiopathic anteiror uveitis
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11
Q

Intermediate uveitis DiffDx

A 
Sarcoidosis 
TB
Syphilis 
Lyme 
MS
Idiopathic intermediate uveitis
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12
Q

Post uveitis and panuveitis diffdx

A 
Toxoplasmosis 
Toxocariasis
Sarcoidosis 
TB
Syphilis 
Lyme 
Here 
Rubella or measles 
Candida albicans 
VKH
Idiopathic
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13
Q

Juvenile idiopathic arthritis (JRA)

A
  • anterior uveitis
  • arteritis of at least 6 weeks without identifiable cause in chidlren < 16
  • most common cause of anterior uveitis in chidlren
  • risk of uveitis greater in the 1st 4 years after JRA diagnosis
  • can be seen before or after joint symptoms
  • more aggressive course if the interval between the arthritis and uveitis is short
  • run antinuclear antibody lab (ANA)
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14
Q

Characteristics of anterior uveitis from JRA

A
  • usually bilateral
  • non-granulomatous with fine to medium KPs
  • granulomatous precipitates can be seen in some kids
  • chronic inflammation can lead to: band K, postieror synechiae, hypotony, cataract, glaucoma
  • important for uveitis screening for children with JRA, especially in the 1st 4 years diagnosis. With with PCP on this
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15
Q

Intermediate uveitis in kids

A

-inflammation at the vitreous base over the CB, pars plana, anterior vitreous and peripheral retina

can occur with any of these disorder

  • sarcoidosis
  • TB
  • Syphilis
  • Lyme
  • MS
  • Idiopathic (pars planitis)

Snow banking
Vitreous cells

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16
Q

Toxoplasmosis

A
  • posterior uveitis
  • caused by toxoplasma Gondi
  • cats are host
  • cat feces can be ingested by animals and humans
  • congenital or acquired from eating undercooked infected meat or contaminated water
  • predilection for heart muscle, neural tissue and the retina
  • reunion ELISA
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17
Q

Characteristics of toxoplasmosis

A
  • remains dormant until cyst erupts
  • systemic infection present as fever, lymphadenopathy, sore throat
  • can also be congential via transplacental transmission
  • once of the TORCH congenital infections
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18
Q

TORCH congential infections

A

Toxoplasmosis
Rubella
CMV
Herpes

19
Q

Signs and symptoms of toxoplasmosis

A
  • manifests as retinitis, choroiditis, iritis
  • the active area of retinal inflammation is thickened and cream colored with overlying vitritis in the macualr scar
  • Atrophic chorioretinal scar (satellite lesion)
  • Dx based on the characteristic retinal lesion
  • inflammation can come from reactivated toxoplasmosis
  • systemic treatment includes antimicrobals with or without oral steroids
  • vision can be compromised based on where the lesion is
20
Q

Toxocariasis

A
  • posterior uveitis
  • nematodes in dogs and cats
  • primarily in kids
  • contracted though ingestion of soil contaminated by dogs and cats
  • usually unilateral and not associated with systemic problems
  • average age of onset is 11
  • could appear as post pole granuloma, peripheral granuloma or endophthalmitis
  • run ELISA
21
Q

Appearance of toxocaraisis

A
  • no external evidence of inflammation
  • leukocoria, strab, or decreased VA present
  • treatment by observing the peripheral lesion
  • periocular or systemi steroids for the posterior lesions and endophthalmitis
  • or surgical intervention for retinal traction, cataract, glaucoma
  • parasite already dead so no anti parasitic
22
Q

Sarcoidosis

A
  • panuveitis
  • if in kids under 5, there is a triad of uveitis, arthritis, and each
  • in older kids, there ar pulmonary abnormalities and lymph node abnormalities (as seen in adutls)
  • anterior uveitis is the most common but there can be panuveitis
  • diagnosis and treatemtn is simialr to adults-ACE and chest X ray
  • ACE in healthy kids higher than in adutls so can be misleading so careful systemic diagnosis
23
Q

Masquerades of uveitis

A 
Retinoblastoma
Leukemia 
Intraocular FB
Malignant melanoma 
RD
24
Q

How to tell RB from anteiror uveitis

A

Ultrasound, MRI

25
Q

How to tell leukemia from anterior uveitis

A

Bone marrow biopsy

26
Q

How t tell FB from anteiror uveitis

A

X- ray or ultrasound

27
Q

How to tell malignant melanoma from anteiror uveitis

A

FA, ultrasound

28
Q

How to tell RD from anterior uveitis

A

Fundus eval

29
Q

Masquerades of posterior uveitis in kids

A

RP
RB
MS

30
Q

How to tell RP from posterior uveitis

A

ERG, VF

31
Q

How to tell RB from posterior uveitis

A

Ultrasound, MRI

32
Q

How to tell MS from posterior uveitis

A

Neuro exam

33
Q

Evaluation of uveitis

A
  • can defer workup of isolated anteiror uveitis until unresponsive or recurrent
  • need detiualed history, throughout eval, and labs
34
Q

Labs for JRA

A

ANA

35
Q

Labs for sarcoidosis

A

ACE

chest x ray

36
Q

TB labs

A

TB skin test, chest x ray

37
Q

Labs for syphilis

A

FTA-ABS

38
Q

Lyme labs

A

Lyme serology

39
Q

Herpes labs

A

Presentation

40
Q

Fuchs heterochromia iridocytltis labs

A

Presentation

41
Q

Toxoplasmosis and toxocariases labs

A

ELISA

42
Q

Ankylosing spondylitis labs

A

H:A B27

43
Q

Uveitis managements

A
  • eliminate inflammation before complications
  • anterior: topical corticosteroids and cycloplegic agents
  • sub-tenon steroid injections can be used to improve penetration for intermediate or postieror
  • pred forte every 2 hours then taper, atropine 1% BID
  • RTO frequently for IOP check (watch for steroid responders)
  • short course of oral steroids. Caution with use
  • glaucoma and cataracts are complications after oral steroids
  • risk of systemic steroids include, growth retardation, osteoporosis and fractures, DM, HTN, diopathic intracranial HTN (pseudotumor)
  • NSAIDs, be careful of GI probs
  • systemic immunosuppressive therapy
  • methotrexate
44
Q

Surgeries for uveitis

A

Chidlren may need surgeries for uveitis complications

Indicated for

  • band K
  • cataracts
  • glaucoma

3F: Peds Final (11 decks)

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