How does intermediate uveitis differ in timeframe compared other anterior?
Intermediate is less acute than anterior (it’s subacute/chronic)
What are the additional causes of intermediate uveitis compared to anterior?
Infectious - (TB, syphilis) but also weird things from animals like Lyme disease, Toxocara, and Leprosy
Inflammation - Multiple Sclerosis, IBD, Blau Syndrome
Anterior causes are HBSS
Symptoms and signs of intermediate uveitis?
Asymptomatic OR floaters, blurry vision
Vitreous cells, haze, snow banking, snowballs (complications such as macular oedema, retinal neovascularisation.
What percentage of intermediate uveitis patients develop MS in the long run?
15%
How to treat intermediate uveitis?
Topical steroids not that useful
Subtenon steroids
Systemic steroids
Is posterior uveitis sight-threatening?
Yes
How do the causes of posterior uveitis differ from anterior and intermediate?
Similar infectious causes as anterior but additional fungal (tend to cause chorioretinitis) and protozoal causes
Extra Inflammatory causes to consider are MS, Birdshot chorioretinopathy (HLA-A29), VKH and sympathetic ophthalmia. Sarcoidosis as per AAU.
Lymphoma still masquerading possibility
What are the signs of posterior uveitis?
Retinitis - pale retina
Choroiditis - circular lesions (yellow/white fluffy if active; well de-marcated and possibly pigmented if old)
Retinal vasculitis - venous cuffing (yellow/white sheathing representing periphlebitis), dilatation, occlusion, leakage (haemorrhage) and ischaemia (cotton wool spots)
It’s usually veins affected. If arteries affected, think systemic vasculitides.
What extra investigation might you order in posterior uveitis compared other anterior?
If suspecting MS, head imaging/neuro referral
Birdshot -> HLA-A29
How do you treat posterior uveitis?
If infectious (suspect if immunocompromised - HIV/IVDU/chemo/steroids) -> antimicrobials
If inflammatory -> systemic steroids (topical only useful for anterior uveitis element if present)
What is sympathetic ophthalmia?
Bilateral, rare but life threatening GRANULOMATOUS pan-uveitis following penetrating trauma/surgery to the fellow eye
(ocular immune privilege is lost and body launches attack on fellow eye)
Characteristic signs of sympathetic ophthalmia?
Dalen-Fuch’s nodules (between RPE and Bruch’s membrane)
Mutton Fat KP’s
(+vitritis, AC cells/haze)
Symptoms of sympathetic ophthalmia?
Those of pan uveitis
i.e blurry vision, floaters, pain, photophobia
