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A seg > Anterior Uveitis > Flashcards

Anterior Uveitis Flashcards

1
Q

Anterior uveitis is the inflammation of

A

Pars plicata and/or the iris.

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2
Q

idiopathic in __% of cases

A

50

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3
Q

Etiology/associations

A 
50% idiopathic 
Post op 
Trauma
Autoimmune- SLE, JIA, IBD, ankylosing spondylitis. 
HLA B27 positive 
Systemic infection- Herpes simplex or zoster, TB. 
Inflammation elsewhere in globe 
Anterior segment ischemia 
Retinal detachment 
Lens or drug induced. 
Cancer
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4
Q

Laterality

A

Systemic disease usually causes bilateral.

Exception- herpes usually unilateral.

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5
Q

Symptoms

A 
Red eye
Eye pain 
Tearing 
Photophobia 
Blurred vision
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6
Q

Signs

A

Injection of the conj and/or around the limbus (ciliary flush, circumlimbal flush)

AC rxn- WBC in AC. If severe, hypopyon can form.

Flare in AC (protein)

Ciliary flush

KP

Busacca/Koeppe nodules

PAS or PS

Pupillary mitosis

Low IOP in acute phase, High in chronic phase due to inflammatory disease obstructing TM or steroids.

Iris atrophy

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7
Q

ciliary flush, circumlimbal flush

A

Injection of the conj and or around the limbus

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8
Q

Keratic precipitates (KP)

A

WBCs on the K endothelium.

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9
Q

Fine KPs

A

Small, punctate, white WBCs on the K endothelium

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10
Q

Mutton Fat KPs

A

Large, greasy, yellow WBCs on the K endothelium. Typically inferior in arlt’s triangle.

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11
Q

Arlt’s triangle

A

Characteristic of granulatomous infection. Triangle inferior K endothelium

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12
Q

Busacca/Koeppe nodules

A

WBCs on the iris.

Busacca- mid periphery
Koeppe nodules keep to the pupillary margin

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13
Q

Peripheral anterior synechia (PAS)

A

Peripheral iris stuck to peripheral cornea

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14
Q

Posterior synechia (PS)

A

Iris pupillary zone stuck to the anterior lens.

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15
Q

How does IOP changed based on acute or chronic uveitis?

A

Acute- Lower IOP. (higher if herpetic etiology)

Chronic- Higher IOP. Due to inflammatory debris obstructing the TM or use of steroids.

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16
Q

Complications

A

Cystoid macular edema (CME)

PSC

Band keratopathy (Linear band of calcium that deposits at the level of bowman’s layer and anterior stroma)

Glaucoma

17
Q

Cystoid macular edema (CME)

A

Due to chronic anterior uveitis with spillover into the macula.

18
Q

What is band keratopathy?

A

Linear band of calcium that deposits at the level of bowman’s layer and anterior stroma

19
Q

Management

A

Topical cycloplegic
Topical steroid (oral for severe)
Break PS with 10% phenyl or 1% atropine
Consider IOP lowering med (prostaglandins can make inflam worse)
Order lab work if bilateral, chronic, recurrent
Refer out for systemic tx

20
Q

Most common form of uveitis

A

Anterior uveitis

21
Q

Can you clinically distinguish between inflammation of iris and pars plicata?

A

No

22
Q

Can patients have symptoms a few days before clinical signs are present?

A

Yes

23
Q

Intermediate uveitis

A

Inflammation of pars plana, peripheral retina and vitreous

24
Q

Posterior uveitis

A

Inflammation of choroid/retina

Can also involve blood vessels (vasculitis) and/or the ON (optic neuritis)

25
Q

Panuveitis

A

Anterior + intermediate + posterior uveitis with no predominant site

26
Q

Dilation with uveitis can lead to

A

Shedding of pigment cells into the aqueous.

But always want to dilate to check for posterior involvement.

27
Q

How to describe the inflammatory response

A

Onset - sudden or insidious

Duration- limited (less than 3 months) or chronic (greater than 3 months)

Clinical course- acute (sudden/limited) or chronic (insidious and persistent) or recurrent.

Non granulomatous- Strong immune response. Main cells involved are lymphocytes and plasma cells. Tends to be acute uveitis.

Granulomatous- Main cells involved are non phagocytic macrophages called epithelia cells that fuse together to create granuloma. Tends to be chronic uveitis.

28
Q

Granulomatous signs

A

Chronic uveitis
Mutton fat KPs
Busacca or Koeppe nodules.

29
Q

Fibrinous/plasmoid aqueous is more common in ___ positive patients

A

HLA B27

30
Q

Hypopyon is more common in ___ disease and ____ positive pts

A

Bechet’s and HLA B27

A seg (33 decks)

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