Uvea Flashcards Preview

RUSVM SAM 2 > Uvea > Flashcards

Flashcards in Uvea Deck (42):
1

What are the components of the uvea?

Anterior
- iris and ciliary body

Posterior
-choroid

2

What is the blood supply that encircles the iris?

Major arterial circle

3

What are the zones of the iris?

Ciliary zone

Iris collarette (persistent pupillary membranes arise from his junction)

Pupillary zone

4

What is a persistent pupillary membrane (PPM) ?

Incomplete absorption of embryonic vascular tissue and mesenchymal strands

Originating form iris collarette
- iris - iris

- iris - lens (remnants can leave pigment on anterior lens capsule, often cause focal cataracts )

- iris - cornea (can see from side, transversing anterior chamber and can result from scaring where they attach)

5

What is the function of the uvea?

Aqueous production
Maintenance of blood-ocular barrier (clear ocular media)
Light regulation
Accommodation

6

What are the components of the blood-ocular barrier ?

Blood-aqueous barrier
-iris blood vessel endothelium
-ciliary body epithelium

Blood-retinal barrier
-retinal blood vessel endothelium
-retinal pigment epithelium

7

What is the function of the blood-ocular barrier?

Prevent passage of protein and cells into the anterior chamber and posterior segment

Allows clear media for vision

Disruption of barrier = uveitis

8

What is the pathophysiology of inflammation of the uvea?

Increased blood supply

Increased vessel permeability

White blood cell migration

Breakdown of the blood-ocular barrier

9

What do you call inflammation of the iris and ciliary body?

Anterior uveitis (iridocyclitis)

10

What do you call inflammation of the choroid?

Posterior uveitis ( choroiditis)

11

What do you call inflammation of the entire uvea?

Panuveitis

12

What do you call inflammation of the entire uvea and intraocular contents?

Endophthalmitits

13

What do you call inflammation of all the ocular and intraocular structures?

Panophtalmitis

14

What clinical signs are seen with uveitis?

Blepharospasm
Epiphora
Photophobia
Red eye
- ciliary flush
- episceral injection
Corneal edema

Miosis
Aqueous flare
Hyphema
Hypopyon
Fibrin
Keratic precipitates
Swollen/thickened iris
Iris hyperemia
Rubeosis iridis
Decreased intraocular pressure
Active chorioretinal lesions

15

What causes the miosis seen with uveitis?

Inflammation due to prostaglandins

= causes pain from ciliary body spasm
= causes iris sphincter muscle contraction

16

What causes an aqueous flare?

Increased turbidity due to breakdown of the blood-aqueous barrier

Protein and cells in AC cause light scattering

Detected with very focal light source close to the cornea in a dark room

17

What do you call blood in the anterior chamber?

Hyphema

18

What do you call WBC in the anterior chamber?

Hypopyon

19

What are keratic precipitates?

Inflammatory cells and fribrin adhered to corneal endothelium

20

What is rubeosis iridis?

Neovascularization of iris surface (chronic)

21

Why do you have a deceased ocular pressure with uveitis?

Inflammation driven by prostaglandins

Decreased aqueous humor production

Normal IOP is 10-20mmHG

22

Why do you see active chorioretinal lesions with uveitis?

Breakdown of blood-retinal barrier

Hyporeflective, raised, and poorly circumscribed lesions

Retinal edema

Subretinal infiltrates/glaucoma

Retinal hemorrhage

Retinal detachment

Vitreous haze

23

What are clinical signs of CHRONIC uveitis?

Posterior synechia
-dyscoria (abnormally shaped pupil)
- iris bombe (apposition of iris and lens prevents aqueous from flowing into posterior of anterior chamber)

Iris hyperpigmentation

Cataracts
Secondary glaucoma
Retinal detachments
Phthisis bulbi

24

What are the types of uveitis?

Exogenous= external to the eye
-blunt or perforating trauma
-corneal ulceration

Endogenous
-infectious, neoplasia, metabolic, auto-immune, drug-induced

25

What are infectous causes of canine uveitis?

Prototheca (algae)

Borrelia, brucella, lepto

Aspergillosis, blasto, crypto, histo, coccidioides

Angiostrongylus, baylisascaria, Diptera, drofilaria, toxocara

Leishmania, neospora, toxo, trypanosoma

Erhlichia, rickettsia

Adenovirus, distemper, herpes

26

What type of infectious uveitis has pyogranulomatous inflammation and involves the posterior segment ?

Disseminated mycotic

27

What type of uveitis will you see migratory tracts in retina?

Intraocular nematodiasis

28

What type of uveitis is associated with vasculitis and retinal hemorrhage, thrombocytopenia, platelet dysfunction, and hypervisocity?

Rickettsial disease (Ehrlichia)

29

What are non-infectous causes of uveitis?

Immune mediated - idiopathic most commonly

Metabolic - DM, hyperlipidemia, hypertension

Neoplastic - histiocytic proliferative disease, hyperviscocity syndome, lymphosarcoma, melanoma

Trauma

30

What is a lens induced uveitis?

Leakage of lens protein from a cataract

Suspect in any red eye with a cataract

31

What is uveodermatologic syndrome?

Autoimmune disease directed against melanocytes

Severe bilateral panuveitis
Depigmentaion of iris and or choroid

Ulceration and vitiligo of facial mucocutaneous junctions

32

What breed of dog gets pigmentary deposits on the lens an corneal endothelium, iris hperpigmentation, and uveal cysts ?

Golden retrievers

33

What are the infectious causes of feline uveitis ?

FIV, FeLV, FIP and toxo

Also fungal
Diptera
And bacterial

34

What is likely the cause of a chorioretintitis with concurrency URI, swelling over the bridge of the nose, and cutaneous lesions

Cryptococcosis

35

How will you work up a canine uveitis case?

travel history
PE
CBC
Chem
UA
Thoracic rads
Tick titers
Fungal titers

If hyphema present:
Coag panel
BP
CBC

36

How will you work up a feline uveitis case?

Travel history
PE
CBC
Chem
UA
Thoracic rads

FIV/FLV
Toxo titer
Fungal titers

Hyphema:
Coag
BP
CBC

37

What is the treatment of uveitis?

Primary cause (if known)

All required anti-inflammatories (topical steroids +/- NSAIDS)
Topical atropine

+/- systemic corticosteroids OR systemic NSAIDS
+/- systemic antimicrobials

38

What topical corticosteroids are appropriate for treatment of uveitis?

Prednisolone acetate

Dexamethasone (neopolydex)

39

What topical NSAIDS are appropriate for treating uveitis?

Flurbiprofen
Diclofenac
Ketorolac

Can be used with topical steroids

40

What causes of uveitis must you rule out before starting systemic corticosteroids?

Infectious causes
Prednisone (canine)
Prednisolone (cat)

41

What systemic NSAIDS are appropriate for treating uveitis?

Carprofen or Meloxicam (dog)

Robenacoxib (cat)

42

What is are the benefits to using a topical mydratics for uveitis?

Atropine

Reduce pain of ciliary body spasm
Reduces risk of posterior synechia
Stablilizes blood-ocular barrier