6. Posterior Uveitis A

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sookylala
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235113
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6. Posterior Uveitis A
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2013-11-08 01:29:41
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posterior uveitis
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  1. Anterior uveitis classifications?
    • Iritis: iris
    • Iridocyclitis: iris and anterior ciliary body
    • Anterior cyclitis: anterior ciliary body
  2. Intermediate uveitis?
    • vitreous
    • pars plana
    • posterior cyclitis
  3. Posterior uveitis?
    • chorioditis: focal, multifocal, diffuse
    • retinitis: retina
    • Chorioretinitis: mostly choroid
    • Retinochorioditis: mostly retina
    • Vasculitis: vessels
  4. Panuveitis, Endophthalmitis, Panophthalmitis?
    • Pan- diffused, uveal tract
    • Endo- whole eye, excluding sclera
    • Pan- whole eye incl extraocular ext
  5. Cells in the aqueous?
    leukocytes, erythoctyes or pigments cells
  6. Flare in ant chamber?
    • protein leaking from iris/ciliary body due to breakdown in BAB
    • hazy due to tyndall effect
    • fibrin
  7. Definitions of chronic, acute, recurrent?
    • acute: sudden onset, limited duration
    • recurrent: persistent, repeated episodes, separated by episodes of inactivity w/o tx 
    • chronic: persisten with relapse <3m after stopping tx
  8. SUN grading for Ant Cham cells?
    • 0: <1
    • 0.5: 1-5
    • 1+: 6-15
    • 2+: 16-25
    • 3+: 26- 50
    • 4+: >50
  9. Sun grading for ant cham flare?
    • 0: none
    • 1+: faint
    • 2+ moderate- iris and lens detail clear
    • 3+: marked- iris and lens detail hazy
    • 4+: intense- fibrin or plastic aqueous
  10. Grading for hazy vitreous?
    • 0: no haze
    • Trace: slight blurring OD margin
    • 1: Slightly blurred ON and vessels
    • 2+: Mod blurred ON and vessels
    • 3+: ONH border blurry but visible
    • 4+: ONH obscured
  11. Sx and signs of AAU?
    • vessel injection, sluggish pupil
    • cells and flare
    • hypopyon, synechiae
    • low IOP
    • unilateral pain, photophobia, tearing, red eye
  12. sx and signs of CAU?
    • bilateral
    • cells- variable
    • Iris nodules- koeppe, busacca
    • KP: mutton fat greasy
    • 2ndy complications- glaucoma and cataract
  13. sx and signs of Intermediate uveitis?
    • cells
    • vitreous condensation/snowballs
    • vascular changes in retina
    • CMO
    • grey white plaque at edge of retina
    • bi-asym, blurry vision
  14. systemic associations with interm uveitis?
    • MS
    • idiopathic
    • sarcoidosis
    • lyme- ticks
    • toxocariasis
  15. ddx of intermediate uveitis?
    • fuchs heterochromic uveitis: yes- vitreous inflammation; no- uni, CMO
    • lymphoma- yes infiltrates, no snowballs
    • peripheral toxocara granuloma- no unilateral
  16. cyclopegia?
    • relives pain of by immobilising inflamed iris/ciliary body
    • prevent synechiae
    • stabilise BAB
    • reduce cells and flare
  17. sx of post u?
    • blurry vision + floaters/decreased VA
    • field defects
    • photopsias/metamophopsias
    • nyctalopia
    • redness/pain/photophobia if AntCh presenet
  18. 2ndy complications of PU?
    RD, CMO, CNV, EM, chorio/retinal atrophy/necrosis
  19. Retinitis features?
    • focal/multi
    • active appear as whitish retinal lesions with blurry borders due to edema
    • edges become more defined as it resolves
    • usually + vitritis
  20. Choroiditis features?
    • focal/multifocal or geographic
    • active lesions appear as round yellow nodules in choroid: retina raised/flat
  21. Vasculitis features?
    • 1st/2ndy retinitis
    • arterioles/venules inflam of BV walls
    • active: patchy sheathing
    • exudates macular edema, OD swelling,  vit cells
    • retinal haemorrhage, vessel occlusion
  22. ddx for vasculitis?
    • diabetic retinopathy
    • BRVO/BRAO
  23. Difference venous and arterial vascultis?
    • venous: common, non-disease specific, sheathing
    • arterial: uncommon, behcets, ARN, PORN, SLE, lupus
    • art+ven: behcets, ARN, toxo
  24. What is sarcoidosis?
    • idiopathic multisystem involvement- lymph nodes, liver, spleen, skin , lungs, eyes
    • granulomatous inflammatory disorder
  25. Who does sarchoidosis affect?
    • F
    • 20-50
    • african americans/ scandinavians
    • bilateral
  26. Sarcoidosis ant sx?
    • mutton fat kp, iris nodules
    • snowballs
    • bilateral
    • acute/chronic
    • peripheral synechiae
  27. Sarcoidosis post sx?
    • periphlebitis: candle wax drippings
    • choroidal infiltrates: multifocal choroiditis
    • retinal granulomas
    • vasculitis/vitritis
    • retinal glanulomas
    • ON: edema, atrophy, nodules
  28. Systemic sx of sarcoidosis?
    • facial palsy
    • enlargement of salivary glands
    • chest x ray
    • lung infiltrate
    • arthritis
  29. What is Behcet's syndrome?
    • idiopathic
    • recurrent eps of orogenital ulcers and vasculitis
  30. Who does behcets typically affect?
    • eastern meditteranean and Japan
    • HLA-B51
    • 30yo Male
    • bilateral
  31. Ant features of Behcets
    recurrent bi AAU: pain, flare, non gran, mobile hypopyon, fine KP
  32. Post features of Behcets?
    • retinal vasculitis and haemorrhage: leakage-> retinal/disc edema, ischaemia
    • periphlebitis: occlusive
    • vasculitis: long term, necrotising
    • retinitis+vitritis
  33. Systemic sx of behcets?
    gential ulcers, skin lesions, arthritis
  34. What is VKH?
    • idiopathic inflammatory autoimmune disease affecting melanocytes
    • auditory/cutaneous inflammation: alopecia, vitiligo, poliosis
  35. Who does VKH affect primarily?
    • 20-50
    • W
    • asian/hipsanic/native american
  36. Post features of VKH?
    • diffuse choroidal infiltration
    • serous RD
    • CNV
    • disc edema
    • diffuse RPE atrophy
    • chronic: depigmented lesions
  37. Ant features of VKH?
    • flare
    • cells
    • granulomatous KP
  38. What is sympathetic ophthalmia?
    bilateral diffuse granulomatous uveitis
  39. Cuase of SO?
    • penetrating trauma or intracular surgery
    • autoimmune response
  40. Sx of SO?
    • bilateral eye pain, photophobia, decreased VA
    • Red eye
    • photopsia
    • floaters
    • photophobia
  41. Ant features of SO?
    chronic/acute uveitis with MF KP, pos synechiae, ^IOP
  42. Post features of SO?
    • yellowish-whitish choroidal lesions
    • dalen-fuchs nodules-lymphocutes
    • chorioretinal atrophy
    • serous retinal detachment
    • vasculitis
    • OD swelling
  43. DDX of SO?
    • VKH: no trauma
    • Gran Uv: sarcoidoisis, TB and syphilis
    • tumour
  44. TX of SO?
    emergency room

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