Uveitis (M1)

Question 1

What are the symptoms of uveitis?

Answer 1

1. red eye
2. pain
3. photophobia
4. tearing
5. blurred vision

Question 2

What are the ocular signs of uveitis?

Answer 2

1. circumlimbal flush
2. anterior chamber reaction (cells, flare, or hypopyon)
3. keratic precipitates (KP)
4. pupillary miosis
5. iris nodules

Question 3

What does mutton fat KPs indicate as the type of uveitis? 1. What are the possible underlying causes of this? 2

Answer 3

1. granulomatous form

2. Sarcoid, syphilis, toxo, TB, zoster

Question 4

What is the iris nodule type that is at the pupil margin?

Answer 4

Koeppe

Question 5

What is the iris nodule type that is along the surface of the iris?

Answer 5

Busacca

Question 6

What are possible ocular complications of uveitis?

Answer 6

1. posterior synechiae
2. peripheral anterior synechiae
3. uveitic glaucoma
4. cataract (PSC)
5. cystoid macular edema (CME)

Question 7

What is the main medication used for uveitis (and the dose)?

Answer 7

1. pred acetate, Pred Forte DAW (every 1 hr initially)

2. durazol (every 2 hrs initially)

Question 8

What is the number one cause of treatment of uveitis failure?

Answer 8

under dosing steroids

Question 9

When should additional anti-inflammatory options be used to treat uveitis besides just topical steroids?

Answer 9

1. no improvement on topical therapy

2. posterior uveitis

Question 10

What are the additional treatments used for posterior uveitis (with the medications used)?

Answer 10

1. subtenons steroid injection (triamcinolone or methylprednisolone)
2. intraocular steroid injection (triamcinolone)
3. intravitreal implant (Retisert (flucinolone) or Ozurdex (dexamethasone))
4. systemic steroids (oral prednisolone or methylprednisolone)
5. oral immunosuppressive agents (cyclosporine, methotrexate, humira)

Question 11

What is the hallmark of posterior uveitis?

Answer 11

vitreal cells or flare

Question 12

Why are cycloplegics used in the treatment of uveitis?

Answer 12

1. put ciliary body at rest (relieve pain)
2. stabilizes blood-aqueous barrier
3. prevents posterior synechiae formation

Question 13

What are the cycloplegics used to treat uveitis (and benefit of each)?

Answer 13

1. Atropine (long duration)
2. Homatropine (works for a few days)
3. Cyclopentalate (more available and works for a few days)

Question 14

What are the common treatment protocol (drug and how often taken) for mild to moderate uveitis?

Answer 14

1. pred forte (q1hr) or durezol (q2hr)

2. 5% homatropine (tid) or 1% cyclopentolate (tid)

Question 15

What are the common treatment protocol (drug and how often taken) for moderate to severe uveitis?

Answer 15

1. pred forte (q1hr) or durezol (q2hr)

2. 1% atropine (bid)

Question 16

What is the medication (with how often taken) to prevent posterior synechiae?

Answer 16

1% cyclopentolate (tid)

Question 17

What is used to break a posterior synechiae?

Answer 17

1. 1% atropine bid

2. if still persists then 2.5-10% phenylephrine bid

Question 18

What are the topical anti-glaucoma agents used to treat steroid-induced glaucoma while there is a uveitis?

Answer 18

1. Beta blocker
2. alpha agonist
3. carbonic anhydrase inhibitor

Question 19

What anti-glaucoma agent is contraindicated for the treatment of steroid-induced glaucoma with a uveitis (and why)?

Answer 19

1. pilocarpine (opens blood-aqueous barrier so worsens uveitis and causes pain)
2. prostaglandins (inflammatory mediator)