Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Ocular Disease > Uveitis > Flashcards

Uveitis Flashcards

(115 cards)

Start Studying
1
Q

Which IOP lowering class of drugs would you want to avoid when treating a steroid-responder in the management of uveitis?

A

prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 mainstays of treatment for most uveitis?

A

Corticosteroids, cycloplegics, and treating the underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which steroid drops are good choices for anterior uveitis?

A

Pred acetate susp. (generic), 1% Pred Forte (brand), and Durezol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the benefits and considerations for using Durezol?

A

Do not have to shake so is simpler for the patient, QID dosing instead of q1hr, stronger, $200-300, can be more likely to increase IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the benefits and considerations for using Pred Forte?

A

also expensive, have to shake, not as strong as Durezol, or as likely to increase IOP, dosing q1-2hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When would you consider using a weaker steroid for uveitis?

A

for mild anterior uveitis, and if the patient is a steroid responder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

General guidelines for steroid dosing for uveitis

A

hit it hard! q1-2hr for 1-2wks, may need loading dose, maintain dose until AC is free of cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you taper in uveitis?

A

SLOW taper is very important, but can be very variable. Adjust based on severity/propensity for recurrence/length of tx
ex. QID x1wk, TID x1wk, BID x1wk, QD x1wk, stop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Instructions on the Rx for steroid for uveitis

A

ex. Pred Forte, 1 gtt OD q1hr while awake, taper as directed, 0 refills, NO SUBSTITUTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a pulse dose?

A

circumstances when steroids are used for a short period of time and don’t require a taper, such as for corneal/conjunctival disease such as dry eye or episcleritis. Infrequently used in treating uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the ocular side effects for topical steroids?

A

increased IOP, PSC, increased risk of bacterial/viral infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some systemic side effects of steroids?

A

increased serum glucose, hyperlipidemia, hypertension, sodium and water retention edema, centripetal obesity, buffalo hump, impaired wound healing, suppression of hypothalamic-pituitary-adrenal system, secondary infections, osteoporosis, psychiatric, gastritis, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What purpose do cycloplegics play in treating uveitis?

A

Cycloplegics prevent ciliary spasm, reducing symptoms and improving comfort of the patient, while stabiling blood aqueous barrier, and preventing formation of posterior synechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which cycloplegics are the best for uveitis?

A

1 is homatropine 5%, can be hard to find though, then atropine, or cyclopentolate.

Scopolamine and tropicamide are not used for uveitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a contraindication that should be considered when prescribing a cycloplegic for uveitis?

A

narrow angles! and also the stronger cycloplegics are contraindicated in patients with Down syndrome (try to use the weakest ones if required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drop do we use to break posterior iris synechiae?

A

10% phenylephrine, in office only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are other considerations for a uveitis exam?

A

DFE for every anterior uveitis patient same day is required! Have to look for signs of intermediate and posterior uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is the first follow up for uveitis patients?

A

RTC 1-3 days, not much improvement yet, and don’t release the patient once you start tapering the steroid as rebound inflammation may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can we do for prophylaxis for uveitis?

A

Pred Forte may be used in a low dose indefinitely for those with frequent recurrence or chronic disease. 1 drop Pred Forte QD or every other day. Or small dose 10-20mg prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When would you try oral/intra-/peri-ocular injected steroids?

A

when pred forte isn’t enough in moderate to severe non-infectious inflammation, posterior seg involvement (CME), or when the anterior uveitis is resistant to topicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the usual choice and dose for oral steroids for uveitis?

A

0.5-1.5 mg/kg/day followed by taper (about 40-120 mg daily)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the added side effects for steroids injected periocularly (sub-tenon or sub-conj)?

A

sub-conj heme, conj/Tenon scarring, scleral perforation, abscess/infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What steroids are used IVT for uveitis?

A

IVT triamcinolone (IVTA), Triescence or Kenalog
effective for 3 months in non-vitrectomized eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some medium to long-duration implanted steroids?

A

Ozurdex (dexamethasone)
Retisert, Yutiq, Iluvien (flucinolone acetonide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the added side effects for the medium to long-duration implanted steroid options?
higher likelihood of IOP spike, RD, vitreous hemorrhage, endophthalmitis, accelerated cataract formation
26
Ozurdex
FDA approved for posterior uveitis, biodegradable, injected into vitreous, effective for 3-6mo
27
Retisert
fluocinolone acetonide implantable device, FDA approved for posterior uveitis, non-biodegradable, sutured to sclera, effective for 2.5 years, higher sustained daily dose and others
28
Yutiq
fluocinolone acetonide insert, non-biodegradable, injected into vitreous, effective for 3 years, FDA approved for non-infectious posterior uveitis, 2019
29
Iluvien
fluocinolone acetonide insert, non-biodegradable, injected into vitreous, effective for 3 years, FDA approved for DME, but may be used off-label in uveitis
30
Immunosuppressive agents used in uveitis
biologics - infliximab, adalimumab, etanercept antimetabolites - methotrexate, azathioprine, mycophenolate mofetil T-cell inhibitors, alkylating agents
31
Humira (Adalimumab)
TNFa inhibitor, SQ injection, the only systemic non-steroid med FDA approved for non-infectious uveitis (intermediate, posterior, and pan) 2016. typically used alongside steroid therapy for chronic inflammation for RA, JIA and HLA B27 diseases
32
Treatments for infectious uveitis
topical/IVT/po/IV antibiotics, antivirals, antiprotozoans, antifungals, etc.
33
Surgical managment for uveitis
unresponsive to medical tx, or for secondary complications like CME, ERM, RD, hypotony, glaucoma, cataract, vitreous opacification, lens-induced uveitis, endophthalmitis, or for placement of drug delivery system
34
Anterior uveitis symptoms
hyperemia, ocular pain (unique dull pain), photophobia, blurred vision, headache, (rarely asymptomatic)
35
Intermediate/posterior uveitis symptoms
possibly asymptomatic, blurred vision, floaters
36
Case history questions for uveitis
Laterality, timing/nature of onset, associated symptoms (positive and negative), aggravating/relieving factors, previous events
37
uveitis classification for onset
acute: sudden onset <6wks duration chronic: persistent relapse in <3mo after d/c tx recurrent: repeated episodes separated by periods of inactivity without tx >3mo in duration
38
granulomatous uveitis classification
presence of granulomatous signs: mutton fat KPs, Bussaca iris nodules, choroidal granulomas due to granulomatous disease
39
What are the granulomatous diseases that can cause uveitis? (the ones that are capable of causing both gran and non-gran)
Lens-induced, VKH, Sympathetic ophthalmia, Sarcoidosis, Herpes, Intraocular foreign body, TB, Syphilis
40
What are the conditions that can cause uveitis but only non-granulomatous?
Toxoplasmosis, Behcets, Traumatic, MS, Onchocerciasis, Toxocariasis, TINU, JIA, Drug-induced, UGH, HLA-B27 diseases, Bartonella, TASS, Glaucomatocyclitic Crisis, Fuchs heterochromatic iridocyclitis, and Lyme disease
41
When other structures of the eye are involved with anterior uveitis we can refer to them as
Keratouveitis, or sclerouveitis
42
What is the most common form of uveitis (which area in eye)?
Anterior uveitis, includes iritis, iridocyclitis, and trabeculitis
43
Common signs of anterior uveitis
conjunctival injection, AC cells and flare, KPs, iris synechiae, hypopyon, iris nodules
44
Hypopyon
layering/settling of WBCs and protein in inferior AC, grading is based on height (ex. 2mm)
45
What are the 3 types of iris synechiae?
Anterior (iris to cornea), posterior (iris to lens), and peripheral anterior (PAS - iris to TM or peripheral cornea)
46
What secondary complication happens with PAS?
angle closure glaucoma
47
What secondary complications can happen with posterior synechiae?
pupillary block glaucoma and iris bombe
48
What is the difference between Busacca and Koeppe nodules?
Koeppe nodules are on the iris margin and are non-granulomatous, while Busacca iris nodules can be found anywhere on iris surface and are pathognomonic for granulomatous disease
49
What are the signs of intermediate uveitis?
vitritis, pars planitis: vitreous cells, haze, snowbanking (sometimes cells are spillover from AC)
50
What are the possible signs of posterior uveitis
Retinitis/choroiditis: infiltrates, RPE atrophy, window defects, RPE hyperplasia, subretinal fibrosis, optic disc edema, CME, SRD, TRD, retinal vasculitis, angiitis, arteritis, periphlebitis, exudates
51
Panuveitis
inflammation in several ocular structures (AC and vitreous/retina/choroid) must rule out infectious endophthalmitis!
52
Approximately how much of NGAU cases (non-traumatic) are idiopathic (no associated systemic or ocular condition)?
half
53
Uveitis is more likely to be systemic disease-mediated if
bilateral, recurrent, intermediate/posterior seg involved, granulomatous, pediatric, or does not respond to standard therapy
54
Sensitivity definition
the proportion of positives that are correctly labeled as such
55
Specificity definition
the proportion of negatives that are correctly labeled as such
56
Sensitivity formula (not PPV)
Sensitivity = TP/P = TP/(TP+FN)
57
Positive Predictive Value
PPV = TP/(TP+FP)
58
Specificity formula (not NPV)
Specificity = TN/N = TN/(TN+FP)
59
Negative Predictive Value
NPV = TN/(TN+FN)
60
CBC w/diff
combines several tests of the hematologic system, inexpensive, fast, common screening of RBCs, WBCs and platelets
61
Neutrophils/PMNs can show:
acute bacterial infection and trauma
62
Basophils and Eosinophils can show:
allergic or parasitic infection
63
Lymphocytes on bloodwork can show:
chronic bacterial or acute viral infections
64
ESR
sensitive but not specific, test for acute inflammation, injury and infection norms for men is age/2 and for women is (age+10)/2 values >30 are typically abnormal
65
CRP
non-specific inflammation marker, typically should be <1.0 mg/dL
66
CMP
14 tests: glucose, calcium, albumin, total protein, sodium, potassium, CO2, chloride, BUN, creatinine, ALP, ALT, AST liver enzymes, bilirubin
67
ELISA
enzyme-linked immunosorbent assay used to detect organisms that aren't easily cultured HIV, toxo, TB, cocci, VZV, HSV, Lyme, WNV, HBV
68
IgM on ELISA indicates?
recent/active infection
69
IgG in ELISA indicates?
previous infection
70
What are the seronegative spondyloarthropathies associated with causing anterior uveitis?
Psoriatic arthritis, Ankylosing spondylitis, IBD (Crohn's and Ulcerative Cholitis), Reactive arthritis, Non-specific HLA-B27 disease
71
HLA-B27+ percentages:
Highest prevalence in Whites and northern Europeans (~8%) Between 32-50% of all cases of anterior uveitis are HLA-B27+ 6% of the US population is HLA-B27+ 88-90% of those w/ankylosing spondylitis are HLA-B27+ 8% of caucasian have the gene, of these 2% will eventually get spondylitis
72
Systemic features of seronegative spondyloarthropathies
ocular inflammation (anterior uveitis), sacroiliitis with or without spondylitis on x-ray, inflammatroy asymmetric peripheral arthritis primarily in lower limbs, RF negative, ANA negative, strong association with HLA-B27, mucocutaneous lesions, rare cardiac disease
73
Ankylosing spondylitis
most common cause of uveitis among HLA-B27 diseases, young 15-40yo M>F, lower back pain, chronic arthritis of spine and sacroiliac joints, "bamboo spine" deformity
74
What type of uveitis often presents due to ankylosing spondylitis?
unilateral, alternating, recurrent acute anterior uveitis
75
DX and TX for ankylosing spondylitis
DX: SI x-ray, ESR and CRP may also be elevated TX: oral steroid and mydriatic, referral to rheumatology, good repsonse to NSAIDs, also immunosuppressive therapy, physical therapy
76
Psoriatic arthritis
causes NGAU, conjunctivitis, is in 1-2% of the caucasian population DX: clinical suspicion, rheumatology consult TX: corticosteroid, mydriatics, NSAIDs, other immunosuppressive therapy, physical therapy
77
Reactive arthritis
young 15-40yo M>F, systemic triad: urethritis, arthritis, mucocutaneous (mouth and genital) lesions. Ocular: conjunctivitis and NGAU
78
IBD
GI symptoms and arthritis that waxes and wanes, anterior uveitis, episcleritis DX: GI consult, colonoscopy w/biopsy
79
IBD tx
Ocular tx - steroid and mydriatic Systemic tx - immunosuppressive therapy (be careful with NSAIDs as can exacerbate GI symptoms), surgical excision of inflamed bowel, physical therapy
80
Sarcoidosis
multisystem granulomatous disease, non-caseating (skin, eye, lung, lymph node involvement), african descent, F>M, adults, mortality of 3-10% Symptoms: SOB, fever, fatigue, pulmonary granulomas, skin lesions Ocular: dry eye, eyelid/orbital granulomas, uveitis (often anterior granulomatous, and often bilateral)
81
Sarcoidosis testing/dx
elevated serum ACE, elevated serum/urine calcium, abnormal CXR: bilateral hilar lymphadenopathy, abnormal gallium scan (panda and lambda sign), definitive dx w/biopsy showing non-caseating granulomas
82
Sarcoidosis tx
ocular tx: steroid, mydriatic, ATs for dry eye, oculoplastics consult if granulomas affecting lids systemic tx: steroids and other immunosuppressive therapy pulmonology, dermatology, etc.
83
VKH
primarily in darker complexions, 20-40yo, slight F>M, an autoimmune disorder involving multiple systems (ocular, auditory, nervous, and integumentary), often HLA-B22+
84
VKH symptoms and ocular presentation
Ocular: diffuse granulomatous uveitis w/SRD, reccurence common, starts as choroiditis and gets worse, to bilateral panuveitis and SRD, "sunset glow" fundus Prodromal phase: fever, HA, neck stiffness, vertigo Systemic: tinnitus, vitiligo, poliosis, alopecia
85
Behcet disease
relapsing vasculitis/inflammatory disorder, triad: ocular inflammation, oral/genital aphthous ulcers (painful), skin lesions Asian M>F, often HLA-B51+ Tx: systemic steroids limited so need to use other immunomodulatory therapy
86
Behcet disease ocular manifestations
Anterior uveitis with hypopyon, often recurrent but not chronic also possible: retinal vasculitis, retinal hemorrhages, and vein occlusions, mac edema, optic disc edema
87
OIS
characterized by lack of blood flow to the eye, thrombotic in carotid arteries, >50yo with new-onset anterior uveitis, M>F, mild AC reaction (20% of the time), dot and blot hemes, amaurosis fugax, ischemia eventually, TIAs and CVAs
88
OIS tx
OIS uveitis is non-responsive to steroids can do a carotid endarterectomy when benefit outweighs risks
89
Intermediate uveitis DDx
Idiopathic, sarcoidosis, syphilis, Lyme, cat scratch disease, MS, intraocular lymphoma
90
MS associated intermediate uveitis
Often with pars plana snowbanking, demyelinating disease of CNS Dx with MRI 1% of pts with MS will have uveitis 1% of uveitis pts will have MS
91
What percent of all uveitis cases are pediatric?
6%
92
Most pediatric uveitis is:
anterior, non-infectious, due to JIA (95% of non infectious pediatric cases are JIA or other spondyloarthropathies)
93
JIA
Chronic bilateral NGAU (recurrent, often asymptomatic!) oligoarticular JIA at highest risk, RF negative, make up 95% of childhood anterior uveitis, F>M, age 4-16 can present with band keratopathy, and irregular pupil due to posterior synechiae
94
pediatric uveitis prognosis with the presence of synechiae
(+) PS: 58% ended up 20/200 or worse (-) PS: 3% ended up 20/200 or worse ANA+, younger age, and uveitis preceding arthritis is also associated with poorer outcomes
95
Managing JIA uveitis
ANY CHILD with uveitis warrants rheumatology consult pts with chronic anterior uveitis should be seen at least q3mo
96
TINU: Tubulointerstitial Nephritis and Uveitis Syndrome
Bilateral NGAU possible cell-mediated hypersensitivity, F>M, children and young adults, rare systemic: high ESR, proteinuria, increased urinary beta 2 microglobulin, and serum creatinine
97
TINU dx and tx
DX: renal biopsy, nephrology, pediatrics, urinary beta 2 microglobulin TX: topical steroid/cycloplegic, systemic steroids/immunomodulators recurrence in >50% of cases with uveitis
98
Glaucomatocyclitic Crisis
20-50yo, M=F, recurrent, unilateral trabeculitis, mild NGAU, extremely high IOP, mild discomfort, diagnosis of exclusion, tx with IOP lowering drops, corticosteroids QID
99
Fuchs heterochromic iridocyclitis
young adults, M=F, idiopathic, chronic mild unilateral NGAU, stellate KP, smooth iris, heterochromia in later stages, unilateral PSC
100
Lens-induced uveitis
auto-immune type reaction to excessive leakage of lens material, accompanied by ocular hypertension, r/o endophthalmitis! and sympathetic ophthalmia
101
UGH - Uveitis Glaucoma Hyphema Syndrome
triad of anterior uveitis, hyphema, and increased IOP, can be caused by AC-IOL friction against iris or from iris implants
102
What do you assume hyphema is from if no trauma/surgical history?
assume NVI
103
considerations when a patient has hyphema
wait until cleared before doing gonio to look for angle recession, limit physical activity, sleep w/head elevated, manage any ocular HTN, sx management if non-clearing, uncontrolled IOP, or corneal staining
104
Traumatic uveitis
20% of all iritis, young M>F, NGAU Vossius ring, dx: h/o of recent injury tx: cycloplegic, pred acetate 1% QID usually sufficient
105
Vossius ring
pigment on anterior capsule of lens due to severe blunt trauma mimics pigment due to posterior synechiae
106
Endophthalmitis symptoms
redness, sensitivity to light, vision loss, pain (RSVP) INFECTIOUS!
107
managing endophthalmitis
treat empirically, don't wait for confirmation, IVT antibiotics presenting VA is most important prognostic indicator review importance of lid hygiene with patients before surgery!
108
TASS
rare sterile inflammation in the immediate post-op period (12-24hr) after cataract sx tx: topical steroid once endophthalmitis is ruled out, otherwise treat as infectious
109
Sympathetic ophthalmia
rare inflammatory condition in which one eye with penetrating injury or surgery incites an inflammatory response in the other eye. presents as a granulomatous non-necrotizing inflammation in uveal tract of both eyes (bilateral panuveitis)
110
Drug-induced uveitis
bisphosphonates (Bonia and Fosamax), oral fluoroquinolones (moxi), rifabutin, systemic sulfonamides, cidofovir, intradermal vaccines (influenza, hepatitis B, BCG)
111
Immune recovery uveitis
immune response after HIV+ individuals start HAART therapy and CD4+ T-lymphocytes rise. Low-grade vitritis with or without papillitis, CME, ERM
112
Uveitis in pregnancy/breastfeeding
pred forte is not tested in human trials but is expected to be low risk for the fetus due to limited systemic absorption when in doubt call the OB
113
Acute Uveitis (causes summary)
Traumatic, ankylosis spondylitis (not complete)
114
Chronic uveitis (causes summary)
Fuchs heterochromic iridocyclitis, JIA (not complete)
115
Bilateral uveitis (causes summary)
TINU, JIA, sarcoidosis (not complete)

Ocular Disease (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions