1
Q
Anterior Uveitis
A
Inflammation involving anterior uveal tract (iris and/or ciliary body)
2
Q
Intermediate uveitis
A
Vitreous inflammation including pars planitis
3
Q
Posterior uveitis
A
Inflammation involving the retina and/or choroid
4
Q
Panuveitis
A
All uveal structures involved
5
Q
Types of Infectious uveitis
A
Bacterial, viral, fungal, parasitic
6
Q
Iritis
A
- Inflammation of the iris and iridocyclitis
- can involve involve the anterior ciliary body
7
Q
Uveitis Classification, in terms of location, cause and onset
A
Location
- anterior
- intermediate
- posterior
- panuveitis
Cause
- infectious
- non-infectious
- masquerade (neoplastic or non-neoplastic)
Onset
- acute
- recurrent
- chronic
- persistent
8
Q
Acute Anterior Uveitis (AAU) and aetiology
A
- most common presentation
- may be caused by cross reactivity with selective microbial antigens in predisposed individuals
- can be caused by trauma
- can be secondary to bacterial keratitis and scleritis
9
Q
Chronic Anterior Uveitis (CAU)
A
- less common
- commonly bilateral and associated with systemic disease
- variable prognosis
10
Q
Anterior Uveitis Clinical Features
A
- pain
- vision loss
- photophobia
- redness
- watery discharge
- circumlimbal flush
- miosis
- AC cells - suggest inflammatory response
- aqueous flare - amines of of clear fluid
- hypopyon - whitish exudate of inflammatory cells in the inferior AC
- keratic precipitates - deposits on corneal endothelium
- iris nodules
- posterior synechiae
- iris atrophy
- iris neovasc - esp in chronic
- reduced IOP
11
Q
Anterior Chamber Grading for cells
A
0 = <1
0.5+ = 1-5
1+ = 6-15
2+= 16-25
3+ = 26-50
4+ = >50
12
Q
Vitreous Grading of Haze
A
0 = good view of NFL
1+ = Clear disc and vessels but hazy NFL
2+ = disc and vessels hazy
3+ = only disc visible
4+ = disc not visible
13
Q
Anterior Chamber Grading for Flare
A
0 = none
1+ = faint
2+ = moderate
3+ = marked
4+ = intense
14
Q
Anterior Uveitis Management
A
- single episode AAU doesn’t require investigation
- recurrent/bilateral/chronic AAU require investigation
- uveitis screen
- blood tests
- urine sample
- chest x-ray
15
Q
AAU Pharmacological Treatment
A
Topical
- predforte
- maxidex
- cyclopentolate
- atropine
Periocular
- subconj dexamethosone
- subconj betnosol
- subconj mydricaine
Intraocular
- Ozurdex implant
Systemic
- oral steroids
- oral second line immunosuppression
16
Q
Intermediate Uveitis Clinical Features
A
Symptoms
- blurred vision
- floaters
- pain/redness
- photophobia
Signs
- AC cells
- high or low IOP
- cataract
- vitreous cells
- snowballs/snowbanking
- CMO
17
Q
IU investigation
A
- uveitis screen
- flourescein angiography
- AC or vitreous trap
18
Q
IU - viral causes
A
- herpes simplex virus
- varicella zoster virus
- cytomegalovirus
- Epstein Barr virus
19
Q
IU treatment
A
- topical predforte
- maxidex
- cyclopentolate
- atropine
- intraretinal ocular steroid
- antibiotic/antiviral/anti fungal
- systemic steroids
- 2nd line immunosuppression
20
Q
Types of Posterior Uveitis
A
- Retinitis - whitish retinal opacities with indistinct borders
- Choroiditis - round yellow nodule
- Vasculitis - may affect arteries and veins
21
Q
What is Aniridia
A
- bilateral hypoplasia
- ranges from small defect on iris to total loss of iris
- associated with foveal hypoplasia
- glaucoma in 75%
22
Q
Aniridia - Treatment
A
- treat glaucoma
- painted contact lens
- prosthetic iris implant
- cataract surgery
23
Q
What is Axenfield-Reiger syndrome
A
Umbrella term for a group of disorders involving iris and angle malformations
24
Q
Axenfield anomaly
A
- posterior embrytoxon
- peripheraliris strands attached to cornea
- ocular defect caused by abnormal development of anterior segment
- anteriorly placed schwalbes line and iris bands extending to the cornea
25
What is reigers anomaly
- posterior embryotoxon
- iris stromal hypoplasia
- ectropion uvea (iris pigment on anterior eye surface)
- corectopia
- full thickness iris defects
26
Axenfield-Reiger Management
- glaucoma develops in 50%
- surgical interventions for iris abnormalities
- supportive
27
What is Coloboma
- defect resulting from failure of closure of embryologic
- can affect any layer from disc to eyelids
- typically inferonasal Portion of iris
- associated with CHARGE syndrome
- Coloboma
- Heart defects
- choanal Atresia
- Retardation of growth
- Genital abnormalities
- Ear abnormalities
28
Fuchs Hetereocromic Cyclitis (FHC)
- Chronic Non-glaucomtous uveitis
- often asymptomatic - low grade grumbling uveitis
- 90% unilateral
29
Fuchs Heterocromic Cyclitis signs
- iris heterochromia
- Stellate KPs
- mild flare
- iris atrophy
- iris nodules
- cataract
- raised IOP
30
Fuchs Heterochromic Cyclitis Treatment
- observation
- topical steroids for exacerbations
- topical treatment for glaucoma - may need laser/surgery
- cataract surgery
31
Juvenile Idiopathic Arthritis (JIA)
- Most common condition associated with childhood uveitis
- asymptomatic therefore children with arthritis are screened
- uveitis may not be presenting feature of the disease
32
Juvenile Idiopathic arthritis signs
- band keratopathy
- uveitis
- cataract
- glaucoma
33
Juvenile Idiopathic arthritis treatment
- topical treatments often insufficient
- joint treatment with paediatricians and rheumatology
- require immunosuppression
34
CMV retinitis
- usually immunosuppressed pateients
- most commonly seen in HIV patients
- treatment is for the eye but also to prevent infection elsewhere
- HAART therapy
35
What are Acute retinal Necrosis (ARN) and progressive outer retinal necrosis (PORN )
- necrosis of retinal tissue
36
Acute retinal necrosis diagnostic criteria
- one or more foci of full thickness
- peripheral retina location
- rapid progression
- circumferential direction
- occlusive vasculopathy
- prominent AC and vitreous inflammation
- optic neuropathy/atrophy
37
Progressive outer retinal necrosis diagnostic criteria
- multiple foci of deep retinal pacification which may be confluent
- peripheral retina - macular involvement
- extremely rapid progression
- no consistent direction
- no vascular inflammation
- perivenular clearing of retinal opacification
38
Acute retinal necrosis treatment
- intravitreal foscarnet
- IV aciclovir
- Oral Valaciclovir
- Famciclovir
- systemic corticosteroids
- topical corticosteroids
39
Chorioretinitis types
White dot syndromes
- multiple evanescent white dot syndrome
- acute posterior multi focal placoid pigment epitheliopathy
- birdshot chorioretinopathy
- multi focal choroiditis
- serpiginous choroidopathy
40
Uveal Tumours
- iris lesions
- iris nodules
- iris melanomas
- ciliary body melanomas
- choroidal tumours
- choroidal Naevus
41
What are iris lesions
- pigmented usually flat iris lesion
- 15% risk of malignancy
- pupil architecture may be affected
42
What are isis nodules
- can be present in inflammatory conditions and systemic disease
- busacca and koeppe nodules
43
What is iris melanoma, and its risk factors
- similar appearance to melanoma
- can distort iris architecture And pupil margin
- may invade into angle
Risk Factors
- fair skin
- iris naevi
- numerous cutaneous
- sunlight exposure
44
Ciliary Body Melanoma, and its treatment
- difficult to diagnose
- present late with visual symptoms
- same risk factors as iris melanoma
Treatment
- radiotherapy
- enucleation
- chemotherapy if metastasis
45
What is a choroidal Naevus
- incidental finding
- present in 5/10% of population
- change is suspicious
- usually flat
- life long monitoring
46
Choroidal Naevus Signs
- pigmented retina lesion
- over lying drusen
- flat
- depigmented halo
Suspicious signs
- lipofuscin
- symptomatic
- within 3mm of optic disc
- >2mm in height and 5mm in diameter
47
Choroidal Naevus Treatment
- monitor with photography
- 6 months intially then annually
- if concerned then refer to HES
48
What is a Choroidal Melanoma
- most common intraocular malignancy
- same risk factors as iris melanoma
- usually asymptomatic
- metastasis can occur to liver
- mortality at 50% over 10 years
49
Choroidal Melanoma signs
- solitary elevated pigment mass
- collar stud appearance
- lipofuscin
- localised retinal detachment
- Vitiris
- sentinal vessels, rubeosis, choroidal folds
- possibly symptomatic -> suspicious
50
What are Choroidal Dystrophies
- group of inherited disorders affecting choroidal function
- RPE, choriocappilaris and photoreceptors with progressive involvement of larg choroidal vessels
- chorioderemia
- gyrate atrophy
- progressive bifocal chorioretinal atrophy
51
What is Choroideremia, and its signs and symptoms
- progressive, diffuse degeneration of choroid, RPE and photoreceptors
- very poor prognosis
Symptoms
- usually diagnosed in adolescence
- nyctalopia
- reduced peripheral vision
- eventually loss of central vision
Signs
- RPE mottling
- mid-peripheral RPE changes, which spread centrally and peripherally
- end stage
- choroidal vessels run over bare sclera
- retinal arteriolar attenuation
- optic atrophy
52
Choroideraemia - Treatment
- supportive
- LVA
- Blind registration
- gene therapy
53
Gyrate Atrophy
- rare autosomal recessive condition
- enzyme deficiency leads to choroidal atrophy
- legal blindness by age 50
54
Gyrate atrophy signs and symptoms
Symptoms
- nyctalopia
- peripheral field loss
- central field loss
Signs
- Mid peripheral de-pigment spots
- well defined peripheral atrophic patches with scalloped edges
- atrophic lesions eventually coalesce
- fovea lost in later stages
- may develop ER or CMO
55
Gyrate Atrophy Treatment
- Arginine restricted diet
- pyridoxine supplements
- gene therapy research
Clinical Opthalmology
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