Uveitis (M1) Flashcards
What are the symptoms of uveitis?
- red eye
- pain
- photophobia
- tearing
- blurred vision
What are the ocular signs of uveitis?
- circumlimbal flush
- anterior chamber reaction (cells, flare, or hypopyon)
- keratic precipitates (KP)
- pupillary miosis
- iris nodules
What does mutton fat KPs indicate as the type of uveitis? 1. What are the possible underlying causes of this? 2
- granulomatous form
2. Sarcoid, syphilis, toxo, TB, zoster
What is the iris nodule type that is at the pupil margin?
Koeppe
What is the iris nodule type that is along the surface of the iris?
Busacca
What are possible ocular complications of uveitis?
- posterior synechiae
- peripheral anterior synechiae
- uveitic glaucoma
- cataract (PSC)
- cystoid macular edema (CME)
What is the main medication used for uveitis (and the dose)?
- pred acetate, Pred Forte DAW (every 1 hr initially)
2. durazol (every 2 hrs initially)
What is the number one cause of treatment of uveitis failure?
under dosing steroids
When should additional anti-inflammatory options be used to treat uveitis besides just topical steroids?
- no improvement on topical therapy
2. posterior uveitis
What are the additional treatments used for posterior uveitis (with the medications used)?
- subtenons steroid injection (triamcinolone or methylprednisolone)
- intraocular steroid injection (triamcinolone)
- intravitreal implant (Retisert (flucinolone) or Ozurdex (dexamethasone))
- systemic steroids (oral prednisolone or methylprednisolone)
- oral immunosuppressive agents (cyclosporine, methotrexate, humira)
What is the hallmark of posterior uveitis?
vitreal cells or flare
Why are cycloplegics used in the treatment of uveitis?
- put ciliary body at rest (relieve pain)
- stabilizes blood-aqueous barrier
- prevents posterior synechiae formation
What are the cycloplegics used to treat uveitis (and benefit of each)?
- Atropine (long duration)
- Homatropine (works for a few days)
- Cyclopentalate (more available and works for a few days)
What are the common treatment protocol (drug and how often taken) for mild to moderate uveitis?
- pred forte (q1hr) or durezol (q2hr)
2. 5% homatropine (tid) or 1% cyclopentolate (tid)
What are the common treatment protocol (drug and how often taken) for moderate to severe uveitis?
- pred forte (q1hr) or durezol (q2hr)
2. 1% atropine (bid)
What is the medication (with how often taken) to prevent posterior synechiae?
1% cyclopentolate (tid)
What is used to break a posterior synechiae?
- 1% atropine bid
2. if still persists then 2.5-10% phenylephrine bid
What are the topical anti-glaucoma agents used to treat steroid-induced glaucoma while there is a uveitis?
- Beta blocker
- alpha agonist
- carbonic anhydrase inhibitor
What anti-glaucoma agent is contraindicated for the treatment of steroid-induced glaucoma with a uveitis (and why)?
- pilocarpine (opens blood-aqueous barrier so worsens uveitis and causes pain)
- prostaglandins (inflammatory mediator)
