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Uveaitis Flashcards

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1
Q

What is the Blood Aqueous barrier made of?

A
  1. Ciliary body Non pigment epithelial cells
  2. Iris blood vessel Endothelial cells
  3. Trabecular Meshwork Blood vessels
  4. Canal of Schlem endothelial cells
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2
Q

What does the Vascular uveal tract comprise of?

A

Iris, ciliary body and choroid

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3
Q

What is the function of the Vascular uveal tract?

A

a. Regulating power of the eye
b. Accommodation
c. Pupil size- controlling retinal illumination
d. Pigment absorption cells (reduce internal reflection and harmful UV radiation)

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4
Q

What creates an autoimmune disease?

A

A chronic or recurrent uncontrolled immune response or a pathological immune response

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5
Q

What 2 structures of the eye cannot regenerate if damaged?

A

Neurosensory layers

Retinal Ganglion cells

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6
Q

What are cytokines?

A

Proteins which signals other leukocytes that amplify or suppress immune response

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7
Q

What do anti inflammatory cytokines do?

A

Create an immunosuppressive environment

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8
Q

Is immunosuppressive environment present in Uveitis?

A

No. This environment prevents the intraocular inflammation which is the hallmark of uveitis

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9
Q

When does uveitis arise?

A

When the balance between inflammatory and anti inflammatory cytokines shifts towards inflammatory cytokines

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10
Q

What are self antigens?

A

Substances that healthy immune system learns to ignore as the hosts own body produces these

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11
Q

How can self antigens cause an inflammatory response?

A

If they are not recognised by the immune system, this would then be identified as a pathogenic antigen leading to reproduction of antibodies and hence an inflammatory response.

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12
Q

What are the causes of uveitis?

A
  1. High choroid blood flow (a systemic association)
  2. Infectious agents in the vascular system (Ample exposure to the uvea)
  3. Presumed Autoimmune Origin
  4. Idiopathic by 50%
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13
Q

Definition of uveitis?

A

Inflammation of the uvea tract (retina, optic nerve, iris, sclera)
Intraocular inflammation compromises the blood ocular barrier.

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14
Q

What is the prevelance of uveitis?

A

Worldwide= 10%
Developed countries= 10-20%
Anterior more common
Age onset 20-60 year olds

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15
Q

Anterior uveitis signs?

A
  1. Conjunctival hypereamia
  2. Episcleral/scleral vessels dilation
  3. Ciliary Flush (bulbar Limbal region)
  4. Keratitic precipitates
  5. A/C cells or flare
  6. Hypopyon
  7. Posterior synachiae- iris bombe
  8. Anterior synachiae
  9. Complications- Cataract and SACG
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16
Q

Anterior Uveitis sxs?

A
  1. SUDDEN/ACUTE
  2. Redness (Sclera/conj/episcleral
  3. Pain
  4. Photophobia
  5. Lacrimation
  6. Blurred vision
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17
Q

What is flare a result of?

A

Protein leaking from blood vessels during active inflammation

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18
Q

Where are the cells and flare located?

A

Anterior chamber

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19
Q

What is hypopyon associated with aside from uveitis?

A

Endophthalmitis

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20
Q

If a posterior synachiae was present, what assessment would be required?

A

Gonioscopy

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21
Q

Where are KPs found?

A

Corneal endothelium

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22
Q

Where is the 1st sight of inflamm activity in anterior uveitis?

Study These Flashcards
A

Iris and ciliary body

23
Q

What does aqueous flare cause?

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A

Light scatter

24
Q

What happens to the cells and flare when inflammation activity stops

Study These Flashcards
A

Flare may continue to leak

Cells stops as inflammations stops

25
What are the primary complications of uveitis?
Secondary glaucoma | Cataracts
26
What causes the pain in ant uveitis?
Induced spasm of the ciliary muscle
27
What would cause the IOPs to increase in any uveitis?
Secondary glaucoma and steroids
28
Where is the pain innervation from in ant uveitis?
Trigeminal nerve
29
Conditions of Posterior uveitis?
1. Vitritis 2. Cystoid Macula Oedema 3. Retinal vasculitis 4. Inflamm of Uvea- serous RD 5. Retinitis/Choroiditis (Chorioretinitis) 6. Active Retinitis 7. Inactive retinitis 8. ONH inflammation
30
What is the 2nd most common vision loss in post uveitis?
Vitritis
31
Vitritis signs?
``` Vitreous haze (cells and proteins) Clumps- 'snowballs' ```
32
What are the signs of active choroiditis?
Circular lesions and elevated | Creamy/yellow/grey
33
What is the hallmark for Inactive retinitis?
Pigement margins on chorioretinal scarring | Pigement is caused by hypoplasia of RPE
34
What condition is associated with ONH inflammation?
Optic neuritis
35
What are the retinal vasculitis signs?
Vascular sheathing | Retinal infiltrates- can lead to haemm, Cotton wool spots, retinal neovasc
36
Active retinitis signs?
Fluffy indistinct margins Pale yellow colour Inflamm activitiy in vitreous and A/C Obscured underlying retinal tissue and BV
37
Sxs of post uveitis?
Depends on severity and location Vitritis and MO= Blurred vision, sudden onset, bilateral, floaters, constant flashing lights
38
What are less common sxs in post uveitis?
Pain and photophobia
39
The different sxs with their conditions...
40
What signs are being shown and what condition is this?
Sign- Snowball | Condition- Vitritis
41
What condition is being shown and what key feature suggests this?
Inactive chorioretinal scarring | Dark marginal regions of hypoplasia
42
Anterior Uveitis- what are the non infectious causes?
1. Systemic Rheumatic disorders 2. Inflammatory bowel syndrome 3. Sarcoidosis 4. Behcets Syndrome
43
Anterior Uveaitis- what are the infectious causes?
1. HSV 2. HZV 3. Tuberculosis 4. Syphilis
44
Posterior Uveitis- What are the non infectious causes?
1. Sarcoidosis 2. Multiple Sclerosis 3. Behcets syndrome
45
Posterior Uveitis- What are the infectious causes?
1. Toxoplasmosis 2. Tuberculosis 3. Cytomegalovirus 4. Syphilis 5. Toxocariasis 6. HSV 7. HZV
46
What are the potential infectious causes for posterior and anterior uveitis?
1. HSV 2. HZV 3. Tubercolosis 4. Syphilis
47
What are the potential non infectious causes for posterior and anterior uveitis?
1. Sarcoidosis | 2. Behcets disease
48
How to refer for ACUTE uveitis?
Same day phone call as risk of complications
49
When is a referral non urgent in uveitis?
Longstanding hx of recurrent inflamm and doubts if active inflamm
50
How is uveitis managed by ophthalmologists?
Topical ocular corticosteroids | POMs only
51
Name the medication used to treat?
Prednisolone Dexamethasone Fluoromethalone Betamethasone
52
How to treat Anterior uveitis?
Mydriatics- relieve pain and prevent posterior synachiae
53
How to treat posterior Uveitis?
Intravitreal steroid injections on tendon/orbital floor | Risk of cat and glaucoma

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