Uveitis Flashcards
(25 cards)
The uveal tract is composed of the (3)
- Iris
- Ciliary body
- Choroid
Function of the uvea.
provides the blood supply of the eye
Define uveitis.
Uveitis = vasculitis-inflammation of part or all of the uvea which includes the iris, ciliary body and choroid.
- Anterior uveitis = iris and ciliary body involvement.
- Posterior uveitis/chorioretinitis = choroid and retina involvement.
Endophthalmitis =
Panophthalmitis =
Endophthalmitis = inflammation of the inside of the eye and adjacent tissue.
Panophthalmitis = inflammation of intra- and extraocular tissues.
These are uveitis-like direct destruction of uveal tissues or the presence of immune-mediated events associated endogenous causes.
Uveitis – inflammation of part or all of the uvea.
Clinical signs of uveitis. (10+)
- Pain /blepharospasm
- Increased tearing
- Decreased vision
- Conjunctival hyperemia
- Corneal edema +/-corneal vascularization
- Aqueous flare seen with slit lamp biomicroscope
(cloudy aqueous in anterior chamber) and cells - Miosis due to pain
- Iris hyperemia and swelling
- Iris infiltration
- Hyphema - blood in anterior chamber
- Fibrin in anterior chamber
- Hypopyon – pus in anterior chamber
- Keratic precipitates
Keratic precipitates due to uveitis.
Fibrin in anterior chamber due to uveitis.
Clinical signs and complications of chronic uveitis. (8)
- Iris bombe (s)
- Glaucoma
- Cataract formation
- Lens luxation
- Endophthalmitis /panophthalmitis
- Phthisis bulbi/eye atrophy
- Chronic unresponsive to medication inflammation, pain, glaucoma
- Vision impairment
What is an iris bombe?
Adhesion between the iris and the capsule of the
lens of the eye creating a 360 degree area of
adhesion.
Prevents the moving of aqueous from posterior
chamber to the anterior chamber and as result -
glaucoma.
What causes uveitis in cats? (6)
Uveitis results from either ocular or systemic disease or both combined.
- Idiophatic/immune-mediated uveitis (≤70%)
- Trauma like corneal ulcer, perforation of cornea
- Systemic infections: FIV, FeLV, FIP, Toxoplasmosis,
Bartonellosis - Neoplasia in uvea, usually melanoma; systemic lymphoma
- Systemic hypertension
- Very rare: systemic fungal diseses (cryptococcosis,
blastomycosis …)
What causes uveitis in dogs? (7)
- Idiophatic/immune-mediated uveitis (≤70%)
- Trauma – corneal ulcer, perforation of cornea
- Lens-induced
- Systemic neoplasia: lymphoma, hemangiosarcoma, mammary gland carcinoma, osteosarcoma
- Neoplasia in uvea, usually melanoma, adenocarcinama
- Uveodermathological syndrome
- Systemic inf diseases: leptospirosis, borreliosis, erlichiosis, leishmaniasis, dirofillariasis
What is uveodermathological syndrome in dogs?
Uveodermatologic syndrome (UDS) is a rare autoimmune disease in dogs that primarily affects the eyes, skin, and nervous system. Huskies predisposed.
It is caused by the immune system attacking melanocytes, the pigment-producing cells in the body. This results in ocular inflammation (uveitis), depigmentation of the skin, and sometimes neurological symptoms.
Lifelong treatment cause its autoimmune. Big risk of blindness, glaucoma.
What causes uveitis in horses? (4)
- Idiophatic/immune-mediated uveitis (≤70%)
- Trauma – corneal ulcer, perforation of cornea
- Systemic inf diseases: leptospirosis
- Equine Recurrent Uveitis (ERU)
Explain Equine Recurrent Uveitis (ERU)
Equine Recurrent Uveitis (ERU), also known as moon blindness, is a chronic, immune-mediated inflammatory condition affecting the uveal tract of a horse’s eye, leading to repeated episodes of uveitis.
It is the most common cause of blindness in horses and can result from bacterial, viral, parasitic, or autoimmune triggers, with Leptospira infection being a notable risk factor.
ERU causes painful flare-ups characterized by eye redness, tearing, squinting, and sensitivity to light, which progressively damage ocular structures, leading to cataracts, glaucoma, and eventual vision loss.
Management includes anti-inflammatory medications, immunosuppressive therapy, and in severe cases, surgical interventions like vitrectomy or sustained-release cyclosporine implants to reduce recurrence and preserve vision.
Describe Lens-induced uveitis, Phacoclastic uveitis:
a severe, acute form of uveitis that occurs when lens proteins leak into the eye, triggering an intense inflammatory response.
This condition typically results from lens capsule rupture due to trauma or congenital defects, leading to exposure of normally sequestered lens material.
It is characterized by sudden onset of pain, redness, swelling, and potentially severe vision loss. Without prompt treatment, which may include aggressive anti-inflammatory therapy and surgical removal of the damaged lens (lens extraction), phacoclastic uveitis can lead to irreversible ocular damage and blindness.
phacoLYTIC uveitis is different
e.g. cat-claw injury - perforation of cornea
Describe Lens-induced uveitis, Phacolytic uveitis:
is a form of lens-induced uveitis that occurs due to the gradual leakage of lens proteins from a hypermature cataract, triggering a low-grade inflammatory response in the eye.
Unlike phacoclastic uveitis, which results from an acute rupture of the lens capsule, phacolytic uveitis develops more slowly as the lens fibers degenerate and release proteins that the immune system perceives as foreign.
Clinical signs include mild to moderate eye redness, aqueous flare, inflammatory cells in the anterior chamber, and occasional glaucoma due to protein-induced trabecular meshwork obstruction.
Treatment typically involves anti-inflammatory medications to control inflammation, and definitive management often requires cataract removal to eliminate the source of antigenic lens material.
phacoCLASTIC uveitis is different, due to penetrative injury
due to hypermature cataracts
most common infectious cause of uveitis in cats
The most common infectious cause of uveitis in cats is Feline Infectious Peritonitis (FIP), caused by a mutated form of the feline coronavirus.
FIP-associated uveitis occurs due to immune-complex deposition and widespread inflammation, often leading to anterior or posterior uveitis, keratic precipitates, fibrin accumulation, and retinal changes.
Other infectious causes include
Toxoplasma gondii,
Feline Leukemia Virus (FeLV), Feline Immunodeficiency Virus (FIV) (image),
and Bartonella henselae.
Chorioretinitis in dogs is
inflammation of the choroid and retina, often caused by infectious, immune-mediated, or systemic diseases.
Common causes include
Canine Distemper Virus (CDV),
Toxoplasma gondii,
Neospora caninum,
Ehrlichia, and fungal infections like Blastomycosis.
It can also result from immune-mediated conditions or systemic hypertension.
Clinical signs may include vision loss, retinal detachment, hemorrhages, and inflammation seen on ophthalmic examination.
Diagnosis involves fundoscopic examination, blood tests, and imaging, while treatment focuses on addressing the underlying cause and controlling inflammation with corticosteroids or other immunosuppressive drugs.
Pictured: Mydriasis, very slow and incomplete pupillary light reflex, decreases the vision caused by chronic uveitis/ chorioretinitis and retinal detachment (exudate under retina and detachment, 1).
Subretinal hemorrhages in dog (1)
Diagnosis of canine chorioretinitis.
The cause is found by exclusion.
* History
* Clinical signs
* Complete ophthalmic examination with ophthalmoscopy, tonometry, ocular ultrasound
- General examination, incl X-R, ultrasound, blood analysis.
- Specific tests, depend on the species of the animal.
- Aqueocentesis could even be considerd.
Idiophatic/immune-mediated uveitis (≤70%)
Goals of treatment of uveitis (6)
- Reduction and control of inflammation
- Reduction of pain
- Preservation of functional pupil
- Prevention or treatment of secondary glaucoma
- Reduction and control secondary bacterial infections
- Treatment of the cause whenever possible.
The mainstay drug therapy for anterior segment uveitis? (2)
- Topical corticosteroids
Prednisolone acetate (1% or 0.125%) and dexamethasone will penetrate intact corneal epithelium and reach the anterior uveal tract.
- Topical and systemic NSAID’s
Provide less significant immunosuppression, but may be useful if infectious disease is suspected or an uninfected corneal ulcer is present.
NB recent intraocular hemorrhage is a contraindication for NSAID use. And the usual caution is warranted with systemic use of NSAID’s in cats.
The mainstay drug therapy for posterior segment uveitis? (4)
- Systemic corticosteroids for posterior uveitis when more significant immunomodulation is necessary than topical could provide.
Also, when corneal ulceration prohibits their topical use.
NB do not use systemic corticosteroids until infectious etiologies are eliminated.
- Systemic treatment with immunosupressive drugs
(cyclosporine or azathioprine) - Pupil dilation
- AB tx - if systemic disease is suspected. Consider clindamycin (10-25mg/kg PO BID) or doxycycline (5mg/kg PO SID) while diagnostic assays are pending.
