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54 Cards in this Set
- Front
- Back
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Acute Uveitis Signs |
Edema Vasculitis (Periarteritis & Periphlebitis) Presence of WBCs Keractic Precips -Small and fine (non-granulomatous = pathological) -Large and greasy (macrophages) -Fibrinous KP -Retrocorneal membranes = striae due to endo stress) -Fibrin clot = severe ant. uveitis results in damage to iris vessel allowing for fibrin to leak out in AC -HLB 27 --> AS -"Plastic aqueous" |
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Grading Cells and Flare |
Cells Stage I = 10-20 Stage IV = 60-100
Flare Stage II = Noticeable: (lens, iris clear) Stage III = Marked lens and hazy iris (Spidery web) Stage IV = plastic iris |
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Vitreous changes |
"String of pearls" Looks like cataracts Normal = 20/20 Mild = 20/30 Mod = 20/50 Severe = 20/100
Headlight in fog |
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Structural Damage Mild |
Minor Band Keratopathy Low grade cells and flare Pigmentary keratic precipitates Minor iris atrophy |
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Structural Damage Moderate |
Anterior synechiae Posterior synechiae (iris/CBB rotation) Moderate iris atrophy Reversible glaucoma |
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Structural Damage Severe |
Irreversible glaucoma or hypotony due to CB destruction Corneal edema and opacity Pupillary block/ iris bombe (why we dilate to prevent this!) Choroidal scars RD Macular edema, cyst, hole Pthisis bulbi |
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Anterior Uveitis (Mild and Acute), Firm feature, management, assoc. findings |
NO STRUCTURAL DAMAGE! Fine cellular precips AC run up to grade II Management -Steroids and cycloplegia Assoc. findings -Idiopathic -Sarcoidosis |
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Anterior Uveitis (Severe) |
STRUCTURAL DAMAGE! II-IV AC rxn Plasmoid aqueous Associated findings -HLA-B27 = Ankylosing spondylitis
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Ankylosing Spondylitis (Tests, Management) |
Tests -Spinal X-rays and HLA-typing ordered -Neg, repeat 2 years
Management -Cycloplegia -Topical sterotemic NSAIDs for joint diseaseids -Systemic NSAIDs for joint dise |
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Chronic Anterior Uveitis- Fuch's uveitis syndrome |
Chronic low grade non-granulomaous inflammation (unilateral) Keratic Precips Reduced adrenergic innervation leads to iris hypopigmentation
Related infection -60% of FUS patients in Brazil and france show toxo -Rubella antibody
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Juvenile Chronic arthritis (presentation, subtypes) |
Limping, lethargy, flu-like symptoms Persistent joint swell/pain
Females 3-8 -Strong HLA-DR5
Males 9-11 -Strong HLA-B27
Sub-types -Pauciarticular (1-4 joints affected) -Females, HLA-DR5 association -++ANA
Polyarticular (5 or more joints)
Systemic onset (Still's disease)
Ocular Findings -Band keratopathy -Koeppe nodules -Posterior synechiae
Tx -NSAIDs/Aspiring long-term -Methotrexate (lower production of cells) |
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Chronic Anterior Uveitis Management |
Iris atrophy Synechiae Cataracts Endothelial damage Band keratopathy |
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Recurrent Anterior Uveitis (Associated Diseases) |
AS Sarcoidosis Behcet's syndrome SLE
Infections -Lyme, HSV, HZ
HLA-B27 uveitis without arthritis |
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Anterior Uveitis General Management |
Dilate patient Complete fundus exam R/o infections R/o posterior involvement
Drugs Mild-Mod = Pred. acetate 1% 4-6x day or Durexol 0.05% BID-TID Mod-Sever = Pred. acetate 1% q 1-2h or Durezol 0.05% q 2-4 h until responding |
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Anterior Uveitis IOP Management (simple inflammatory open angle IOP, steroid response to glaucoma, glaucoma-cyclitic crisis) |
Simple Inflammatory Open Angle IOP -angle is open, WBC/flare visible in AC -Inc. pigmentation -WBC congestion leads to TM blockage
Steroid response to glaucoma -IOP spike after 1-4 week of steroid use -Reduce steroid dosage such as loteprednol or FML -Change to NSAIDs
Glaucomato-cyltitic crisis -Finnish descent -Unilateral, recurrent, open angle, no synechiae -Tx with timolol, dorzolamide |
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Intermediate Uveitis (with and w/o inferior exudates) |
Intermediate uveitis and inferior exudate -Pars planitis
Intermediate uveitis without inferior exudates -Vitritis and peripheral vasculitis -Infectious diseases
Periphlebitis -"Skip lesions" -Associated with MS |
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Pars Planitis |
20% uveitis in children--> think MS Common symp = floaters Snowball inferiorly Vitritis** Front of eye white and quiet
Tx 1st line- periocular steroids 2nd line- intravitreal steroids 3rd line- oral steroids short term
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Retinitis Overview |
"White, fluffy lesions"--> looks like CWS Between RPE and NFL
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Retinitis: Toxoplasmosis (profile, presentation, management) |
50% of USA exposed 80% of posterior uveitis in Brazil Cat litter, undercooked meat
Presentation -Focal necrotizing tissue -Satellite lesions -Vitritis
Management -ELISA, PCR, hemaglutination (Diagnostic testing)
Triple Therapy -Pyimethamine -Sulfadiazine -Folinic acid |
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Toxocariasis (Profile, patho, diagnostic test, management) |
Profile -Dog ownership highest RF
Patho -Helminthic infection by roundworm
Presentation -Macular granuloma -Peripheral granuloma -Chronic endophthalmitis
UPVAL in younger person (Leukocoria)
Diagnostic Testing -ELISA
Management -Anti-helmithic agents
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Rapidly progressive diffuse retinitis (RPDR)-Acute Retinal Necrosis (ARN) |
Profile -Immunodeficient and healthy adults
Pathogenesis -Herpes virus -CNS reactivation --> active replication virions cause retinitis
Presentation -Starts as anterior uveitis--> posterior -See fluid and exudates leaking out as infiltrates |
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Progressive Outer Retinal Necrosis (PORN) |
Profile -Herpes Zoster, AIDs
Presentation -Multiple break out lesions in retina -Similar to ARM but less vitrifies due to lack of immune system
Management -Intravitreal steroids -Laser therapy |
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Slowly Progressive Retinitis (CMV retinitis) |
Profile -Most common congenital viral infection -Seen in HIV patients
Pathogenesis -Spread via contact bodily fluids -Latent infection T-cells (< 50 cells/mm3)
Presentation -Begin in posterior pole or periphery -PIZZA AND CHEESE
Management -HAART (reduces HIV) -Macula--> gancyclovir |
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Immune Recovery Retinitis |
Patho/Profile -Immune attack on residual antigens from previous CMV retinitis
Presentation -Vitritis -VME -Epiretinal membrane
Management -Anti-CMV treatment -Oral steroids |
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HIV and Ocular Disease (associated disease, HIV retinopathy presentation) |
Associated disease -Karposi's sarcoma -Burkitt's lymphoma
HIV retinopathy -CWS and NFL hemes seen in 70% of HI V infected patients
Management -Single CWS required work-up to R/O HIV -If HIV, begin HAART |
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Retinal Vasculitis: SLE (Profile, Pathogenesis) |
Autoimmune disease of CT with many clinical manifestation (Joint, skin, BV, heart, eyes)
Females 8:1 AA Risk Factors -Genetics, smoking, post-menopausal estrogen supplements
Hx of arthralgia and fever (92%)
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SLE (any 4) |
Butterfly rash Discoid rash Arthritis Oral ulcers Neurologic disorder Anti-nuclear antibody |
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SLE: Presentation |
Cutaneous lesions -Butterfly malar rash -Mucous membrane ulcers -Discoid lupis
Eyes -K-sicca -Scleritis/Episcleritis -Ischemic optic neuropathy |
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SLE: Diagnostic Tests |
CBC - Anemia present 60-80% PTT and PT ANA/ENA non-specific (90% SLE) Tissue biopsy
Management -Systemic- NSAIDs and salicylates -Cutaneous disease- Hydroxychloroquine -Ocular surface- AT, topical steroids, cycloplegics -Ischemic vasculitis- systemic steroidoP |
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Polyarteritis Nodosa: PAN vs ICRVO "severe SLE" (Profile, patho, presentation, management) |
High mortality if not treated Age 40-60 Males> females
Autoimmune vasculitis of small to medium vessels
Presentation -Ischemic organ damage -Eye (<10%) -Rosary bead arteries
DDx -Other causes of periarteritis (SLE, Behcet's sarcoidosis
Tx -Systemic steroids -Cyclophosphamide if pt going to die |
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Periphlebitis: Eales Disease (Profile, Patho, Presentation, Management |
Profile INDIAN
Patho -HLA-B51 association
Presentation -History of floaters -Obliterative periphlebitis -Mid-perphery--> ora serrate
Management -Inactive--> Vit A and C supplementation -Active--> Oral steroids until controlled |
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Frosted Branch Angiitis (Idiopathic vs. Non-Idiopathic) |
Idiopathic -Young Asians -Vitritis -Similar to Eales but more central
Non-idiopathic form -CMV, ARN -Sarcoidosis, MS, SLE -Immune complex driven vasculitis
Treatment -Oral steroids 80-100 mg x 10 days |
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White Dot Syndromes (Below RPE) Overview |
No direct systemic association -Diagnosis of Exclusion -Flu-like symptoms
Complex immune disease -Presumed ocular histoplasmosis -Serpiginous choroiditis
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Multiple Evanescent White Dot Syndrome (MEWDS) |
Profile -Unilateral -Antecedent flu 50% -Myopia common -Orange-grains in macula
Patho -Uncertain -HLA-B51 -Hep A vaccine
Presentation -VA better than 20/50 -Paramacular clusters (Dalmatian spots FFA)
Management -Observe |
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Acute Posterior Multifocal Placoid Pigment Eiptheliopathy (ARMPEE) |
Profile -Flu-like symptoms -80% caucasian
Patho -Hyper immune response
Presentation -SUPVAL or BUPVAL
Creamy plaque-like lesions Scarring in the end FFA- early stage HYPO, late stage HYPER
DDx -Any white dot syndrome
Management -Observation if only ocular involvement -Oral steroids if CNS involvement
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Birdshot Retinochoroiditis |
Profile -Bilateral chorioretinitis -HLA-A29 90%**
Patho -Immune attack on retinal or choroidal antigens
Symp -Decreased CV, nyctalopia, floaters
Presentation -Dense vitritis -Birdshot pattern infiltrates
Management -Active: steroids -Long term: cyclosporine, methotrexate -Investigative: oral tolerization with retinal S antigen
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MC-PIC-DSF |
Profile -PIC = pseudohistoplasmosis -Young myopic females** -Photopsias, scotoma
Patho -Unknown
Presentation -Multi-focal choroiditis = small punched out lesions -PIC = small soft lesions, mimic POHS, no triad! -Diffuse subretinal fibrosis = multifocal chorioretinal infiltrates that coalesce into large lesions and heals with sub retinal fibrosis
Tx -TNF may help |
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POHS (Profile, Patho |
Profile -Most prevalent in USA* -20-25 years
Patho -Fungal infection Histoplasma capsulatum
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Three theories of POHS (Classic, Immune, Autoimmune) |
Classic -Subclinical choroiditis due to infection
Immune -Uveitis due to direct infection but residual fungal antigens persist leading to chronic low grade inflamm CNVM
Autoimmune -Uveitis due to infection by inflammation that alters local tissue antigens |
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POHS: Triad |
CNVM Peripapillary atrophy Chorioretinal scars |
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POHS: DDx |
If active/vitritis, then NOT histoplasmosis |
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POHS: Management |
Anti-VEGF/IVTA Combination PDT and Anti-VEGF/IVTA Monitor fellow eye |
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Serpiginous Choroiditis (3 S's) |
Retinal S antigen Winding Serpentine lesions Due to recurrent placoid lesions (rattle SNAKE print) |
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Serpiginous Choroiditis |
Triple Therapy 1. Cyclosporine A 2. Azathioprine 3. Prednisolone |
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Panuveitis (Behcet's)- Major Criteria |
Oral Ulcer Cutaneous lesions Uveitis--> 60-80% Genital lesions |
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Behcet's (Patho and Presentation) |
HLA-B51 associations Heat shock proteins- cells under sress
Presentation -Recurrent non-granulomatous uveitis is most common finding* -Iris atrophy -Vitritis -Periphlebitis and Periarteritis |
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Behcet's Management (Work up and Tx Anterior and Posterior Uveitis) |
Diagnostic Work-up -HLA-B51, HLA-B27 -Skin pathergy test
Anterior Uveitis -Aggressive steroids and mydriatics Posterior Uveitis -Intravitreal/subtensons capsule steroid injecton -Systemic steroids with slow taper -Colchicine: maintenance therapy |
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Sarcoidosis (Profile, Patho) |
Profile Young adults 20-40 AA 85% show ant segment changes
Pathogenesis -Wide spread non-caseating epithelial cell granuloma -SACE is a barometer of granulomatous activity
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Sarcoidosis (Systemic findings) |
Pulmonary hilar adenopthy: 90% Parotid adenopathy and lacrimal glands--> dry eye and mouth |
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Sarcoidosis (ocular findings) |
Eyelid nodules Conjunctival and lacrimal gland infiltration Periphlebitis--> candle-wax droppings |
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Sarcoidosis (Management) |
Anterior Uveitis -Topical steroids and cycloplegics
Posterior uveitis -Subtenous and steroid depot -Oral steroids
Long-term management -1st line methotrexate -2nd line hydroxychloroquine |
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Tuberculosis (Profile, Patho) |
Profile -Risk Factors--> HIV, immunosuppression
Patho -Primary infection = mycobacterium TB -Post primary infection = hematogenous spread
-Phlycentule, interstitial keratitis, nodosum, iritis |
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TB (ocular signs) |
Arid ulceration of skin mucous membranes Phylctenules Reactive interstitial keratitis Choroiditis |
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TB (management) |
Chest X-day PPD Biopsy of granulomatous tissue Caseating granuloma
Tx -Anterior uveitis--> topica steroids and cycloplegics |
