Uveitis

Question 1

What is Uveitis?

Answer 1

Uveitis/iritis = inflammation of the uveal tract = (iris, ciliary body, and choroid)

• Might be associated with inflammation of nearby tract
• Can be differentiated into Anterior Uveitis (inflammation of the iris + Ciliary body)
• And Posterior Uvieitis ( inflammation of choroid, retina and virtious body)

Question 2

What is the Uvea of the eye?

Answer 2

= Ciliary Body, Choroid and Iris together

Question 3

What is the epidemiology of Uveitis?

Answer 3

• Anterior uveitis is most common type (90% of uveitis) ca. 38-714/100.000
• 5-10% of visual impairment worldwide

Question 4

What is the aetiology of Uveitis?

Answer 4

1. Ideopathic
2. Infectious
3. Non-infectious (autoimmune)

Question 5

What are possibel infectious causes for uveitis?

Answer 5

Mostly Viral:

• HSV
• Herpes zoster Virus
• CMV
• Toxoplasmosis

Question 6

What are possible autoimmune causes for Uveitis?

Answer 6

Normally leading to anterior uveitis

• Seronegative arthropathies
• IBD
• Autoimmune disease/ vasculitis
• Sarcoidosis
• MS
• Non-infectious
  
  • Eye trauma
  • Neoplasm

Question 7

What are risk factors for the development of uveitis?

Answer 7

• Autoimmune disorders/ infections
• Recent eye trauma or surgery
• A personal history of uveitis.
• Aged over 20 years — around 90% of cases of anterior uveitis, with a mean onset of 40 years.
• Having the genetic marker HLA (Human Leukocyte Antigen) -B27

Question 8

What are presenting signs and symptoms of anterior Uveitis?

Answer 8

Normally Unilateral, unless systemic (autoimmune) cause supsected

• Dull, progressive periocular pain
• Might be worse when contracting ciliary muscles e.g. when reading
• Ocular hyperemia (red eye)
• Photophobia
• Decreased visual acuity (blurry vision)
• Increased lacrimation (epiphora)
• An unreactive or distorted pupil (due to the iris sticking to the lens)
• Hypopyon
• Sedimentation of lukocytes at bottom of anterior chamber

Question 9

What are possible signs and symptoms of a posterior uveitis?

Answer 9

• Painless visual disturbances
• Floaters/scotomata
• Decreased Visual accurity

Question 10

What are “ Floaters” or Scotomata?

Answer 10

A collection of deposits in the vitreous body of the retina perceived as spots or strings drifting through the visual field. Easier to see against bright lighting and tend to move away when gazed at directly.

Question 11

Which investigations would you order in a patient with suspected Uveitis?

Answer 11

• Visual acurtiy
  
  • Might be decreased
• Torch light-pupillary reflex
  
  • Photobia?
• Check for any trauma in face/around eye
• Intraocular pressure measuring (Uveitis might lead to closed-angle glaucoma)
• Slid-lamp examination

Question 12

What are possible causes for Ptosis?

Answer 12

Causes we need to know are

• Horners Syndrome
• 3rd Nerve Palsy
• Age
• Myastenia Gravis

Other causes include

• Involutional (i.e. ageing)
• Congenital (if severe, this may obscure the visual axis, preventing a clear retinal image being formed and thus causing amblyopia)
• Mechanical, e.g. eyelid tumour, inflammation with eyelid swelling (e.g. in preseptal or orbital cellulitis) or uncommonly, enophthalmos (e.g. due to orbital fracture)
• Neuromuscular junction (NMJ) disease, e.g. myasthenia gravis. This would typically be variable and fatiguable.
• Myopathy, e.g. chronic progressive external ophthalmoplegia
• Neurological, e.g. third nerve palsy (classically associated with all eye movements reduced except abduction, and an abnormally large pupil), Horner’s syndrome