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Ocular Disease II > Uveitis: Non-infectious Etiologies > Flashcards

Uveitis: Non-infectious Etiologies Flashcards

1
Q

Phacoanaphylaxia/Lens-Induced Uveitis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Granulomatous Inflammatory Response
  2. Immune RxN against Lens Proteins released after SURGERY or TRAUMATIC Disruption of Lens Capsule
    (Spontaneous by hypermature lens, Ocular trauma, Cataract surgery)
  3. None
  4. KP (Mutton Fat), Ant Chamber Cells and Flare, Hypopyon
  5. Differential (Infection), Culture, Stain
  6. Vitrectomy (Remove Lens Material), Cycloplegics, Corticosteroids, NSAIDs, IOP Lowering Drugs (B-Blockers, A-Agonists, Carbonic Anhydrase Inhibitors)
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2
Q

Toxic Anterior Segment Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Sterile, Non-infectious postoperative Inflammatory Response (TOXIC DAMAGE)
  2. Anterior Segment Surgery, Irrigating Solution (Anesthetics, Salt solution, Antibiotics,MOST COMMON is CATARACT SURGERY)
  3. None
  4. Similar to Endophthalmitis, but RAPID ONSET (12-24 hrs after surgery). Toxins damage tissue. Diffuse CORNEAL EDEMA, Increased IOP, Iris Atrophy, Cells and Flare, Hypopyon

Distinguishing Features: PUPIL: Dilated, Irregular, Nonreactive. INCREASED IOP. Signs and Symptoms Limited to ANTERIOR CHAMBER

  1. Rule out infection (otherwise it’s probably endophthalmitis). CORTICOSTEROIDS (1 drop every hr for 3 days) Watch for signs of Bacterial infection. NSAIDs
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3
Q

Laser-Induced Uveitis (Page 247)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammation after laser procedures
  2. Laser surgery
  3. None
  4. Conjunctivitis MOST COMMON (seen in all pts after laser procedures, but degree varies). Hypopyon, ENDOPHTHALMITIS (possible but rare)
  5. Exam and History of Laser procedures in or around the eye.
  6. Corticosteroids
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4
Q

Idiopathic Anterior Uveitis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Anterior Uveitis
  2. Idiopathic (50% of all causes/cases)
  3. NONE
  4. Anterior Uveitis symptoms. CAN NOT HAVE ANY SYSTEMIC DISEASE ASSOCIATIONS and CANNOT HAVE HLA-B27 Haplotype (this is associated w/Anterior Segment Inflammatory Disease)
  5. Rule out other causes and HLA-B27 Haplotype
  6. Prednisolone Acetate (1%) and Scopolamine 0.25% qd
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5
Q

HLA-B27

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Class 1 surfacing antigen
  2. ???
    * It’s associated w/many pathologies but not the Direct cause of any. Includes Inflammatory diseases like Ankylosing Spondylitis
  3. Genetic Screening/Fingerprinting
  4. None…Treat any associating pathologies
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6
Q

Ankylosing Spondylitis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Systemic Rheumatic Disease (Chronic Inflammatory disease of Axial Skeleton). Joints, Spine, and Sacroiliac Joint of pelvis
  2. Associated with TNF-a, IL-1 and HLA-B27
  3. See 1.
  4. 40%: Uveitis, Eye Pain, Vision loss, Floaters, Photophobia. ANTERIOR UVEITIS: Unilateral w/Pain, redness, Photophobia (complain 1-2 days before cells and flare are evident). MEN more than women.
  5. HLA-B27(96% of pts have this), TNF, IL-1
    Imaging, Lab Tests
  6. Good posture, Physical Therapy, Pain relievers (NSAIDS (Naproxen and Indomethacin)), Surgery in severe cases.

TNF Blockers, Sulfasalazine (if they don’t respond to NSAIDs or are CI)

Cytotoxic Therapy (Methotrexate): Severe Cases

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7
Q

Reactive Arthritis (Reiter’s Syndrome)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. AI that causes inflammation
  2. 2ndary to Bacterial Infection: Usually bacteria that infect Genitourinary System, or Digestive System
  3. Polyarthritis, Urethritis, Keratoderma Blenorrhagica (lesions on hands and feet), Balanitis Circinata (lesion on penis), Aphthous Stomatitis (Oral lesion)
  4. Conjunctivitis MOST COMMON, Iritis, Keratitis, Anterior Uveitis
  5. Blood Test: See if infection is there, Sedimentation test, HLA-B27 marker, X-ray
  6. Topical Corticosteroids and Mydriatics, NSAIDs, Immunosuppressive Therapy (Azathioprine and Methotrexate), Anti-TNF, Physical Therapy)
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8
Q

JIA

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. AI disease
  2. Unknown
  3. Joint pain, swelling, stiffness, growth problems, Flare up and disappearance of symptoms is common
  4. Most Frequent cause of UVEITIS in Children. If untreated, it can lead to Cataracts, Glaucoma, and Blindness
  5. Blood Tests: ESR, C-reactive Protein, ANA, RF (many JIA pts are Negative), X-rays to r/o Fractures, tumors, infection, congenital defects
  6. Medications for pain (careful w/corticosteroids…they can interfere w/growth), Physical therapy, Surgery in severe cases
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9
Q

Psoriatic Arthritis (44-49)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Arthritis Associated w/Psoriasis of the Skin
  2. ??
  3. Sausage-like swelling in 1 or more fingers or toes, Joint Pain, Pitting or separation of nails from nail bed. Red patches of skin topped w/SILVERY SCALES
  4. Uveitis. Anterior segment
  5. Rheumatoid Factors, Sedimentation Rate, HLA-B27 marker, Skin Biopsies
  6. Anti-TNF, Anti-uveitis w/Topical Corticosteroid and a drop to induce Cycloplegia and Mydriasis
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10
Q

IBD

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Chronic inflammation (ulcerative colitis, and Crohn’s disease)
  2. ???
  3. Abdominal Cramps, pain, fever, weight loss, no appetite, bloody diarrhea
  4. Episcleritis, Keratopathy, Uveitis
  5. Blood work: look for Anemia or infection. Stool: Look for WBC
  6. Anti-inflammatory, Immune Suppressors, Antibiotics, Surgery
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11
Q

Fuchs Herterochromic Iridocyclitis (FHI)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Iris Inflammation: 1 iris changes color
  2. Idiopathic
  3. None
  4. Blurred vision, Floaters, Fine KP, Heterochromia. Usually Asymptomatic
  5. Exam
  6. None usually. Floaters: Vitrectomy
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12
Q

Glaucomatocyclitic Crisis (Posner-Schlossman Syndrome)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Recurrent episodes of High IOP (40-80) along with Mild Anterior Uveitis
  2. May be related to Herpes Virus
  3. None
  4. High IOP w/signs of closed or clogged angle w/inflammation
  5. history and Angle exam.
  6. Corticosteroids (short course), Glaucoma drops like Beta Blockers
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13
Q

Tubulointerstitial Nephritis and Uveitis Syndrome (TINU)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Rare, Anterior Non-Granulomatous Uveitis and kidney inflammation
  2. Idiopathic
  3. Abdominal Pain, Anemia, Fever, Fatigue, Malaise. Can be Asymptomatic. Kidney Problems precede Eye problems usually.
  4. Posterior Synechiae, KP, Iritis
  5. Urinalysis, Renal Biopsy for DEFINITIVE DIAGNOSES
  6. Can resolve on its own. Steroids (TOPICAL FIRST, if it doesn’t resolve, then SYSTEMIC)

Refer to Nephrologist

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14
Q

Schwartz Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Rhegmatogenous Retinal Detachment w/cells in AC and INCREASED IOP
    (RD due to sparation at Ora Serrata or Break in NPE at Pars Plana or Pars Plicata)
  2. Blunt Trauma (50%):
  3. NONE
  4. Anterior Uveitis that doesn’t respond to Corticosteroid Tx. Resolved w/Successful Tx of Retinal Detachment. Increased IOP seen as a consequence of seeking RD Tx.

Also Open Angle Glaucoma

  1. Should be Differential for any case of Acute Open Angle Glaucoma esp in YOUNG w/History of Blunt Trauma
  2. Resolve Retinal Detachment, then other symptoms resolve on their own.
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15
Q

Sarcoidosis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammatory cell collection (Granulomas) in various parts of the body. (usually seen in LUNGs, Lymph nodes, eye, and Skin)
  2. AI RxN to an unknown substance.
  3. Depends on organ. Can develop fast and leave quickly or gradually develop and last years. (Fatigue, Fever, Lymphadenopathy, Weight loss, Cough, Shortness of breath, Wheezing, Chest Pains), Rash, Color change, Nodules
  4. Blurred vision, Pain, severe redness, photophobia. ANTERIOR UVEITIS: MOST COMMON (Granulomatous Mutton Fat KPs, Iris Nodules, Posterior Synechiae, Peripheral Anterior Synechiae), Posterior uveitis possible

SNOWBALLS (Gray-Green-White Opacities: String of Pearls)

  1. Chest X-Ray, CT scan of Chest. Blood: ACE, Lysozyme, Calcium. Pulmonary Function Tests. Urinalysis for Elevated Calcium
  2. Can Clear up on its own. No Known cure. Treat each symptom individually.

First Line: Oral Corticosteroids

Pred Forte 1% is most Effective for ANTERIOR UVEITIS

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16
Q

Sympathetic Ophthalmia

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Bilateral Granulomatous Uveitis
  2. Trauma (to one eye will cause inflammatory response in both eyes), Surgery (Vitrectomy)
  3. None
  4. Mutton Fat KP, Dalen-Fuchs Nodules (White-Yellow Lesions in Retinal Periphery)
  5. FA (Evaluate degree of Posterior Segment Disease), ICG Angiography (Dark spots in Choroid = Active disease), B-Scan (choroidal thickening and RD)
  6. Corticosteroids (Prednisone), Immunosuppressive Agents (Ciclosporin), Enucleation
    * Hard to Differentiate from SO and VKH (pts w/ VKH have no history of trauma)
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17
Q

Vogt-Koyanagi-Harada Disease

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammatory Condition. Affects BOTH EYES, Inner ear, Skin, Hair, and CNS
  2. HLA predisposition
  3. Onset: SEVERE HEADACHE, Light sensitivity, Tinnitus (ringing in ears)

Few days to Weeks: Blurry Vision and Eye Pain, Acute Uveitis

Posterior Uveitis: Disk Hyperemia, Bilateral Chronic Iridocyclitis, Exudative Retinal Detachments, Increased IOP

Chronic Stage: Depigmentation of CHOROID, Dalen-Fuchs Nodules in Periphery

ALOPECIA (HAIR LOSS) and Poliosis

  1. Disc Edema and Serous Retinal Detachments
  2. Fluorescein Angiogram (Several Hyperfluorescent Spots), Ultrasound, ICG Angiography, LP for CSF analysis
  3. Severe Posterior Uveitis: Systemic Corticosteroids, Immunosuppressive Drugs

Chronic Phase (Anterior Uveitis): Azathioprine and Methotrexate (Cytotoxic Tx)

Surgery for Glaucoma: Trabeculotomy

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18
Q

Birdshot Retinochoroidopathy

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Chronic Posterior Uveitis (middle age to old) Mean age of 50
  2. Unknown. STRONG LINK to HLA-B29. Inherited Immune System Dysregulation possible
  3. ????
  4. Vitritis, Multiple Hypo-Pigmented Spots in Posterior Pole (Birdshot)

Decreased VA, Floaters, Night Blindness (Nyctalopia)

  1. HLA-B29 Blood test (High false negatives)
    FA: Early: Isofluorescence (RPE intact), Late Focal Depigmentation: Hypofluorescence (RPE Atrophy), Late diffuse Stage: Hyperfluorescence

OCT: RPE Degeneration

  1. Immunosuppressants: Cyclosporin. F/u every 4-6 wks.
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19
Q

Behcet Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Recurrent Episodes of Orogenital Ulceration and Vasculitis (3rd decade. Males more than females: Japan, Eastern Mediterranean Regions)
  2. Idiopathic
  3. Arthritis, Recurrent Orogenital Ulcers, Skin Hypersensitivity, Vasculitis, Aneurysms.
  4. Anterior Uveitis (Hypopyon), Optic Atrophy (end Stages), Retinitis, Retinal Vasculitis, Vitritis (Active Disease)
  5. HLA-B5, Recurrent Oral Ulcers (3x’s in 1 year) And at least 2 of the following: Recurrent Genital ulcers, Ocular inflammation, Skin lesions, Positive Pathergy Test
  6. Systemic Steroids; Immunosuppressive Agents (Azathioprine; Ciclosporin)
20
Q

Eales’ Disease

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Disorder of the Walls of the Peripheral Retinal Vessels
  2. Idiopathic
  3. None
  4. Vascular Sheathing, Vascular Occlusions, Vitreous Hemorrhage, Peripheral Neo, Mild Uveitis COMMON
  5. Diagnosis of Exclusion
  6. PRP (Panretinal Photocoagulation), Feeder Vessel Photocoagulation, Steroids, Immunosuppressants, Intravitreal VEGF Inhibitors
21
Q

IRVAN Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Retinal Vasculitis Disorder
  2. ???
  3. None
  4. Usually Asymptomatic (possible vision loss). Idiopathic retinal vasculitis, Aneurysms, Neuroretinitis, MILD ANTERIOR UVEITIS
  5. Fluorescein Angiograph (prominent vascular dilation w/late staining of Macro-Aneurysms and Retinal Arteriole Walls). Peripheral Retina: Extensive areas of Capillary Non-Perfusion

ONH has Extensive leaking in late stages of angiogram

  1. Laser Coagulation
22
Q

Frosted Branch Angiitis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Sheathing of Retinal Vessels
  2. Idiopathic
  3. None….???
  4. Acute Vision Loss (20/100 to light Perception, INTERMEDIATE UVEITIS and RETINAL EDEMA (65-70%)
  5. Ophthalmoscopy, Fluorescein Angiogram, Visual Field Test, ERG
  6. Systemic Steroids (Prednisone)
23
Q

SLE

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Chronic AI disease. Can hit any organ
  2. AI…but unknown why it happens.
  3. Fatigue, loss of appetite, hair loss, arthritis, mouth and nose ulcers, facial rash (Butterfly Rash). Unusual sensitivity to Sunlight.
  4. Dry eyes, Scleritis, BV changes in retina. Nerve damage to muscles controlling eye movement and vision
  5. ANA test, Oral Ulcers, Arthritis, Blood Disorder, Renal issues, Malar Rash, Discoid Rash, Neurologic Disorder
  6. Prevent Flares and reduce severity of them. Tx: Corticosteroids and Anti-Malarial Drugs
24
Q

Polyarteritis Nodosa (PAN)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Systemic Necrotizing Vasculitis of Small to Medium Size Muscular Arteries
  2. Unknown
  3. Ischemia and Infarction to Supplied tissue (usually Heart (Heart Attack, Pericarditis), skin (Rashes, Swelling, Lumps), kidneys (Hypertension, Uremia), NS (Stroke or Seizure).
  4. Non-Granulomatous Uveitis, Peripheral Ulcerative Keratitis, Retinal Vasculitis, Pseudo Tumor of orbit. CRA Occlusion. Scleritis. Ocular inflammation usually the EARLIEST Presenting Manifestation
  5. Physical Exam. Some Lab tests: CBC, ESR, CRP, Biopsy)
  6. Primary Tx: Steroids (Prednison and Cyclophosphamide).

Cytotoxic Immunosuppressive Therapy (Methotrexate) can also be used.

25
Q

Granulomatosis w/Polyangiitis (Wegener Granulomatosis)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Rare form of Vasculitis. Involves small and medium sized vessels
  2. ???
  3. Chronic Sinusitis, Rhinitis, Epistaxis, Serous Otitis, Respiratory disease, Fevers, Night Sweats, Fatigue, Weight Loss, Heart symptoms, Muscle and NS Symptoms
  4. Conjunctivitis, Episcerlitis, Uveitis, Optic Nerve Vasculitis, Retinal Artery Occlusion, Nasolacrimal Duct occlusion, Proptosis
  5. Clinical Features and Tests like ANCA and Biopsy of affected tissue
  6. Glucocorticoids and Immunosuppressive Drugs (Clyclophosphamide, Methotrexate, or Azathioprine)
26
Q

Relapsing Polychondritis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Chronic Disorder of Cartilage (Recurrent Episodes of PAINFUL Inflammation of ALL Kinds of Cartilage)
  2. Unknown. Maybe AI.
  3. Red Ear Syndrome (Ears, Nose, Joints) most common, also heart and BVs

SUDDEN PAIN at ONSET; Redness, Swelling, Tender. Floppy ears and Saddle Nose, Joint Inflammation (Pain, Swelling, stiffness)

  1. Mild or Severe. Vision can be damaged. Cataracts caused by Inflammation or from CORTISONE Tx.
  2. Hx and Physical Exam. Blood tests to indicate inflammation (ESR, C-Reactive Protein)
  3. Mild: NSAIDS (Ibuprofen)

Cortisone meds usually needed (Prednisone)

High Dose Steroids for Eye and Breathing airway at first. Most Pts need steroids for Long-term use.

*Methotrexate…Promising Tx. (reduces steroid needs)

27
Q

Multiple Sclerosis (MS)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Chronic AI disease. Attacks CNS Myelin Sheath
  2. ???
  3. Fatigue, Numbness, Gait walking/coordination problems
  4. Blurred vision, Nystagmus, Vision Loss
  5. Have to find AT LEAST 2 or more separate damages to CNS that occur at least 1 month apart. so use VEP, MRI, Blood test, and Spinal tap for confirmation
  6. None. Manage w/meds, physical therapy, plasma exchange
28
Q

Serpiginous Choroidopathy

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Grey-Yellowish Subretinal Infiltrates. Spread from Peripapillary Region in SNAKE LIKE FASHION
  3. None
  4. Central Scotoma, Painless Unilateral Vision Loss, Metamorphopsia. NO OCULAR SYMPTOMS seen UNLESS MACULA DAMAGED
  5. ERG, IGA (Indocyanine Green), Fluorescein Angiography, Fundus Autofluorescence
  6. Krypton/Argon Laser to stop development of Neovascular Membrane

Prednisolong, Immunosuppressive Agents (Azathiopine, Cyclosporin), Interferon

*NO Tx Needed unless FOVEA Involved

29
Q

Multiple Evanescent White Dot Syndrome (MEWDS)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammation at Choriocapillaris
  2. Idiopathic
  3. None
  4. Decreased VA, Enlarged Blind Spot, Panuveitis, Photopsia, Relative APD, Small flat white dots on POSTERIOR POLE, Mild Vitritis
  5. Visual inspection
  6. None. Resolves in about 6 weeks
30
Q

Multifocal Choroiditis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammatory disorder. Affects Choroid, retina, vitreous.
  2. Idiopathic
  3. None
  4. Anterior uveitis, vitritis, diffuse chorioretinal lesions, papillary scarring, macular and peripapillary choroidal neovascular membranes (CNVMs)

Enlarged Physiologic Blind Spot and Decreased VA

  1. Fluorescein Angiography (Acute lesions)

Electroretinography (normal or borderline in about 1/2 of pts)

Test VF can reveal Enlarged Blind Spot, Scotoma, or Large Temporal Field Defects

  1. Corticosteroids initially. Discontinued when recovery doesn’t happen.

Immunosuppressive Agents

Extrafoveal Membranes removed by Laser

31
Q

Acute Retinal Pigment Epitheliitis (Krill Disease)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. ??
  2. Rare, Idiopathic
  3. None
  4. Decreased VA, Macula has 2-4 clusters of small grey spots at level of RPE surrounded by HYPOPIGMENTED YELLOW Halos. Lesions come on about 1-2 weeks after onset of symptoms.
  5. FA: Hyperfluorescence and EOG is Subnormal
  6. Self limiting after 6-12 wks
32
Q

Punctate Inner Choroidopathy

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Inflammatory disorder of the Choroid
  2. Idiopathic
  3. None
  4. Yellow/gray lesions (Deep, punched out, Cylindric). CNVM. NO VITRITIS. Blurred Vision. Scotoma
  5. Rule out Infection. FA. Indocyanine Green
  6. Treat for CNVM if Any
33
Q

Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Sudden appearance of Multiple, yellow white, flat inflammatory lesions at RPE and Choriocapillaris
  2. Associated w/Adenovirus Type 5 infection, Cerebral Vasculitis, and Erythema Nodosum
  3. Flu like prodrome
  4. Sudden usually BILATERAL, PAINLESS Loss of Vision. Central or Paracentral Scotomas. Multiple round, circumscribed, flat yellow white subretinal lesions involving RPE

Episcleritis, Ant Uveitis, Vitritis, Retinal Vasculitis, and Papilitis

  1. Exam. (Retinal Lesions), Hypersensitivity to Microbial Antigens (flu-like illness), Positive PPD Skin Tests, HLA Haplotypes, MHC Proteins can present viral or bacterial antigens to T cells and start immune response.
  2. Ocular: Self-limiting (about 80% untreated pts have a VA of 20/40 or better)

Systemic Steroids (inflammation)

Cyclosporin: Combo of Steroid and Cytotoxic Therapy

34
Q

Acute Zonal Occult Outer Retinopathy (AZOOR)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Rapid VF Loss that can’t be Explained by any changes viewed Ophthalmoscopically
  2. Idiophathic
  3. None
  4. Abnormal ERG, Uni or Bi, Increased Blind spot, Photopsia, RPE disturbances over time, Scotoma (Pt complains of dark spot in VF)
  5. Dx of exclusion. Associated w/Several Retinal Disease: MEWDS (White dot syndrome), AIBSE (Acute idiopathic blind spot enlargement syndrome), AMN (Acute Macular Neuroretinitis), PIC (Punctate inner choroiditis), etc.
  6. Corticosteroids, immunosuppressive agents, and Anti-microbials (all are ineffective)

usually resolves in about 6 months

35
Q

Persistent Placoid Maculopathy

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Central whitish plaque-like lesion involving the fovea. BILATERAL (1 of 3 WHITE DOT SYNDROMES) The other 2 are Macular Serpiginous Choroiditis and APMPPE
  2. Only been 6 patients (BILTERAL, Symmetric)
  3. None
  4. CNV in 11/12 eyes. 9 had Disciform Mascular Scars. PERSISTENT LESIONS w/mild Decrease in VA, unless complicated by CNV or RPE Damage
  5. FA, ICG Angiography (Hypofluorescence)
36
Q

Primary Intraocular Lymphoma (PIOL)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Rare form of Non-Hodgkin’s lymphome
  2. Comes from lymphoid tissue in the eye. BILATERAL 80%
  3. Non-hodgkin’s…??
  4. Masquerades as CHRONIC INTERMEDIATE UVEITIS. Blurred vision, floaters, cells in vitreous, multifocal cream-colored subretinal lesions
  5. Tissue Sample (Vitrectomy or Lumbar Puncture). Identify ATYPICAL LYMPHOID CELLS (Molecular analysis, flow cytometry)
  6. Local (intrathecal, intravitreal) and Systemic Chemo and Radiation. Effective, but RELAPSE rate is HIGH
37
Q

Non-Hodgkins Lymphoma (Pg 401-406)

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. ???
  2. Epstein-Barr Virus, HIV, other AI disease
  3. Single or Multiple Discrete Intracranial Nodules, Intradural Spinal Masses, Diffuse Meningeal or Periventricular Lesions.
  4. Vitritis (subretinal infiltrates), Anterior or Posterior Uveitis, Hypopyon or Hyphema, Metastasizes to the Eye
  5. MRI, Fundus Exam, Lumbar Puncture
  6. Chemo, Radiation, Stem cell transplant
38
Q

Choroidal Metastasis

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Tumor
  2. Other tumors in body Metastasize to the Choroid
  3. Depends on etiology of tumor)
  4. Usually Asymptomatic. Sometimes they will see Flashing Lights, Floating Spots, or Distorted Vision
  5. Ultrasound (poorly circumscribed lesion). Careful Pt History needed. Pt may already know they have cancer elsewhere in the body.
  6. Radiation. Sometimes Chemo. Surgery is rarely needed.
39
Q

Ocular Ischemic Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Ocular signs and symptoms
  2. 2ndary to Severe, Chronic, Arterial Hypoperfusion of the eye
  3. Dull radiating ache over the eye and eyebrow
  4. Amaurosis Fugax (Acute Vision loss due to reduced BF to the Eye), Blot retinal hemorrhages, dilated and beaded Retinal veins, decreased ocular perfusion pressure, Edema, ANTERIOR UVEITIS, Cherry red spot on Macula, Cotton wool spots, Arterial Pulsation, Neo.
  5. ESR if Giant cell Arteritis suspected. Determine Point of blockage
  6. Increase BF and Dislodge Emboli.
    a. 500 mg IV Acetazolide
    b. 100 mg IV Methylprednisolone
    c. Paracentesis of Aq Humor to Decrease IOP Acutely
    d. PRP: Neo tx
40
Q

Retinoblastoma

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Cancer of Retina. MOST common cancer affecting the Eye in Children. (Rare in adults)
  2. Genetic Mutations or inherited from parents (RB1 or Rb gene)
    * Unilateral more common. Bilateral = usually hereditary
  3. None
  4. White Reflex (Leukocoria), Poor vision, Strab, Pain, Proptosis, “Rosette” Tumors from Photoreceptors can enlarge and metastasize to Vitreous (Seeding), Center of Tumor can be Necrotic w/Hemorrhage
  5. By Age of 3. Clinical. Image: Ultrasound, CT, MRI, Genetic test.
  6. Depends. Chemo, Radiation, Cryotherapy, Enucleation PREFERRED for UNILATERAL Case.

95% survival if contained w/in the eye.

41
Q

Paraneoplastic Syndrome

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Collection of Symptoms
  2. Due to AI response to NEOPLASM
  3. Fever, Cachexia, SLE, Renal problems, Diarrhea, Anemia, Cushing’s Syndrome, Etc
  4. Inflammation, AI Retinopathy, Masquerade as Uveitis
  5. CBC, Urinalysis, CSF test. Imaging: CT, PET, SPECT, Ab tests
  6. Treat underlying tumor, Immune-mediated disorder, and use CYCLOSPORINE if Ab’s are detected
42
Q

Pigment Dispersion Syndrome

  1. What is it?
  2. Cause?
    (Abiotrophy Theory and Campbell’s Theory)
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Pigment coming off the Iris
  2. Abiotrophy Theory: Premature Degeneration

Campbell’s Theory: Mechanical Rubbing

  1. None
  2. Classic Triad: Krukenberg Spindle, Radial Iris Transillumination Defects, and Pigment Deposition on Trabecular Meshwork
  3. Clinical
  4. Glaucoma Tx (Prostaglandins, Beta-Blockers, etc)
    * Risk for Pigmentary Glaucoma and Risk for Retinal Detachment
43
Q

Drug Induced Uveitis

  1. What is it?
  2. Cause? (4 types: C-RST)
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Uveitis Caused by Drugs
  2. Cidofovir, Rifabutin, Sulfonamides, Topical Prostaglandin Analogs
  3. None
  4. Anterior Uveitis, Ocular Inflammation
  5. Nongranulomatous: Fluroescent Treponemal Antibody to Rule out Syphilis

Granulomatous: Purified Protein Derivative Test, Chest X-ray, Serum and Urine Calcium Test, and ACE test to Rule out Tuberculosis and Sarcoidosis

  1. Cycloplege pt w/Scopolamine bid. Then Topical Steroid (Prednisolone Acetate: 1 drop every 1-6 hrs)
44
Q

Phacomorphic Glaucoma

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Glaucoma
  2. Due to 2ndary Angle Closure Glaucoma from Swelling lens due to advanced cataract, traumatic cataract, etc. Can Lead to Pupillary Block and Angle Closure
  3. Acute Pain, Nausea, Vomiting
  4. Blurred vision (decreased before Acute episode due to history of Cataract), HIGH IOP (more than 35 mmHg), irregular pupil, corneal edema, conj and episcleral vessels injected, Shallow Ant Chamber, Lens Enlargement and Forward Displacement, Unequal Cataract formation b/w the 2 eyes.
    * MORE Common in Smaller Hyperopic Eyes w/a Larger Lens and a Shallower AC
  5. Gonioscopy or OCT
  6. DROP IOP to prevent more damage to Optic Nerve, clear cornea and prevent Synechiae formation. IOP reduction needed to Prep pt for LASER IRIDOTOMY to relieve PUPILLARY BLOCK that’s CAUSING the GLAUCOMA. Cataract surgery if needed.
45
Q

Phacolytic Glaucoma

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Mature or Hypermature cataract leaks proteins into Anterior Chamber
  2. Cataracts
  3. None
  4. SUDDEN OCULAR PAIN. Decreased VA. Pre-existing cataract, Cells/flare, increased IOP, Injection, Possible Pseudohypopyon
  5. Exam
  6. REMOVE CATARACT. in the meantime, control Inflammation (Corticosteroids), and Lower IOP (Beta Blockers, Alpha Antagonists, and CA Inhibitors)
46
Q

Corneal Graft Rejection

  1. What is it?
  2. Cause?
  3. Systemic Symptoms?
  4. Ocular Symptoms?
  5. Diagnosis?
  6. Treatment?
A
  1. Corneal Graft that’s being rejected
  2. Unknown
  3. None
  4. Asymptomatic, Decreased VAs, Redness, Pain, Irritation, Photophobia
  5. Clinical
  6. Topical Corticosteroids
    * Endothelial Rejection (Khodadoust Line)
    * Epithelial Rejection (Sub-Epithelial Infiltrations)

Ocular Disease II (15 decks)

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