Ciliary Body: Ocular Conditions Associated With Anterior Uveitis Flashcards
(35 cards)
Posner-Schlossman Syndrome (glaucomatocyclitic crisis)
acute, recurrent anterior uveitis with markedly elevated IOP
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) etiology/associations
- idiopathic
- however, evidence suggests connection with herpes simplex (HSV) or cytomegalovirus (CMV) infection
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) demographics
typically occurs between the ages of 20-50 years
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) laterality
unilateral»_space;> bilateral
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) symptoms
- asymptomatic
- mild to no red eye
- mild eye pain- “dull ache” or “pressure”
- mild photophobia
- halos
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) signs
- white eye or minimal injection of the conj and/or limbus (no ciliary flush)
- mild AC rxn (cells much more common than flare)
- few fine KPs, non-granulomatous
- markedly increased IOP, typically 40-60 mmHg
- microcystic corneal edema, secondary to elevated IOP
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) complications
-secondary glaucoma (inflammatory): due to inflammatory debris obstructing the TM or trabeculitis, additional risk of ONH damage over time from IOP spikes
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) management
- self-limiting (occur and resolve spontaneously regardless of treatment); attacks usually subside within a few hours to a few weeks; intervals between attacks vary from a few days to several years
- topical steroid during acute attacks; may or may not improve inflammatory response; Pred Acetate 1% qid-q1h until improved, then taper
- IOP lowering meds during acute attacks (in tandem with steroid Tx); prostaglandins can make the inflammation worse; between episodes, IOP is typically within a normal range; if glaucoma develops, treatment will be ongoing
Posner-Schlossman Syndrome (glaucomatocyclitic crisis):
- must monitor for ____
- how?
glaucoma;
- IOP
- gonioscopy
- thorough DFE
- baseline testing, to repeat as indicated to assess for progression: ONH photos, ONH OCT (RNFL), GCC, HVF (start with 24-2, then 10-2 if needed)
Posner-Schlossman Syndrome (glaucomatocyclitic crisis) clinical pearls:
- treatment only necessary during _____
- when condition recurs it involves _____
- eventually, episodes _____
- rare after _____
“outbreak”;
the same eye;
appear to stop;
age 60
Fuchs’ Heterochromic Iridocyclitis (FHIC)
chronic anterior uveitis with non-hereditary heterochromia
Fuchs’ Heterochromic Iridocyclitis (FHIC) etiology/assocations
- idiopathic
- however, evidence suggests connections to rubella viral infection
Fuchs’ Heterochromic Iridocyclitis (FHIC) demographics
typically begins between the ages of 20-30 years
Fuchs’ Heterochromic Iridocyclitis (FHIC) laterality
unilateral > bilateral
Fuchs’ Heterochromic Iridocyclitis (FHIC) symptoms
- typically asymptomatic
- if symptoms occur: mild redness and mild pain, “discomfort”
- may notice discoloration of iris (change in color over time is pathognomonic for FHIC)
- blurry vision; cataract development
Fuchs’ Heterochromic Iridocyclitis (FHIC) signs
- minimal to no injection of the conj and/or limbus
- mild AC rxn: cells, may also present in anterior vitreous
- diffuse iris stromal atrophy leading to a lighter colored iris with TIDs
- diffuse fine, stellate KPs, non-granulomatous
- fine vascularization of the angle (TM) and iris root
- rare: Koeppe or Busacca nodules, iris sphincter atrophy –> irregular pupil shape
Fuchs’ Heterochromic Iridocyclitis (FHIC) complications
- PSC: due to chronic anterior uveitis, typically the cause of visual changes
- secondary glaucoma (inflammatory): due to inflammatory debris or blood obstructing the TM
- hyphema (blood in AC): due to leakage of blood from fine blood vessels in the angle; recurrent, spontaneous
Fuchs’ Heterochromic Iridocyclitis (FHIC) management
- inflammatory response generally unresponsive to steroids
- a trial of steroids may be attempted, but they should be tapered quickly if there is no response
- elevated IOP typically does not improve with topical treatment
Fuchs’ Heterochromic Iridocyclitis (FHIC):
- must monitor for _____
- how?
glaucoma;
- IOP
- gonioscopy
- thorough DFE
- baseline testing, to repeat as indicated to assess for progression: ONH photos, ONH OCT (RNFL), GCC, HVF (start with 24-2, then 10-2 if needed)
Fuchs’ Heterochromic Iridocyclitis (FHIC):
-if glaucoma develops, 70% failure on _____; best IOP control with ____
topical therapy;
trabeculectomy and shunt surgeries (Ahmed Glaucoma Valve)
Fuchs’ Heterochromic Iridocyclitis (FHIC):
-if PSC/cataract develops, _____
cataract surgery (phacoemulsification with PCIOL)
Fuchs’ Heterochromic Iridocyclitis (FHIC) clinical pearls:
- accounts for ____% of all uveitis cases
- overall incidence of glaucoma ranges from _____%
- cataract development is seen in over ___% of eyes with FHIC (may refer for cataract surgery sooner than “standard” cataract patients)
1-3;
13-60;
80
Uveitis-Glaucoma-Hyphema syndrome (UGH)
anterior uveitis with elevated IOP, pigment dispersion, and/or hyphema post cataract surgery
Uveitis-Glaucoma-Hyphema syndrome (UGH) etiology
- chafing/disruption of the iris or CB by an IOL
- mechanical trauma from IOL malpositioning; less likely with PCIOL placed in the capsular bag; more likely with an ACIOL or sulcus PCIOL
