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52 Cards in this Set
- Front
- Back
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Acute nongranulomatous iritis and iridocyclitis - List the noninfectious etiologies
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1. HLA-B27 related diseases
2. TINU 3. Glaucomatocyclitic crisis 4. Lens-associated uveitis 5. Post-op inflammation 6. Drug-Induced |
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HLA-B27 related diseases - list
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1. Ankylosing spondylitis
2. Reiter syndrome 3. IBD 4. Psoriatic arthritis |
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Chronic anterior uveitis - List the etiologies
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1. JRA/JIA
2. Fuch's heterochromic iridocyclitis 3. Idiopathic |
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HLA-B27:
What chromosome? |
Ch.6p
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HLA-B27:
% + in general population? % + in patients with acute iritis? % + in pts with ankylosing spondylitis? Chance that + patient develops ankylosing spondylitis or eye disease? % + in Reiter syndrome? |
1.4% - 8% of general population
50% - 60% of pts with acute iritis 90% of pts with ankylosing spondylitis 1/4 develop AK or eye disease 85% - 95% of Reiter syndrome pts |
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Ankylosing spondylitis:
Systemic findings and symptoms? |
lower back pain and stiffness after inactivity
sclerosis and narrowing of joint space on sacroiliac films ligamentous ossification pulmonary apical fibrosis aortitis (5%) --> aortic valvular insufficiency |
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Ankylosing spondylitis:
Treatment |
NSAIDS (mainstay)
Sulfasalazine - decreases morning stiffness and ESR - reduces frequency of recurrences of iritis |
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Reiter syndrome:
Classic triad? Major diagnostic criteria? (2) Minor diagnostic criteria? |
1. nonspecific urethritis
2. polyarthritis 3. conjunctival inflammation often + iritis 1. keratoderma blennorrhagicum 2. circinate balanitis 1. plantar fasciitis 2. Achilles tendonitis 3. sacroiliitis 4. nailbed pitting 5. palate ulcers 6. tongue ulcers |
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Reiter syndrome:
Patient demographics? |
young adult male (90%)
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Reiter syndrome:
Triggers? |
diarrhea or dysentery without urethritis
Chlamydia Ureaplasma urealyticum Shigella Salmonella Yersinia |
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Reiter syndrome:
Describe arthritis onset and pattern? |
arthritis within 30 days of infection in 80% pts
asymmetrically affects knees, ankles, feet, wrists 70% with sacroiliitis |
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Reiter syndrome:
Classification based on sensitivy/specificity |
Episode of arthritis >1 mo with urethritis and/or cervicitis = 84.3% sens./98.2% spec.
Episode of arthritis >1mo and either urethritis or cervicitis or b/l conjunctivitis = 85.5% sens/96.4% spec Episode of arthritis >1mo, conjunctivitis, and urethritis = 50.6% sens/98.8% spec |
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Reither syndrome:
What is the most common eye lesion? |
conjunctivitis - mucopurulent and papillary
+/- punctate and subepith keratitis 5-10% acute nongranulomatous iritis |
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IBD:
What % get iritis in each? |
UC: 5-12%
Chron's: 2.4% |
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IBD:
How many are HLA-B27+? What is typical of pts with IBD and iritis vs sclerouveitis? |
Of all IBD pts, 20% have sacroiliitis, of these 60% are HLA-B27+
Pts with BOTH acute iritis and IBD tend to be HLA-B27 (+) and get sacroiliitis Pts with sclerouveitis and IBD tend to be HLA-B27 (-) and symptoms of RA without sacroiliitis |
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Psoriatic arthritis:
What % develops iritis? What are the distinct clinical features of iritis in this syndrome? |
7-25% develop acute iritis
mean age of onset is older (48y/o vs 30s) bilateral longer duration requires po NSAIDS retinal vasculitis, CME, and papillitis are common |
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Psoriatic arthritis:
What are the systemic associations/findings? |
20% have sacroiliitis
increased frequency of IBD typical cutaneous changes terminal phalangeal joint inflammation ungual involvement |
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Tubulointerstitial nephritis uveitis (TINU):
Patient demographics? What are the HLA associations? |
1. adolescent girls (11-20)
2. women in early 30s HLA-DQ in N. Am. Caucasians HLA-DR14 in Spanish pt |
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TINU:
Presenting ocular symptoms/findings? |
redness
variable pain photophobia blurred vision more severe in recurrent disease - can develop hypopyon posterior segment: diffuse vitreous opacities, ON swelling, retinal exudates Systemic symptoms usually precede ophthalmic |
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TINU:
Diagnostic criteria? |
1. abnl serum Cr or ⇓CrCL
2. abnl UA with ⇑β₂ microglobulin, proteinuria, + eos., pyuria/hematuria, wbc casts, normoglycemic glucosuria 3. associated systemic illness with fever, wt. loss, anorexia, fatigue, arthralgias, myalgias; +/- abnl LFT, eosinophilia, ⇑ESR |
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Glaucomatocyclitic crisis
What is the eponym? |
Posner-Schlossman syndrome
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What is the HLA molecule associated with glaucomatocyclitic crisis?
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HLA-B54
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What are the presenting symptoms/findings in glaucomatocyclitic crisis?
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unilateral, mild, acute iritis
vague symptoms: discomfort, halos, blurred vision ⇑⇑IOP K edema fine KPs low-grade C/F slightly dilated pupil |
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What is the natural course of glaucomatocyclitic crisis?
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episodes = hrs-days
common to recur for years |
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What is the treatment for glaucomatocyclitic crisis?
What should be avoided? |
topical corticosteroids
antiglaucoma meds avoid pilocarpine (exacerbates ciliary spasm) |
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What are the clinical findings in lens-associated uveitis?
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granulomatous or nongranulomatous
KP maybe small or large mild AC rxn - hypopyon common post. synechiae elevated IOP ant vit inflamm is common |
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What are the histopathologic findings in lens-associated uveitis?
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zonal granulomatous inflam centered at the site of lens injury
neuts on lens, surrounded by lymphs, plasma cells, epithelioid cells, occ giant cells |
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What is phacolytic glaucoma?
What are the clinical findings? |
clogging of TM by lens protein and macrophages
⇑⇑IOP refractile bodies in AC (lipid-laden macrophages) no synechiae |
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What does an AC tap show in phacolytic glaucoma?
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swollen macrophages
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What are the causes of delayed-onset post-op uveitis?
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Propionibacterium acnes
Staph epidermidis Candida |
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What are the mechanisms of IOL-associated post-op uveitis?
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surgical manipulation breaks down blood-aqueous barrier
IOL activates complement cascade iris chafing by IOL - esp metal-loop lenses/poorly polished lenses (<1% in modern IOL) ACIOL/iris supported lens can touch cornea |
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What are the clinical findins of IOL-associated uveitis?
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mild inflam - UGH
cellular deposits on IOL synechiae capsular opacification ant. capsule phimosis |
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What caused UGH syndrome in the past?
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irritation of iris root by warped footplates of rigid ACIOLs
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List the causes of drug-induced uveitis.
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Systemic:
rifabutin bisphosphonates sulfonamides diethylcarbamazine (antifilarial agent) OCPs Topical: metipranolol (nonselective adrenergic blocking agent) antichlinesterase inhibitors prostaglandin F2 alpha analogs Intravitreal: antibiotics urokinase cidofovir Vaccines: BCG PPD flu |
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Define chronic anterior uveitis.
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inflammation of the AC that is persistent and relapses in <3mo after d/c tx
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What are the common clinical features of chronic ant. uveitis?
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insiduous onset
variable amt of symptoms unilateral or bilateral amount of inflammation is variable CME common |
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What are the 3 types of JRA/JIA?
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1. systemic onset (Still disease)
2. polyarticular onset 3. pauciarticular onset |
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Systemic onset JRA/JIA (Still disease)
clinical features what % of JRA/JIA % with uveitis |
< 5y/o
fever, rash, LAP, hepatosplenomegaly none-min joint involvement 20% of all JRA/JIA < 6% get uveitis |
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Polyarticular onset JRA/JIA.
clinical features what % of JRA/JIA % with uveitis |
≥ 5 joints in first 6 wks
40% of all JRA/JIA 7-14% of JRA/JIA associated uveitis +RF = no uveitis |
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Pauciarticular onset JRA/JIA.
clinical features % with uveitis |
≤ 4 joints in first 6 wks or no Sx
80-90% of JRA/JIA patients with uveitis |
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What are the 2 types of pauciarticular JRA/JIA?
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Type 1 dz:
girls < 5 y/o + ANA 25% get chronic iridocyclitis Type 2 dz: older boys 75% HLA-B27 + later develop seronegative spondyloarthropathy acute and recurrent uveitis |
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What are the risk factors for developing chronic iridocyclitis in JRA/JIA?
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female
pauciarticular onset +ANA - RF |
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What are the clinical features of JRA/JIA uveitis?
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5-7 yrs after joint dz
no correlation with joint inflamm. mild-mod pain, photophobia, blurred VA fine KP band keratopathy C/F post synechiae cataract |
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What is the treatment of JRA/JIA associated uveitis?
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topical/periocular steroids
avoid systemic steroids NSAIDS can reduce steroid dose low-dose MTX pars plana lensectomy and vitrectomy for CE |
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What are the signs/symptoms of Fuch's heterochromic iridocyclitis?
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unilateral
ASx - mild blurring and discomfort diffuse iris stromal atrophy with variable pigment epith. layer atrophy diffuse, small, white, stellate KPs AC and ant vit cells lighter iris in involved eye |
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What other condition presents with fine, diffuse KP?
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herpetic keratouveitis
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What are the common and uncommon complications?
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common:
glaucoma cataracts angle vessels may bleed in glaucoma surgery uncommon: CME synechiae |
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What is the treatment for Fuch's heterochromic iridocyclitis?
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none
steroids reduce inflam, but do not resolve it cycloplegics are not indicated |
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What is found in the ciliary body on histopath in Fuch's heterochromic iridocyclitis?
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plasma cells
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What is the screening schedule for pauciarticular JRA/JIA?
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if < 7 y/o at onset:
+ ANA Q3-4 mo if no uveitis after 4 yrs --> Q6mo - ANA Q6 mo if no uveitis after 7 yrs --> yearly if 7+ y/o at onset: + ANA or - ANA Q 6mo if no uveitis after 4 yrs --> yearly |
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What is the screening schedule for polyarticular JRA/JIA?
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if < 7 y/o at onset:
+ ANA Q3-4 mo if no uveitis after 4 yrs --> Q6mo - ANA Q6 mo if no uveitis after 7 yrs --> yearly if 7+ y/o at onset: + ANA or - ANA Q 6mo if no uveitis after 4 yrs --> yearly |
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What is the screening schedule for systemic JRA/JIA?
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Q 12 mo regardless of age of onset
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