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RED EYE (UVEITIS) Flashcards

(56 cards)

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1
Q

Uveal tract consist of which 3 main structures?

A
  1. Iris
  2. Ciliary body
  3. Choroid
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2
Q

Anterior uvea

A

Iris to pars plicata

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3
Q

Intermediate uvea

A
  1. Pars plana
  2. Post cyclitis
  3. Vitreous humor
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4
Q

Posterior uvea

A
  1. Retina
  2. Choroid
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5
Q

Acute Uveitis

A

group of inflammatory diseases that produces swelling and destroy eyes tissues (uvea) which slight reduce vision/severe vision loss

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6
Q

Anatomical classification of Uveitis

A

Ant, Intermediate, Post, Panuveities

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7
Q

Primary site of inflammation in anterior uveitis

A

Anterior chamber

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8
Q

C/F of anterior uveitis

A
  1. Rapid onset of unilateral pain
  2. Photophobia
  3. Redness & watery discharge
  4. Mild ocular discomfort
  5. Blurring of vision
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9
Q

Visual acuity in anterior uveitis

A

Variably impaired

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10
Q

Ciliary injection

A
  • key sign of anterior uveitis
  • reddish violet ring of dilation around cornea
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11
Q

Pupillary sphincter spasm

A

Leads to miosis in anterior uveitis

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12
Q

Hypopyon (anterior uveitis)

A

If it is a HLA-B27-related inflammation

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13
Q

Fibrinous exudates (anterior uveitis)

A

Seen in ant chamber
Severe

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14
Q

Keratic precipitates (anterior uveitis)

A

Deposits of corneal endothelium composed of inflammatory cells (lymphocytes, plasma cells & macrophages)

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15
Q

Aqueous flare (anterior uveitis)

A

Haziness of normally clear fluid in ant chamber

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16
Q

Posterior synechiae (anterior uveitis)

A

Inflammatory adhesion between pupil margin & ant lens capsule

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17
Q

Intraocular pressure in anterior uveitis

A

Reduced as a result of impairment of aqueous secretion by ciliary epithelium

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18
Q

What is the primary site of inflammation of intermediate uveitis?

A

Vitreous

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19
Q

C/F of intermediate uveitis

A
  • blurred vision
  • vitreous floaters
  • no pain or redness (usually)
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20
Q

Vitreous in intermediate uveitis

A
  • anterior predominance with vitreous condensation & haze (severe)
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21
Q

Snowballs (intermediate uveitis)

A

Whitish focal collections of inflammatory cells & exudates
- numerous in inferior vitreous

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22
Q

Snowbanking (intermediate uveitis)

A

Grey white fibrovascular/exudative plaque in any/all quadrant
- found inferiorly

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23
Q

What is the primary site of inflammation in posterior uveitis?

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A

Retina/choroid

24
Q

C/F of posterior uveitis

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A
  1. Defective vision
  2. Photopsia
  3. Black floaters
  4. Metamorphosia
  5. Micropsia
  6. Macropsia
  7. Scotoma
25
Signs in vitreous (posterior uveitis)
- fine, stringy, coarse, snowball opacities
26
Features of patches on choroid on active stage (posterior uveitis)
Pale yellow/dirty white patches with irregular edges
27
Features of patches on choroid on healed stage (posterior uveitis)
- Black pigmented clumps at periphery of lesion - involved area = sclera below healed choroid
28
Panuveitis
Inflammation of the whole uvea
29
Acute uveitis
Sudden symptomatic onset - last for 3 months or less
30
Chronic uveitis
- insidious onset and asymptomatic onset - persists longer than 3 months - diagnosed when It causes defective vision
31
Recurrent uveitis
repeated episodes separated by inactive periods of > 3 months w/o treatment
32
Infectious systemic diseases associated with anterior uveitis
- varicella zoster - TB - syphilis - lyme disease
33
Non-infectious systemic diseases associated with anterior uveitis
- HLA B27 +ve - juvenile idiopathic arthritis - sarcoidosis - behcet disease - tubulointersitial nephritis & uveitis syndrome - SLE - multiple sclerosis - drug induced
34
Neoplastic diseases associated with anterior uveitis
- lymphoma - anterior segment melanoma
35
Non-neoplastic diseases associated with anterior uveitis
Juvenile xanthogranuloma
36
Pathological classification
1. Suppurative/purulent uveitis 2. Non-suppurative uveitis - non granulomatous - granulomatous (TB, leprosy, syphilis, sarcoidosis)
37
Difference btwn granulomatous & non granulomatous **Onset**
Granulomatous = insidious Non-granulomatous = acute
38
Difference btwn granulomatous & non granulomatous **Pain**
Granulomatous = minimal Non-granulomatous = marked
39
Difference btwn granulomatous & non granulomatous **photophobia**
Granulomatous = slight Non-granulomatous = marked
40
Difference btwn granulomatous & non granulomatous **ciliary congestion**
Granulomatous = minimal Non-granulomatous = marked
41
Difference btwn granulomatous & non granulomatous **keratic precipitates**
Granulomatous = mutton fat Non-granulomatous = small
42
Difference btwn granulomatous & non granulomatous **aqueous flare**
Granulomatous = marked Non-granulomatous = small
43
Difference btwn granulomatous & non granulomatous **iris nodules**
Granulomatous = present Non-granulomatous = absent
44
Difference btwn granulomatous & non granulomatous **posterior synechiae**
Granulomatous = thick & broad based Non-granulomatous = thin & tenuous
45
Difference btwn granulomatous & non granulomatous **fundus**
Granulomatous = nodular lesions Non-granulomatous = diffuse involvement
46
Lab Tests to be done
- CBC - ESR & CRP - Serological test - syphilis, herpes, toxoplasmosis, HIV - HLA-B27 antigen status test - Antinuclear antibody (ANA) - Antineutrophilic Cystoplasmic Antibody (ANCA) - Mantoux test
47
Ocular imaging
To conclude the severity and type of uveitis present Classify according to the site of inflammation - B-scan - Optical coherence tomography (OCT) - Fluorescein angiography (FA)
48
Imaging done
- Chest X-ray - assess for TB - Sacroiliac joint X-ray
49
Topical steroids given?
Prednisolone 1% OR dexamethasone 0.1%
50
Which should topical steroids be tapered after inflammation is controlled?
- To prevent adhesion of iris to the anterior lens capsule (posterior synechiae) - To stabilize the blood-aqueous barrier and help prevent further leakage (flare) - To relieve pain by immobilizing the iris
51
Cycloplegic agents given?
- Cyclopentolate (12–24 hours) - Homatropine & atropine (10–14 days) prevent the formation of posterior synechiae
52
Mydricaine
- preparation containing adrenaline & atropine - administered by subconjunctival injection - to break fresh PS (post synechiae)
53
Intraocular steroids
Intravitreal triamcinolone occasionally used in anterior uveitis
54
Immunosuppressive agents
- Mycophenolate - Methotrexate - Tacrolimus - Cyclosporines
55
Surgical treatment for uveitis
Removal of the vitreous when persistent floaters impede visual acuity - combine with drug therapy
56
Complications of uveitis
- neovascularization - vitreous hemorrhage (in children) - optic disc swelling - cystoid macular edema - cataract - glaucoma - retinal detachment (uncommon) - posterior synechiae (in ant uveitis)

Ophthal (18 decks)

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