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IOD > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Inflammation

A
  • Function of immune system for defence and repair
  • Inflammatory response to injury, irritation, infection
  • Timeline: brief vasoconstriction, vasodilation, tissue repair and scarring
  • Inappropriate inflammatory responses are hypersensitivity and inflammatory disease
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2
Q

Vasodilation

A
  • Increased blood flow to the affected tissue
  • Redness due to the increased blood flow
  • Increase in temperature
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3
Q

How does inflammation occur and its affect

A
  • Fluid escapes from the blood vessels
  • Accumulates around the tissue= swelling
  • Swelling stimulates sensory nerves= pain
  • Oedema = swelling
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4
Q

Episcleritis

A
  • Effects the outermost layer of the sclera
  • Inflammation of the episcleral tissue
  • Symptoms are acute onset, mostly unilateral, redness, mild discomfort, no pain, unaffected vision
  • Signs are hyperima, vasodilation, increased blood flow, can be sectoral in a defined area
  • Nodular episcleraitis: raised lumps at the area of hyperemia, conjunctiva buldges forward, displaces slit lamp beam
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5
Q

Scleritis

A
  • Severe inflammatory disease of the sclera
  • Stronger systemic association than episclertitis
  • May be first sign of scleritis
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6
Q

Symptoms of scleritis

A
  • 50% unilateral 50% bilateral
  • Redness
  • Pain: moderate to severe, interferes with sleep, worse on the eye movement and touch
  • Effects vision
    Watery eyes
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7
Q

Categories of scleristis

A

Anterior scleritis
- Necrotising
- Non-necrotising
Posterior scleritis

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8
Q

Non necrotising scleritis

A

Diffuse - without nodule, inflammation causing hyperaemia
Nodular - Characterised with the presence of a fixed nodule within the sclera

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9
Q

Necrotising scleritis

A

With inflammation - presence of hyperaemia and patches of avascular tissue indicating scleral necrosis
With inflammation - characterised by the presence of grey/purple plaque without hyperaemia, raising risk of globe perforation

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10
Q

Posterior scleritis

A
  • 10% of the sclertis cases thorough management and evaluation required
  • No redness
  • Behind the orra seratta
  • vision loss and disorientation
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11
Q

Diagnosis of scleritis

A

To distinguish between episcleritis and scleritis phenylephrine is used
- After using phenylephrine if the hyperaemia resolves its episcleritis
- If hyperaemia is consistent it is scleritis
- Also check VA as it effects scleritis

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12
Q

Management of episcleritis and scleritis

A

Episcleritis
- Reassure not sight threatening and will resolve in 1-2 weeks
- Caution recurrent disease
- Cold compressions to promote vasoconstriction
-Flannel soaked in cold water hold over closed eyes for 5 min 2 times min a day
- Artificial tears
- Routine referral on third episode

Scleritis
- Urgent referral to the ophthalmologist
- IP prescribes NSAID flurbiprofen 100mg

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13
Q

Uveitis components

A
  • Uvea includes iris, ciliary body and choroid
  • Anterior uvea: Iris and ciliary body
  • Intermediate uvea: Cilliary body, anterior vitreous and peripheral retina
  • Posterior uvea: Peripheral retina and retinal choroid
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14
Q

Anteiror uveitis

A
  • Most cases are idopathic -no known cause
  • Systemic association witch erthymatosis and inflammatory diseases
  • Associated with ankylosing spobdylitis a disease which causes the inflammation of the spine, px experience back pain
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15
Q

Symptoms of anterior uveitis

A
  • Generally unilateral
  • Aching/ dull ache
  • Sudden onset
  • Recurrent disease
  • Iris and cilliary body packed with photo receptors
  • Pain and odema
  • Pain amplified by eye movement near work and light
  • Redness - vasodilation
  • Reduced vision
  • Lacrimation
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16
Q

Signs of anterior uveitis

A
  • Hyperaemia
  • Circulimbal flush
  • Meiosis
  • Aquesous cell- white blood cells deposited in the anterior chamber
  • Aqueous flare - anterior chamber appears hazy, smokey glow
  • Hypopyon - anterior chamber cells accumulate inferiporly at the inferior chamber
  • Keratic percipitates - inflammatory cells adhere to the anterior chamber
17
Q

Complications of anterior uveitis

A
  • Posterior synechiae - abnormal attachment between the posterior iris and anterior lens, disrupts the flow of aqueous humour pupil block and raised iop
  • Examine pupil margin carefully
  • Measure IOP
18
Q

Anterior uveitis and glaucoma

A

Secondary galucoma
Secondary angle closure glaucoma
- Posterior synache
- raised IOP

Secondary open angle glaucoma
- Reduced aqueous humour outflow
- Raised IOP

19
Q

Intermediate uveitis

A

Inflammation of ciliary body, anterior vitreous and peripheral retinal choroid

20
Q

Intermediate uveitis symptoms

A
  • Reduced vision, gradual over a few days
  • Floaters, sharp increase in the numbers of floaters
  • Vitreous inflammation
21
Q

Signsof intermediate uveitis

A
  • Reduced vision, inflammatory debris
  • Vitritis, accumulation of inflammatory cells in vitreous humour. Accumalation of flare protein
  • Snowball, yellow fluffy collections of accumulation of inflammatory diseases
  • Snow banking, white grey plaques
22
Q

Posterior uveitis

A

Inflammation of peripheral choroid, retina and vitreous

23
Q

Signs of posterior uveitis

A
  • Reduced vision, inflammatory debris
  • Vitritis, inflammatory cells in vitrous humour
  • Chorotidis, multiple yellow fluffy patches
  • Retnitis, indistinct fluffy patches
  • Vasculitis- Inflammation around the retinal blood vesses
  • Cystoid macular odema, accumulation of fluid in the retina, retinal oedema/ swelling
24
Q

Management of uveitis

A

Uveitis, regardless of its type is a sight threatening conditon and should be treated promptly to prevent vision loss and complications

25
Q

Initial assessment for uveitis

A

Measurement of intraocular pressure and dilated fundus examination are essential components of the initial assessment

26
Q

Mydriactic drug uveitis

A
  • Cyclopentolate (1%) is commonly used for dilation in uveitis cases
  • It helps reduce the risk of posterior synachiae and provides relied from and spasms by realxing the sphincter and ciliary muscles
  • Administer 3 times a day for 7 days
27
Q

Referral process uveitis

A
  • Urgent referral to the ophthalmology department for sight threatening uveitis is crucial, preferably via telephone
  • Investigation of associated systemic inflammatory disease is crucial, especially in recurrent cases
28
Q

Intermediate and posterior uveitis management

A
  • topical steroid may not reach sufficient concentration to the vitreous and the retina
  • intraocular steroid injection or systemic administeration of oral steroid

IOD (5 decks)

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