Red Eyes II Flashcards
(14 cards)
Uveitis refers to inflammation of the [] layer of the eye known as the uvea that includes the [3]
Uveitis refers to inflammation of the middle layer of the eye known as the uvea that includes the iris, choroid, and ciliary body.
Describe the typical case of uveitis [1]
- Typical case: Photophobia, dull ache, slightly reduced vision (if presenting early) and a red eye.
The uvea is divided into which three components? [3]
Iris: the coloured part of the eye. It controls the size of the pupil which helps regulate the amount of light entering the eye.
Ciliary body: a ring-shaped structure located behind the iris. It has important functions in accommodation, allowing us to focus on objects at different distances by changing the lens shape. It has several parts including the ciliary muscle, ciliary process, and zonular fibres.
Choroid: this is a thin, dark brown/black layer that extends from the ciliary body to the optic nerve head. Its dark colour is due to melanocytes in its outermost layer. It contains a network of blood vessels that help support the health of the retina.
Uveitis is divided into different types depending on the location that is affected.
The anterior portion of the uvea includes the [2].
The posterior portion of the uvea is known as the [1]
The anterior portion of the uvea includes the iris and ciliary body.
The posterior portion of the uvea is known as the choroid.
Describe the pathophysiology of uveitis
Anterior uveitis
- :this is the most common form of uveitis and refers to inflammation of the anterior portion of the uvea.
- It is characterised by leucocytes in the anterior chamber of the eye.
Posterior uveitis:
- this refers to inflammation in the posterior portion of the uvea.
- It is characterised by leucocytes in the vitreous humour and inflammation of the retina and/or choroid.
Describe the clinical features of anterior uveitis [+]
- acute onset
- ocular discomfort & pain (may increase with use)
- pupil may be irregular and small
- photophobia (often intense)
- blurred vision
- red eye
- lacrimation
- ciliary flush
- hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
- visual acuity initially normal → impaired
Describe what is shown here [1]
Describe how you Ix anterior uveitis [2]
Ocular examination:
- Slit-lamp biomicroscopy is critical for detecting anterior chamber cells, flare, keratic precipitates, and posterior synechiae
- Intraocular pressure measurement and dilated fundus examination should be performed to assess posterior segment involvement and potential complications.
Laboratory investigations:
- Based on the patient’s history and clinical presentation, specific tests can be ordered, such as serologic tests for syphilis, Lyme disease, and toxoplasmosis, and quantiFERON-TB Gold for tuberculosis.
- Autoimmune markers, such as HLA-B27, antinuclear antibody (ANA), and rheumatoid factor, may be considered if an underlying systemic disease is suspected.
PM:
Topical corticosteroids:
- First-line treatment for anterior uveitis includes potent topical corticosteroids (e.g., prednisolone acetate 1% or dexamethasone 0.1%) administered frequently in the acute phase and tapered according to clinical response.
Cycloplegic agents:
- Topical cycloplegics (e.g., tropicamide or homatropine) help relieve ciliary spasm and pain, reduce the risk of posterior synechiae, and maintain the depth of the anterior chamber.
Systemic therapy:
- Oral corticosteroids or immunosuppressive agents (e.g., methotrexate, azathioprine, or mycophenolate mofetil) may be indicated for severe or refractory cases, or when posterior segment involvement is present.
Lecture:
− Topical steroids – tapered – G Dexamethasone 0.1%
− Topical dilating drops – G Cyclopentolate 1%
− Investigate individuals with multiple episodes
Anterior uveitis is characterised by inflammation in the anterior chamber that can lead to the formation of a hypopyon.
What is this? [1]
Hypopyon: fluid level of white cells within the anterior chamber. This is a sign of severe inflammation
This patient has uveitis.
Explain what is seen in the slit lamp photo [1]
Keratic precipitates: cellular deposits on the corneal endothelium)
Describe what is meant by Post-operative Endophthalmitis [1]
- Inflammation of internal eye tissues – usually secondary to infective an organism
- Typically occurs following ophthalmic surgery
Presentation of post-operative endophthalmitis? [4]
Increasing pain, redness, photophobia and reduced vision/floaters
- Typically occurs following ophthalmic surgery
Mx for Post-operative Endophthalmitis? [3]
Management:
− Urgent same-day referral to ophthalmology
− Slit lamp review
− Intravitreal biopsy
− Intravitreal antibiotics
