Disorders Of Anterior Uvea 2

Question 1

Uveitis

Answer 1

Inflammation to any aspect of the uveal tract
• Anterior uveitis - iris + ciliary body
• Posterior uveitis - choroid
• Panuveitis - all three portions

Question 2

Ocular signs of uveitis

Answer 2

Blepharospasm - squinting
• Episcleral injection,
• Ciliary flush
• Corneal edema
• Miosis
• Synechiae
• Aqueous flare
• Hyphema
• Hypopyon
• Keratic precipitates
• Rubiosis iridis
• Hypotony

Question 3

Episceral injection

Answer 3

Congestion of the vessels

Question 4

Ciliary flush

Answer 4

360 degree corneal vascularization
Red appearence around eye, vessels are usually deep, brush like appearence
- indicative of intra ocular disease**

Question 5

Corneal edema

Answer 5

Fluid build up within stromal layer
Blue eye appearence

Question 6

Miosis

Answer 6

Pupillary constriction

Question 7

Synechiae

Answer 7

Adherence of iris to cornea (anterior) or lens (posterior)
Anterior is Common w full thickness perforation of cornea
Posterior is common in uveitis

Question 8

Aqueous flare

Answer 8

Release of protein into the aqueous humor - breakdown of blood aqueous barrier
Leads to cloudy & protrusion of anterior chamber

Question 9

Lipemic aqueous

Answer 9

Unique manifestation of uveitis - presence of lipids

Question 10

Keratic precipitates

Answer 10

Accumulation of inflammatory cells that adhere to corneal endothelium (inner layer)
Common in cats

Question 11

Hypopyon

Answer 11

Accumulation of inflammatory cells (pus) in the anterior chamber -

Question 12

Hyphema

Answer 12

Accumulation of blood in the eye - any chamber but in the eye

Question 13

Rubeosis iridis

Answer 13

Red iris - congestion of iridal vasculature

Question 14

Hypotony

Answer 14

Low Intraocular pressure

Question 15

Uveitis complications

Answer 15

Synechiae - adhesion of lens and iris
• Glaucoma
• Iris bombe
• Cataract -
• Lens instability - break down of zonular fibers
• Retinal detachment
• Phthisis bulbi
List builds /can progress from one disease to the next on the list

Question 16

Mechanism 1 of uveitis to glaucoma

Answer 16

Obstruction of the angle by inflammatory debris

Question 17

Mechanism 2 of uveitis to glaucoma

Answer 17

Formation of Pre-iridal fibrovascular membnrane, lead by inflammatory cells. Drainage is compromised

Question 18

Mechanism 3 of uveitis to glaucoma

Answer 18

Iris Bombe + peripheral anterior synechiae
Accumulation of aqueous humor behind iris due to blocked drainage in eye

Question 19

Causes of uveitis

Answer 19

Primary ocular disease
Idiopathic
Trauma
Ocular manifestations of systemic diseases

Question 20

Primary ocular disease

Answer 20

Cataract
Lens rupture
Corneal ulcer

Question 21

Ocular manifestations of systemic diseases

Answer 21

Infectious
Metabolic
Immune-mediated
Neoplasia

Question 22

What percentage of dogs and cats are idiopathic?

Answer 22

Dogs - 47%
Cats - 70%

Question 23

Lens induced uveitis

Answer 23

Phacolytic Uveitis - Soluble lens protein leaks through an intact lens capsule (cataract) Phacoclastic uveitis - Sudden exposure of intact lens protein (lens capsule tear - trauma)

Question 24

Common causes of uveitis in dogs

Answer 24

Infectious
Lens induced uveitis - 2 types
Reflex uveitis - Corneal/ scleral diseases
Metabolic - Hyperlipidemia
Breed specific

Question 25

Common causes of uveitis in cats

Answer 25

Infectious - Viral (FeLV, FIP, FIV, FHV-1), Bacterial (Bartonella), Fungal (Histoplasma, Blastomyces, Coccidioides), Protozoal (Toxoplasma) • Metabolic - Systemic hypertension • Neoplastic - Lymphoma - most common metastatic

Question 26

Common causes of uveitis for horses

Answer 26

Trauma • Reflex uveitis - Stromal abscess • Equine Recurrence Uveitis (ERU) • Systemic disease - Sepsis in foals, EIA , Potomac Horse Fever etc

Question 27

Equine recurrence uveitis

Answer 27

Most common cause of blindness in horses - suspect immune mediated cause

Question 28

Classifications for ERU

Answer 28

Classic - active bouts w quiet periods Insidious - on going/low grade Posterior - only choroid affected

Question 29

Breeds common w ERU

Answer 29

Appaloosa, draft, warm blood, Icelandic horses

Question 30

treatment for ERU

Answer 30

Supportive, surgical - implant, vitrectomy, Intravitreal infection

Question 31

DX uveitis

Answer 31

History - Vaccination, Life style (indoor/outdoor/travel), Acute/chronic, Previous meds • Physical Exam - Ophthalmic Exam • Minimum data base • CBC, chemistry panel, UA

Question 32

Specific DX for uveitis

Answer 32

Initial serology • Canine: fungal, tick titers, toxoplasmosis • Feline: fungal, FeLV, FIV, FIP, toxoplasmosis • Thoracic radiographs and abdominal ultrasound- fungal/neoplasia is suspected • Ocular ultrasound: ONLY if you cannot see past the iris and lens • Additional systemic testing as indicated by species/patient clinical signs/geographic area

Question 33

TX goals for uveitis

Answer 33

Prevent sequalae • Eliminate intraocular inflammation • Stabilize and restore blood - aqueous barrier • Treat underlying cause when possible!!! Supportive

Question 34

Treating uveitis

Answer 34

Topical anti-inflammatories • Corticosteroids - Prednisolone acetate, Dexamethasone • Non-steroidal anti-inflammatories - Diclofenac, Flurbiprofen, Ketorolac • Systemic anti-inflammatories • Corticosteroids - Prednisone • Non-steroidal anti-inflammatories

Question 35

Topical atropine

Answer 35

Most efficient pain management for the eye Mydriatic (synechia), Cycloplegic (analgesia) • Stabilize blood-aqueous barrier • Systemic therapy if indicated • Antimicrobials • Antifungals

Question 36

Contradictions for atropine

Answer 36

Contraindications • Lens instability • Glaucoma • Dry eye • Parasympatholytic - decrease STT • Bitter taste (CATS)

Question 37

Contractions for topical & systemic steroids

Answer 37

Topical • Potentiate infection - melting ulcer • Decrease would healing • Corneal degeneration - consider switching to a topical NSAID long-term • Systemic • Depends on underlying disease • Rule out infectious causes!