Uveitis

Question 1

Anterior uveitis involves inflammation of the anterior uvea, also called the vascular tunic/layer. The uvea is composed of 3 parts:

• iris
• choroid
• ciliary body

What is the incidence of uveitis?

1 - 4 cases per 100,000
2 - 40.00 cases per 100,000
3 - 400 cases per 100,000
4 - 4000 cases per 100,000

Answer 1

2 - 40.00 cases per 100,000

Equally likely in males and females

Question 2

What is age does the peak incidence of uveitis typically occur?

1 - >65
2 - 40-50
3 - 30-40
4 - 20-30

Answer 2

3 - 30-40

Question 3

The choroid is part of the uvea. Which 2 layers of the eye does the choroid sit between?

1 - lens and sclera
2 - sclera and retina
3 - cornea and lens
4 - retina and lens

Answer 3

2 - sclera and retina

Question 4

There are 3 main types of uveitis:

• anterior uveitis
• posterior uveitis
• intermediate uveitis

Which of these 3 accounts for 75-90% of uveitis?

Answer 4

• anterior uveitis

Question 5

Is uveitis typically uni or bilateral?

Answer 5

• unilateral

Question 6

Anterior uveitis can be caused by a number of factors, but which is often the most common?

1 - infection
2 - idiopathic
3 - autoimmune
4 - ischaemia or malignancy
5 - trauma

Answer 6

3 - autoimmune

Typically the anterior chamber becomes infiltrated by neutrophils, lymphocytes and macrophages.

Hypopyon refers to a fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.

Question 7

Autoimmune causes are among the most common causes of uveitis. Which of the following autoimmune conditions is NOT typically associated with uveitis?

1 - Seronegative ankylosing spondylitis
2 - reactive arthritis
3 - T1DM
4 - inflammatory bowel disease
5 - sarcoidosis
6 - Behçet’s disease

Answer 7

3 - T1DM

Question 8

Which major histocompatibility complex (MHC) molecule present in a number of conditions is linked to causing uveitis?

1 - HLA-B27
2 - HLA-DRB1
3 - HLA-DQA1
4 - HLD-DR2

Answer 8

1 - HLA-B27

Common in ankylosing spondylitis and reactive arthritis

Question 9

Which of the following pathogens has the weakest, if any link with uveitis?

1 - herpes simplex virus (HSV)
2 - hepatitis B
3 - varicella-zoster virus (VZV)
4 - cytomegalovirus (CMV)

Answer 9

2 - hepatitis B

Question 10

Does uveitis typically have an insidious onset or acute onset?

Answer 10

• acute

Question 11

In uveitis, is there any change in visual acuity?

Answer 11

• yes

Typically because of the Hypopyon refers to a fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.

Question 12

Patients typically present with which of the following if they have uveitis?

1 - Painful red eye (typically a dull, aching pain)
2 - Reduced visual acuity
3 - Photophobia (due to ciliary muscle spasm)
4 - Excessive lacrimation (tear production)
5 - all of the above

Answer 12

5 - all of the above

Question 13

When suspecting a patient uveitis, which of the following examination findings would not likely be present?

1 - Ciliary flush
2 - Dilated but unresponsive pupil
3 - Abnormally shaped pupil
4 - Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

Answer 13

2 - Dilated but unresponsive pupil

Typically miosis, a constricted pupil is present due to sphincter muscle contraction

Ciliary flush = ring of red spreading from the cornea outwards

Abnormally shaped pupil is due to posterior synechiae (adhesions) pulling the iris into abnormal shapes

Question 14

What is the term used to describe an abnormally shaped pupil in uveitis?

1 - episcleritis
2 - dendritic ulcer
3 - posterior synechiae
4 - nodular scleritis

Answer 14

3 - posterior synechiae Iris

Caused by attachments to the lens known as posterior synechiae gives rise to irregular shaped iris

Question 15

Depending on the cause of the uveitis, a variety of tests need to be performed following an eye examination. Which of the following would NOT typically be performed?

1 - antibody testing
2 - serologic tests for STIs
3 - quantiFERON-TB Gold for tuberculosis
4 - autoimmune markers, such as HLA-B27, antinuclear antibody (ANA), and rheumatoid factor
5 - eye biopsy

Answer 15

5 - eye biopsy

Not performed

Question 16

The initial aim when treating uveitis is to control inflammation, relieve pain, and prevent complications. All of the following can be used when treating uveitis, but which is 1st line?

1 - topical corticosteroids (e.g., prednisolone acetate 1% or dexamethasone 0.1%)
2 - topical cycloplegics (e.g., tropicamide or homatropine)
3 - oral corticosteroids or immunosuppressive agents (e.g., methotrexate, azathioprine, or mycophenolate mofetil)
4 - antimicrobial therapy
5 - interdisciplinary collaboration

Answer 16

1 - topical corticosteroids (e.g., prednisolone acetate 1% or dexamethasone 0.1%)

Given as eye drops

Question 17

The initial aim when treating uveitis is to control inflammation, relieve pain, and prevent complications. All of the following can be used when treating uveitis, but which is used to help stop ciliary spasm and pain, reduce the risk of posterior synechiae, and maintain the depth of the anterior chamber?

1 - topical corticosteroids (e.g., prednisolone acetate 1% or dexamethasone 0.1%)
2 - topical cycloplegics (e.g., tropicamide or homatropine)
3 - oral corticosteroids or immunosuppressive agents (e.g., methotrexate, azathioprine, or mycophenolate mofetil)
4 - antimicrobial therapy
5 - interdisciplinary collaboration

Answer 17

2 - topical cycloplegics (e.g., tropicamide or homatropine)

Causes paralysis of pupillary muscle causing dilation of the pupil

Question 18

The initial aim when treating uveitis is to control inflammation, relieve pain, and prevent complications. All of the following can be used when treating uveitis, but which is used if the patient is having a severe flare up of an autoimmune condition and uveitis is just a part of this?

1 - topical corticosteroids (e.g., prednisolone acetate 1% or dexamethasone 0.1%)
2 - topical cycloplegics (e.g., tropicamide or homatropine)
3 - oral corticosteroids or immunosuppressive agents (e.g., methotrexate, azathioprine, or mycophenolate mofetil)
4 - antimicrobial therapy
5 - interdisciplinary collaboration

Answer 18

3 - oral corticosteroids or immunosuppressive agents (e.g., methotrexate, azathioprine, or mycophenolate mofetil)

Question 19

According to NICE guidelines, patients with potentially life threatening causes of red eye should be seen how quickly by an opthamologist?

1 - same day assessment
2 - <24h
3 - <48h
4 - <1 week

Answer 19

1 - same day assessment