What symptoms do you get with MEWDS?
Like all the white-dot-syndromes, patients may describe shimmering photopsias, and a central scotoma (actually an enlarged blind spot). They may also have a mild flu-like prodrome before their visual symptoms.
Is multifocal choroiditis a single event or continuous?
It tends to be recurrent, unlike PIC and MEWDS.
How will multifocal choroiditis look different than POHS?
Multifocal choroiditis patients have more vitritis, often an anterior uveitis, and the inactive lesions are generally smaller than POHS. Also, their histo skin test is normal and they may have an abnormal ERG. Also, these patients typically come from areas that you don’t typically don’t associate with histoplasmosis.
What white dot syndrome shows foveal granularity?
MEWDS.
What disease looks like bilateral macular toxoplasmosis scars?
North Carolina macular dystrophy has impressive macular findings that can look like toxoplasmosis. However, unlike a toxo scar, these patients have pretty good vision, no cells, and a family history.
Differential Diagnoses for Neuroretinitis
- Cat Scratch — Bartonella Henselae
- Lyme disease
- Syphilis
- Toxoplasmosis
- Hypertensive retinopathy
- Tuberculosis
- Polyarteritis nodosa
- Tularemia
- Other causes of edema (pseudotumor cerebri, intracranial arteriovenous malformation)
Sight threatening uveitis
- significant vitritis (BIO grade of 3 or more),
- chorioretinitis affecting the posterior pole and macula,
- central retinal vasculitis (involvement of the optic nerve head),
- occlusive vasculitis, and
- neovascularization—retinal or choroidal.
Which white dot syndrome has CNS abnormalities?
AMPPE can give you a cerebral vascular problem.
Where do you see Busacca nodules?
- Busacca nodules are seen on the iris surface with active granulomatous uveitis.
- Koeppe nodules are seen on the pupil margin and can be found with all types of uveitis.
Active chorioretinitis signs
- ill-defined margin of lesion (as opposed to discrete margins of inactive lesions),
- creamy appearance (as opposed to transparent inactive lesions),
- associated (and often mild) vitritis in posterior vitreous gel (or retrohyaloid space), and
- associated retinal edema.
Descriptors of uveitis by SUN (Standardization of Uveitis Nomenclature)
*Onset : sudden, insidious
*Duration: Limited (<=3mos), persistent (>3mos)
*Course:
Acute :Sudden + Limited
Recurrent: Repeat episodes, inactive period>= 3 mos off treatment
Chronic: Persistent, relapse <3 mos off treatment
Grading of AC cells (counted with 1 x 1 mm slit) according to SUN 2005
0: <1
0.5 +:1-5
1+ :6-15
2+: 16-25
3+: 26-50
4+:>50
Who gets PIC (punctate inner choroidopathy)?
This white dot syndrome is slightly more common women in the third or fourth decades. It’s also associated with myopia.
What’s the most common cause of posterior uveitis in the immuno-competent patient?
Toxoplasmosis is the most common cause with a rate of 25 to 30% of the time. IF you have a posterior uveitis, and aren’t sure of the diagnosis, then toxo is a good guess.
What is Purtscher retinopathy?
This occurs following compression crush injuries to the thorax and head that result in hemorrhaging throughout the retina. The idea here is that the injury is big enough to activate compliment, with leukoembolization that ends up clogging arterioles. You can also get fat emboli from crushing long bones that gives a similar appearance.
Do HLA-B27 diseases give a granulomatous or non-granulomatous iritis?
These syndromes, such as ankylosing spondylitis, Reiter syndrome, and inflammatory bowel disease, give a non-granulomatous iritis.
What blood test might you consider with suspected Behcet’s disease?
You can check for HLA-B51. Not many perform the classic pathergy test … where you inject saline under the skin and have the patient return the next day to check for a blister.
