6. Posterior Uveitis A
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Anterior uveitis classifications?
- Iritis: iris
- Iridocyclitis: iris and anterior ciliary body
- Anterior cyclitis: anterior ciliary body
- pars plana
- posterior cyclitis
- chorioditis: focal, multifocal, diffuse
- retinitis: retina
- Chorioretinitis: mostly choroid
- Retinochorioditis: mostly retina
- Vasculitis: vessels
Panuveitis, Endophthalmitis, Panophthalmitis?
- Pan- diffused, uveal tract
- Endo- whole eye, excluding sclera
- Pan- whole eye incl extraocular ext
Cells in the aqueous?
leukocytes, erythoctyes or pigments cells
Flare in ant chamber?
- protein leaking from iris/ciliary body due to breakdown in BAB
- hazy due to tyndall effect
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
SUN grading for Ant Cham cells?
- 0: <1
- 0.5: 1-5
- 1+: 6-15
- 2+: 16-25
- 3+: 26- 50
- 4+: >50
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
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
Sx and signs of AAU?
- vessel injection, sluggish pupil
- cells and flare
- hypopyon, synechiae
- low IOP
- unilateral pain, photophobia, tearing, red eye
sx and signs of CAU?
- cells- variable
- Iris nodules- koeppe, busacca
- KP: mutton fat greasy
- 2ndy complications- glaucoma and cataract
sx and signs of Intermediate uveitis?
- vitreous condensation/snowballs
- vascular changes in retina
- grey white plaque at edge of retina
- bi-asym, blurry vision
systemic associations with interm uveitis?
- lyme- ticks
ddx of intermediate uveitis?
- fuchs heterochromic uveitis: yes- vitreous inflammation; no- uni, CMO
- lymphoma- yes infiltrates, no snowballs
- peripheral toxocara granuloma- no unilateral
- relives pain of by immobilising inflamed iris/ciliary body
- prevent synechiae
- stabilise BAB
- reduce cells and flare
sx of post u?
- blurry vision + floaters/decreased VA
- field defects
- redness/pain/photophobia if AntCh presenet
2ndy complications of PU?
RD, CMO, CNV, EM, chorio/retinal atrophy/necrosis
- active appear as whitish retinal lesions with blurry borders due to edema
- edges become more defined as it resolves
- usually + vitritis
- focal/multifocal or geographic
- active lesions appear as round yellow nodules in choroid: retina raised/flat
- 1st/2ndy retinitis
- arterioles/venules inflam of BV walls
- active: patchy sheathing
- exudates macular edema, OD swelling, vit cells
- retinal haemorrhage, vessel occlusion
ddx for vasculitis?
- diabetic retinopathy
Difference venous and arterial vascultis?
- venous: common, non-disease specific, sheathing
- arterial: uncommon, behcets, ARN, PORN, SLE, lupus
- art+ven: behcets, ARN, toxo
What is sarcoidosis?
- idiopathic multisystem involvement- lymph nodes, liver, spleen, skin , lungs, eyes
- granulomatous inflammatory disorder
Who does sarchoidosis affect?
- african americans/ scandinavians
Sarcoidosis ant sx?
- mutton fat kp, iris nodules
- peripheral synechiae
Sarcoidosis post sx?
- periphlebitis: candle wax drippings
- choroidal infiltrates: multifocal choroiditis
- retinal granulomas
- retinal glanulomas
- ON: edema, atrophy, nodules
Systemic sx of sarcoidosis?
- facial palsy
- enlargement of salivary glands
- chest x ray
- lung infiltrate
What is Behcet's syndrome?
- recurrent eps of orogenital ulcers and vasculitis
Who does behcets typically affect?
- eastern meditteranean and Japan
- 30yo Male
Ant features of Behcets
recurrent bi AAU: pain, flare, non gran, mobile hypopyon, fine KP
Post features of Behcets?
- retinal vasculitis and haemorrhage: leakage-> retinal/disc edema, ischaemia
- periphlebitis: occlusive
- vasculitis: long term, necrotising
Systemic sx of behcets?
gential ulcers, skin lesions, arthritis
What is VKH?
- idiopathic inflammatory autoimmune disease affecting melanocytes
- auditory/cutaneous inflammation: alopecia, vitiligo, poliosis
Who does VKH affect primarily?
- asian/hipsanic/native american
Post features of VKH?
- diffuse choroidal infiltration
- serous RD
- disc edema
- diffuse RPE atrophy
- chronic: depigmented lesions
Ant features of VKH?
- granulomatous KP
What is sympathetic ophthalmia?
bilateral diffuse granulomatous uveitis
Cuase of SO?
- penetrating trauma or intracular surgery
- autoimmune response
Sx of SO?
- bilateral eye pain, photophobia, decreased VA
- Red eye
Ant features of SO?
chronic/acute uveitis with MF KP, pos synechiae, ^IOP
Post features of SO?
- yellowish-whitish choroidal lesions
- dalen-fuchs nodules-lymphocutes
- chorioretinal atrophy
- serous retinal detachment
- OD swelling
DDX of SO?
- VKH: no trauma
- Gran Uv: sarcoidoisis, TB and syphilis
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