Uveitis

Question 1

what is uveitis?

Answer 1

inflammation of uveal tract

Question 2

what are the 4 types of uveitis

Answer 2

• anterior
• intermediate
• posterior
• panuveitis

Question 3

what are the 2 types of anterior uveitis?

Answer 3

• iritis
• iridocyclitis

Question 4

what part of the eye does iritis affect?

Answer 4

iris

Question 5

what part of the eye does iridocyclitis affect?

Answer 5

iris and anterior ciliary body (pars plicata)

Question 6

aetiology?

Answer 6

• autoimmune
• prior infections (Herpes simplex and zoster etc)
• idiopathic
• trauma/infection

Question 7

what can anterior uveitis be classified as (2 groups)?

Answer 7

Granulomatous
Non- granulomatous

Question 8

what is non-granulomatous uveitis?

Answer 8

• acute onset
• fine KPs
• idiopathic

Question 9

what is granulomatous uveitis?

Answer 9

• chronic
• mutton fat KP’s and iris nodules
• linked to systemic conditions

Question 10

which antigen will you most likely test positive with if you have anterior uveitis?

Answer 10

HLA-B27

Question 11

typical symptoms of anterior uveitis?

Answer 11

• Red eye
• Unilateral (bilateral or alternating if chronic)
• rapid onset (acute)
• moderate-severe dull pain (behind the eye)
• reduced/hazy vision
• photophobic (less when chronic)
• epiphora

Question 12

SIGNS of anterior uveitis

Answer 12

• ciliary flush
• KPs
• cells and flare
• iris nodules (granulomatous)
• miosis
• raised IOPS

Question 13

the larger the KPs…

Answer 13

the more chronic the condition

Question 14

what is kruckenberg’s spindle?

Answer 14

melanin forms a line on central cornea

Question 15

what are cells?

Answer 15

WBCs

Question 16

how do you grade cells?

Answer 16

SUN grading scale:

Question 17

what is flare?

Answer 17

proteins leaked from damaged iris blood vessels - bv = increased vascularity

Question 18

cells + flare =

Answer 18

active inflammation

Question 19

flare with NO cells =

Answer 19

no active inflammation

Question 20

2 types of iris nodules?

Answer 20

• bussaca
• koeppe

Question 21

what are bussaca?

Answer 21

whitish yellow lumps on surface of iris

• internal iris stroma
• GRANULOMATOUS UVEITIS

Question 22

what are koeppe?

Answer 22

cellular aggregates at the pupil border
accumulate pigment over time

Question 23

what are the complications of anterior uveitis?

Answer 23

anterior and posterior synechiae?

Question 24

where are anterior synechiae?

Answer 24

between iris and posterior cornea

Question 25

where are posterior synechiae?

Answer 25

between iris and lens

Question 26

OPTOM MANAGEMENT OF FIRST EPISODE?

Answer 26

urgent (1 week) referral to ophthalmologist if severe pain, reduced VA or raised IOP - SAME DAY - sunglasses for photophobia - cycloplegic to prevent synechiae formation and reduce ciliary spasm - analgesics

Question 27

OPTOM MANAGEMENT OF SUBSEQUENT EPISODES?

Answer 27

- refer back to HES - check IOPs - monitor for ocular complications - near add for cyclo?

Question 28

Opthalmologist management of anterior uveitis?

Answer 28

- cyclopentalate 1% - steroid (dex or prednisolone) - treat any glaucoma or immunosuppression

Question 29

DDs of anterior uveitis?

Answer 29

- scleritis - episcleiris - angle closure glaucoma

Question 30

what is the least common type of uveitis?

Answer 30

intermediate

Question 31

what conditions have a strong link with intermediate uveitis?

Answer 31

Multiple Sclerosis (MS)

Question 32

which parts of the eye are affected in intermediate uveitis?

Answer 32

pars plana extreme periphery of retina choroid

Question 33

symptoms of intermediate uveitis?

Answer 33

- bilateral - floaters - inflam cells / debris in the vit humour - reduced VA - inflam cells in the vit humour - hazy vision

Question 34

signs of intermediate uveitis?

Answer 34

- yellow exudates in peripheral retina - exudates may break off and form snow banks

Question 35

OPTOM MANAGEMENT OF INTERMEDIATE UVEITIS

Answer 35

- refer to HES "soon" (dunno about timescale sorry)

Question 36

Opthalmological management of intermediate uveitis?

Answer 36

- steroid drops - steroid injections - immunosuppressants - vitrectomy

Question 37

what are the complications of intermediate uveitis?

Answer 37

- secondary glaucoma - PSC - vitreous detachment / haem - RD / tears - ONH swelling - macular oedema

Question 38

what is the most common cause of posterior uveitis?

Answer 38

toxoplasmosis

Question 39

signs of posterior uveitis?

Answer 39

retinitis (right) and choroiditis (left) and vasculitis (bottom)

Question 40

OPTOM MANAGEMENT OF POSTERIOR UVEITIS

Answer 40

referral to HES "soon"

Question 41

what parts of the eye does panuveitis affect?

Answer 41

UVEA = iris + ciliary body + choroid retina vitreous humour

Question 42

what's the difference between hypopyon and hyphema?

Answer 42

hypopyon = WBCs in AC hyphema = RBCs in AC