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93 Cards in this Set
- Front
- Back
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inflammation of the anterior uvea
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anterior uveitis
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critical sign of uveitis
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cells and flare in the AC
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small dry discrete white blood cells on the corneal endothelium
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nongranulomatous keratic percipitates
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large wet mutton fat clusters of WBC's on the endothelium
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granulomatous keratic percipitates
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clusters of cells on pupil margin
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Koeppe's nodules
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clusters of cells on the anterior iris surface
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Busacca's nodules
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in which type of uveitis are iris nodules seen
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granulomatous
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list symptoms of uveitis
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pain
photophobia blur lacrimation |
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signs of uveitis
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cells and flare
perilimbal injxn (ciliary flush) KP's iris nodules miosis low IOP but then high IOP PAS posterior synchiae vitreal cells |
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characterized by acute onset and small KP's, no iris nodules, and no vitreal, retinal, or choroidal involvement
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non-granulomatous
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characterized by chronic nature, large KPs, iris nodules, minimal symptoms/redness, with vitreal, retinal, or choroidal involvement
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granulomatous
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when should a W/U be performed
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chronic gran. uveitis
after 2nd manifestation |
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what is the purpose of tx in uveitis
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prevent synchiae formation
relieve pain prevent secondary cataracts prevent iris bv damage |
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how does synchiae form
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pupil is miotic and in close contact with anterior lens surface
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what drug prevents synchiae formation and how
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cycloplegics
pupil is dilated and moved away from lens |
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list cycloplegics from strongest to weakest
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ASHCT
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what is the most common cycloplegic used in tx of uveitis
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homatropine 5%
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dosage of cycloplegic
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q2h to TID
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role of steroids in uveitis tx
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reduce inflammation
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what steroid should be used to tx uveitis
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strong steroid that penetrates cornea well
PRED ACETATE 1% |
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dose for steroids in uveitis
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q2h to q1h
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should steroids be tapered in uveitis
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yes gradually or over 2 weeks to prevent rebound
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management of uveitis patients should always include what test
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dilation to check for spillover into PC
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tx of mild uveitis
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homatropine 2% BID to TID
Pred Forte 1% QID follow in 48 hrs to 3-5 days or sooner |
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tx of moderate uveitis
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homatropine 5% QID
Pred Forte 1% q2h oral NSAIDs sunglasses follow in 48 hrs, if stable 3-5 days RTC in 3-5 days |
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tx of severe uveitis
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homatropine 5% q2h or stronger
Pred Acetate 1% q2h or q1h steroid ung at night oral NSAIDs sunglasses made need oral steroids follow in 24hrs then if stable 48 hrs |
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what to check at f/u
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symptoms
changes in AC rxn diation of pupil -. reactivity check IOP if elevated give topical beta blocker |
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when are labs indicated in uveitis
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bilateral cases
granoulmatous recurrent |
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intial lab W/U for uveitis
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ESR
CBC Chest X ray PPD with anergy panel HLA-B27 |
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where are KPs usually found
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inferiorly
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what is flare
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protein transudate from uveal vessels
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what is cells
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WBC's released from uveal vessels
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why does blur occur in uveitis
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clouding of media
poor tear film macular edema posterior uveitis |
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coagulation of exudates in AC seen in severe cases that can block TM
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fibrin - cycltic membranes
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what are iris nodules
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inflammatory cellular infiltration into iris stroma
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purulent exudate in lower AC from inflammed uveal vessels seen in severe cases
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hypopyon
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why is low IOP seen in uveitis at first
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bc CB is "sick" therefore decreased aqueous humor production
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why is high IOP seen later in uveitis
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TM becomes clogged with inflammatory debris or the TM is inflammed
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adhesion btw posterior iris surface to the lens in the pupillary zone
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posterior synchiae
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adhesion of the anterior surface of iris to angle structures
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peripheral anterior synchiae
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how does synchiae arise
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posterior --> heavy exudation of protein
PAS --> swelling of iris root or shallowing of AC from pupil block or organization of exudates in angle |
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what other complications can occur from uveitis
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band K due to chronic inflammation
cataracts |
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inflammatory cells deposited on anterior lens capsule
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lens percipitates
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list causes of acute nongranulomatous uveitis
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trauma
ankylosing spondylitis inflammatory bowel dz Reiter's Glaucomatocycltic crissis phacolytic HSV HZV UGH Bechets MMR chlamydia Toxoplasmosis |
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list causes of chronic nongranulomatous uveitis
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JRA
Fuch's heterochromic iridocyclitis |
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list causes of chronic granulomatous uveitis
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sarcoidosis
syphilis TB SLE |
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what do you order in uveitis W/U
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CBC
ESR ANA RPR or VDRL FTA-ABS PPD Chest x ray lyme titer HLA-B27 ACE toxoplasmosis titer in HIV pts HIV |
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ESR
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elevated in many inflammatory conditions
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ANA
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positive in some autoimmune disorders
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RPR
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active syphilis
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VDRL
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active syphilis
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FTA-ABS
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evidence of syphilis in lifetime
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PPD and anergy panel
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TB
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chest X ray
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TB
sarcoidosis |
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ACE
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elevated in sarcoidosis
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CMV
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bilateral chorioretinitis
immunocomprised pts - HIV |
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HSV
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granulomatous uveitis
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caused by parasite due to blackfly causes subcutaneous nodules in skin, microfilarie in AC, and iridocycltis and chorioretinal lesiosn
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onchocerciasis - river blindness
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iridocycltis
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iris and CB
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presents with anterior or posteriro uveitis either granulomatous or nongranulomatous and iridocyclitis with lesions of plams and soles of feet
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syphilis
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toxoplamosis
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anterior uveitis
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TB
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granullomatous uveitis
retinochoroidyos |
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HLA-B27
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predisposition of uveitis but not diagnostic
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CBS and ESR
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non specific
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affects young men; acute recuurent nongran iridocyclitis; lower back pain or stiffness
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ankylosing spondylitis
due sacroiliac joint X ray |
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recurrent ulcers of mouth or genitals and nonulcerative skin eruptions; bilateral nongran uveitis with hypopyon
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bechet's dz
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iris hypochromia - lighter eye affected with nongran uveitis see neo of iris and angle, secondary cat ad glaucoma
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fuch's heterochromic iridocycltis
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unilateral or bilateral acute iridocyclitis synchronized with attacks of cramping and diarrhea
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IBD - chron's, whipple's, colitis
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intermediate uveitis affects what
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vitreous
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snow back exudation seen overlying pars planiis especialy inferior with peripheral vasculitis and vitreal cells seen in young adults
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intermediate uveitis (pars planitis)
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toxoplamosis
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anterior uveitis
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TB
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granullomatous uveitis
retinochoroidyos |
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HLA-B27
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predisposition of uveitis but not diagnostic
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CBS and ESR
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non specific
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affects young men; acute recuurent nongran iridocyclitis; lower back pain or stiffness
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ankylosing spondylitis
due sacroiliac joint X ray |
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recurrent ulcers of mouth or genitals and nonulcerative skin eruptions; bilateral nongran uveitis with hypopyon
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bechet's dz
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iris hypochromia - lighter eye affected with nongran uveitis see neo of iris and angle, secondary cat ad glaucoma
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fuch's heterochromic iridocycltis
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unilateral or bilateral acute iridocyclitis synchronized with attacks of cramping and diarrhea
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IBD - chron's, whipple's, colitis
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intermediate uveitis affects what
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vitreous
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snow back exudation seen overlying pars planiis especialy inferior with peripheral vasculitis and vitreal cells seen in young adults
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intermediate uveitis (pars planitis)
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chronic uveitis with insidious onset without pain, photophobia, or conj injxn
causes posterior synchiae, cataracts, and secondary glc |
JRA
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JRA is
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seronegative form of RA
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pauciarticular (<5) JRA
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young girls
chronic iridocylcitis |
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polyarticular (>5) JRA
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young boys
acute recurrent iridocycltis |
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open angles, mild inflammation, no sychiae, mild AC rxn with unilateral attack of high IOPs
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posner-schlossman syndrome (glaucomatocycltic crisis)
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triad of urethritis, polyarthritis, mucopurulent conjunctivitis seen with acute iridocyclitis in males
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Reiter's
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insidious oset of uveitis with no symptoms
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RA
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anterior or posterior granulomatous or nongranulomatous bilateral uveitis with conj or skin nodules and retinal vasculitis or focal retinitis or ON inflammation - nodular non-caseating granulamous
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sarcoidosis
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what to order for sarcoid WU
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chest x ray - hllar adenopathy
ACE lysozyme gallium kviem biopsy ANA |
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rare bilateral choroiditis and iridocycltis that follows penetrating ocular injury or surfery see diffuse multifocal choroiditis
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sympathetis ophthalmia
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chronic progressive panuveitis of unknown orgin - gran or nongran
seen PS, vitritis, chorioditis, peripapillary edema, serous RD tinnutis, vitiligo, poliosis, alopecia |
Vogt Koyanagi Harada Syndrome
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posterior uveitis
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retinitis
chorioditis vasculitis |
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panuveitis
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affects entire uveal tracts
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