Panuveitis

Question 1

Vogt–Koyanagi disease

Answer 1

skin changes and anterior uveitis

Question 2

Harada disease

Answer 2

neurological features and exudative retinal detachments

Question 3

VOGT–KOYANAGI–HARADA - phases

Answer 3

Prodromal (CNS, auditory), Acute uveitic (Bilateral granulomatous anterior and multifocal posterior uveitis), Convalescent (skin, depigmented fundus)

Question 4

sunset glow

Answer 4

depigmented fundus in Convalescent phase VKH. Also residual chorioretinal scarring in Sympathetic ophthalmitis

Question 5

Diagnostic criteria for VKH

Answer 5

1. Absence of a history of penetrating ocular trauma 2. Absence of other ocular disease entities 3. Bilateral uveitis 4. Neurological and auditory manifestations 5. Integumentary findings, not preceding

Question 6

CSF in VKH

Answer 6

transient lymphocytic pleocytosis and melanin-containing macrophages

Question 7

secondary Frosted branch angiitis

Answer 7

cytomegalovirus retinitis, lymphoma, leukaemia

Question 8

primary Frosted branch angiitis

Answer 8

idiopathic, children and young adults. bilateral

Question 9

Multifocal choroiditis and panuveitis

Answer 9

bi, asymmetrical, chronic/recurrent, young and middle females, anterior 50%, vitritis, Multiple discrete, ovoid, yellowish-grey. CNV 25-35%, CMO. VF large defects

Question 10

Punctate inner choroidopathy

Answer 10

myopic women, bi sequentially, small yellow–white macular spots, CNV 40%, serous RD

Question 11

Lyme disease

Answer 11

• Uveitis is relatively uncommon but can be anterior (granulomatous or non-granulomatous), intermediate (the most common), or posterior including multifocal choroiditis, vasculitis and neuroretinitis.
• Other manifestations include early (stage 1) transient conjunctivitis, bilateral stromal keratitis, episcleritis, scleritis, orbital myositis, optic neuritis, papilloedema and ocular motor and facial nerve palsy (up to 25% of facial nerve palsy in endemic areas).

Question 12

Acquired syphilis

Answer 12

• Anterior may be granulomatous or non-granulomatous and is bilateral in 50%. Roseolae are dilated iris capillaries • Chorioretinitis is often multifocal, bilateral and associated with vitritis • Acute syphilitic posterior placoid chorioretinopathy • Retinitis • Optic neuritis and neuroretinitis

Question 13

Tuberculosis

Answer 13

• Anterior uveitis granulomatous; iris nodules may be present. • Vitritis • Choroidal granuloma • Choroiditis typically multifocal and in a centrifugally spreading serpiginous • Retinal vasculitis is preferentially venous

Question 14

fluffy ‘cotton ball’ or ‘string of pearls’ colonies

Answer 14

Endogenous Candida endophthalmitis

Question 15

Sympathetic ophthalmitis - what time

Answer 15

between 2 weeks and 3 months after initial injury in 65%.

Question 16

Dalen–Fuchs nodules

Answer 16

granulomas located between Bruch membrane and the RPE

Question 17

Sympathetic ophthalmitis - how often relapse

Answer 17

50%

Question 18

Sympathetic ophthalmitis - FA

Answer 18

multiple foci of leakage at the level of the RPE, with subretinal pooling in the presence of exudative retinal detachment

Question 19

Sympathetic ophthalmitis - ICGA

Answer 19

hypofluorescent spots in active disease, which resolve with treatment

Question 20

LENS-INDUCED UVEITIS - other names

Answer 20

phacogenic (previously phacoanaphylactic)

Question 21

LENS-INDUCED UVEITIS - features

Answer 21

• Anterior uveitis is granulomatous • Corneal oedema is common adjacent to an anterior chamber lens fragment • IOP is frequently elevated. • Vitritis of variable severity is usually present if lens fragments lie within the vitreous cavity

Question 22

Sarcoidosis - most common presentation

Answer 22

granulomatous anterior uveitis

Question 23

Sarcoidosis - ocular inflammation features

Answer 23

1. ‘Mutton fat’ KPs and/or small granulomatous KPs and/or iris nodules 2. Trabecular meshwork (TM) nodules and/or tent-shaped PAS 3. Vitreous opacities: snowballs and/or ‘strings (sznury) of pearls’. 4. Multiple chorioretinal peripheral lesions - uncommon 5. Nodular and/or segmental periphlebitis (± ‘candle wax drippings’ - Perivenous exudates) and/or retinal macroaneurysm 6. Optic disc nodule(s)/granuloma(s) and/or solitary choroidal nodule. 7. Bilaterality. 8. conjunctival nodules, lacrimal gland infiltration, dry eye, eyelid skin nodules, orbital and scleral lesions

Question 24

Sarcoidosis - 5 significant investigations

Answer 24

1. Negative tuberculin skin test in a BCG-vaccinated patient or in a patient having had a positive tuberculin skin test previously. 2. Elevated serum ACE levels and/or elevated serum lysozyme 3. Chest X-ray showing bilateral hilar lymphadenopathy (chest abnormal in 90%), 4. Abnormal liver enzyme tests. 5. Chest CT scan in patients with a negative chest X-ray result

Question 25

Definite ocular sarcoidosis

Answer 25

biopsy-supported diagnosis in the presence of a compatible uveitis

Question 26

Presumed ocular sarcoidosis

Answer 26

biopsy not done but chest X-ray shows BHL (bilateral hilar lymphadenopathy) with a compatible uveitis

Question 27

Probable ocular sarcoidosis

Answer 27

biopsy not done, no BHL on chest X-ray but >3/7 of the intraocular signs above and >2/5 positive laboratory tests

Question 28

Possible ocular sarcoidosis

Answer 28

lung biopsy negative but >4/7 signs and >2/5 positive laboratory tests

Question 29

BEHÇET DISEASE - age

Answer 29

third decade

Question 30

BEHÇET DISEASE - which vessels

Answer 30

Vasculitis (small, medium and large veins and arteries)

Question 31

BEHÇET DISEASE - criteria

Answer 31

recurrent oral ulceration (at least three times in a 12-month period plus at least two of genital ulceration), ocular inflammation, characteristic skin lesions (erythema nodosum, pseudofolliculitis, acneiform nodules, papulopustular lesions) and a pathergy reaction: pustule 24–48 hours after a sterile needle prick (>95% specific). Other: aneurysms, arthritis

Question 32

BEHÇET DISEASE - uveitis features

Answer 32

AAU, often bilateral, is typical. It is not granulomatous. A transient mobile hypopyon in a relatively white eye • Vitritis • Retinitis. Transient superficial white infiltrates that heal without scarring may be seen

Question 33

Toxoplasmosis - definitive host

Answer 33

cat

Question 34

Toxoplasmosis - intermediate hosts

Answer 34

mice, livestock, birds and humans

Question 35

Toxoplasmosis - the average age of presentation

Answer 35

29 years

Question 36

Toxoplasmosis - pregnancy

Answer 36

may provoke the recurrence

Question 37

Toxoplasmosis - uveitis features

Answer 37

• ‘Spill-over’ (rozprzestrzeniający się) anterior uveitis (granulomatous or resemble Fuchs) • A single inflammatory focus - Lesions tend to involve the posterior pole • Vitritis - ‘Headlight in the fog’ • Vasculitis may be arterial, but is more commonly venous • Optic disc oedema is common • Neuroretinitis - acutely acquired rather than reactivated infection

Question 38

average number of recurrent attacks of Toxoplasmosis

Answer 38

2.7

Question 39

Toxoplasmosis - Serology

Answer 39

Toxoplasma IgG antibodies are detectable in the serum within 1–2 weeks of initial infection. Positivity to IgM antibodies usually means that infection has been acquired within the last year

Question 40

Goldmann–Witmer coefficient

Answer 40

Ocular fluid antibody assessment. Calculating the ratio (Goldmann–Witmer coefficient) of specific IgG in aqueous humour to that in serum

Question 41

Toxoplasmosis - treatment

Answer 41

Prednisolone (1 mg/kg) is given initially and tapered according to clinical response, but should always be used in conjunction with a specific anti-Toxoplasma agent, most frequently pyrimethamine combined with sulfadiazine (‘classic’ or ‘triple’ therapy, sometimes supplemented with clindamycin). Some authorities start steroids only after 24–48 hours of antimicrobial therapy.

Question 42

Toxocariasis - how infestation

Answer 42

ingestion of soil or food contaminated with ova shed in canine faeces

Question 43

Toxocariasis - forms

Answer 43

○ Chronic endophthalmitis (include anterior uveitis, vitritis, chorioretinitis, papillitis and a fundus granuloma) ○ Posterior pole or peripheral granuloma without inflammation - older child or adult

Question 44

Onchocerciasis - forms

Answer 44

• Anterior uveitis • Keratitis • Chorioretinitis • Optic neuritis

Question 45

VKH - what ethnic groups

Answer 45

Asian-Indians, Hispanics, Native Americans, Middle Easterners

Question 46

Chronic recurrent stage of VKH

Answer 46

granulomatous anterior uveitis, KPs, iris nodules, posterior synechiae, iris atrophy

Question 47

Owl's eye

Answer 47

inclusion bodies in CMV

Question 48

Langerhans giant cell

Answer 48

mostly tuberculosis, may also sarcoidosis

Question 49

IBD

Answer 49

sclerouveuitis HLA B-B27 (-). B27(+) sacroilitis. intermediate uveitis B27(-)

Question 50

Measles (rubeola) - basic

Answer 50

3 C's: cough, coryza, conjunctivitis

Question 51

Measles (rubeola) - ophthalmic

Answer 51

conjunctivitis, retinopathy (edema, macular star, optic disc swelling, narrowed arterioles, intraretinal hemor). When subsides: bone spicules, salt-and-pepper

Question 52

Which organisms are associated with the best prognosis in endophthalmitis

Answer 52

coagulase-negative staphylococci

Question 53

Which organisms are associated with the worst prognosis in endophthalmitis

Answer 53

Enterococci

Question 54

Primary intraocular lymphoma - diagnosis

Answer 54

IL10:IL6 >1,0 . Myeloid Differentiation Primary Gene 88 (MYD88) mutation. kappa:lambda light-chain ratio of >3 or <0.6 - marker of monoclonality

Question 55

Can present with hypopyon

Answer 55

Behcet, HLA-B27, Rifabutin, lymphoma, TASS

Question 56

candle-wax drippings

Answer 56

peri-venous exudates in sarcoidosis

Question 57

best screening test for sarcoidosis

Answer 57

Chest X-Ray

Question 58

IBD

Answer 58

sclerouveuitis HLA B-B27 (-). B27(+) sacroilitis. intermediate uveitis B27(-)