uveitis

Question 1

what does the uvea consist of?

Answer 1

iris, ciliary body and choroid layer

Question 2

where is anterior uveitis located?

Answer 2

localized primarily to the anterior segment of the eye, involving iris, ciliary body, and pars plicata.

Question 3

where is intermediate uveitis located?

Answer 3

vitreous cavity (hyalitis) and pars plana.

Question 4

where is posterior uveitis localized to?

Answer 4

choroid or retina

Question 5

what are the causes of anterior uveitis?

Answer 5

• most common illnesses associated with AAU are also associated with a genotype known as HLA-B27
• most common association with AAU is ankylosing spondylitis, associated with HLA B27
• Seronegative spondyloarthropathies (a/w HLA-B27): [PAIR] psoriatic arthritis, ankylosing spondylitis, IBD, reactive arthritis
• Sarcoidosis, Behcet’s disease

Infection e.g. hsv, tb, syphilis, candida, toxoplasmosis, cmv, rubella, vzv

Question 6

What are the symptoms of anterior uveitis?

Answer 6

• Red eye and pain
• Photophobia
• Tearing
• Blurry vision (BOV) (corneal oedema, haze in AC, complicated cataract, vitritis, maculoedema (think ant to post))
• Hx of possible systemic disease: joint swelling, joint pain, back pain, rash, urinary symptoms, fever, cough

Question 7

what are the symptoms of acute anterior uveitis?

Answer 7

pain, redness, and photophobia (sensitivity to light), that typically develop rapidly, over a few days, tearing, blurring vision

Question 8

what are the signs of acute anterior uveitis?

Answer 8

• Anterior chamber cell
• Keratic Precipitates: deposits of macrophages on the endothelial surface of the cornea associated with anterior segment inflammation, esp in granulomatous type
• Flare
• Hypopyon
• Iris nodules
• Posterior synechiae
• Fibrin
• Pupillary miosis
• Band keratopathy

Question 9

what are the investigations for anterior uveitis?

Answer 9

• Optical coherence tomography (OCT)
• HLA-B27
• Lumbar spine XR (for ankylosing spondylitis)
• ESR, CRP
• If suspect infective cause: IGRA/TB T spot and CXR (for TB), VDRL & RPR (for syphilis). Toxoplasmosis IgG and IgM. Note TB if recurrent AAU.
• Diagnosis is made by characteristic disease in the setting of known risk factors (HLA-B27), with exclusion of other possible causes.

Question 10

what is the management of anterior uveitis?

Answer 10

• Topical steroids (to reduce inflammation)
• Topical cycloplegic agents, e.g. atropine, cyclopentolate (relieve ciliary spasm & pain)
• mCo-manage associated systemic conditions with RAI (rheumatologist)

Question 11

how would posterior or intermediate uveitis present?

Answer 11

posterior or intermediate uveitis is more likely to be painless but may result in non-specific visual changes, e.g. floaters and reduced visual acuity.

Question 12

what are the causes of pan uveitis?

Answer 12

Inflammatory causes

• Exogenous infections: due to the introduction of organisms into the eye through perforating wound or ulcer.
• Secondary infections: the inflammation of the uveal tract due to its spread from other ocular tissues- cornea, sclera or retina.
• Endogenous infections: bacterial infections such as syphilis, tuberculosis; viral infections such as mumps, smallpox or influenza; and protozoal infections such as toxoplasmosis.

Immune-related inflammation: sensitized ocular tissues excite an immune response on contact with the organisms such as in Behcet syndrome.

Neoplastic causes
Some intraocular malignancies such as retinoblastoma, iris melanoma, and systemic haematological malignancies such as leukemia, lymphoma and histiocytic cell sarcoma can present with features of panuveitis termed ‘masquerade syndromes’.

Traumatic causes

• Blunt or penetrating ocular trauma can produce features of panuveitis.
• Surgical trauma from intraocular procedures such as cataract extraction, trabeculectomy, and vitreoretinal surgery can produce postoperative panuveitis.

Question 13

what are the symptoms of panuveitis?

Answer 13

Pain
Photophobia
Redness
Watery discharge
Blurring of vision
Floaters
Diminution of vision
Flashes of light

Question 14

what are the complications of acute anterior uveitis?

Answer 14

• AAU may have complications such as the formation of posterior synechiae, band keratopathy or a rise in intraocular pressure, which may lead to glaucoma.
• AAU can also cause fluid to accumulate in the portion of the retina responsible for central vision, the macula. This complication is known as cystoid macular edema (CME).
• Patients may also develop a cataract either from inflammation or corticosteroids.