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ANTERIOR UVEITIS EXAM WITH CORRECT SOLUTIONS!!, Exams of Advanced Education

ANTERIOR UVEITIS EXAM WITH CORRECT SOLUTIONS!!

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2024/2025

Available from 07/05/2025

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ANTERIOR UVEITIS EXAM WITH CORRECT SOLUTIONS!!
what is uveitis?
- Inflammation of the uvea due to breakdown of the blood-aqueous barrier
what is the uvea?
- inner vascular coat of the globe
- Iris
- Ciliary body
- Choroid
how do we classify uveitis?
- location
- onset
- clinical pathology
- etiology
what are the different types of anterior uveitis?
- Iris: iritis
- Ciliary body: cyclitis
- Iris & ciliary body: iridocyclitis
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ANTERIOR UVEITIS EXAM WITH CORRECT SOLUTIONS!!

what is uveitis?

  • Inflammation of the uvea due to breakdown of the blood-aqueous barrier

what is the uvea?

  • inner vascular coat of the globe
  • Iris
  • Ciliary body
  • Choroid

how do we classify uveitis?

  • location
  • onset
  • clinical pathology
  • etiology

what are the different types of anterior uveitis?

  • Iris: iritis
  • Ciliary body: cyclitis
  • Iris & ciliary body: iridocyclitis

what is acute uveitis?

  • 90% of all uveitis cases
  • Sudden onset and limited duration (< 3 months), completely resolves once attack is over

what is chronic uveitis?

  • Uveitis recurs in less than 3 months after discontinuing treatment
  • Can last months to years (> 3 months)

what is non-granulomatous uveitis?

  • Immune cells involved: neutrophils, lymphocytes, plasma cells
  • Keratic precipitates: small, stellate, white or pigmented
  • Usually idiopathic, traumatic, postoperative, or HLA-B27 associated (with or without systemic disease)

what is granulomatous uveitis?

  • Immune cells involved: macrophages, epithelioid cells (in addition to neutrophils, lymphocytes, and plasma cells) - Keratic precipitates: large, yellow, "mutton fat" endothelial deposits
  • More chronic course

what are the causes of granulomatous uveitis?

  • Infectious: Syphilis, Lyme, TB
  • Tearing
  • Blurred vision
  • Blepharospasm

what are signs of acute anterior uveitis?

**- Circumlimbal injection: enlargement of episcleral vessels in the region of the CB

  • Anterior chamber cells and/or flare -** Decreased or increased IOP - Pupillary miosis/sluggish pupillary response: spasm of iris sphincter muscle

what are symptoms of chronic anterior uveitis?

- Minimal symptoms

  • May have symptoms of acute anterior uveitis during periods of exacerbation - Decreased VA: due to sequelae of chronic uveitis

what happens if anterior uveitis is left untreated?

  • Corneal endothelial
  • precipitates Iris nodules: ⚫ Busacca: iris stroma, granulomatous

⚫ Koeppe: pupillary margin, both granulomatous and non-granulomatous

  • Posterior synechiae
  • Peripheral anterior synechiae
  • Band keratopathy
  • Posterior Subcapsular Cataract (PSC) (common, could also be caused by steroids)
  • Iris atrophy Iris heterochromia (Fuchs iridocyclitis)
  • Neovascularization of the iris (NVI)
  • Cystoid macular edema
  • Secondary glaucoma

how does anterior uveitis cause secondary glaucoma?

  • Inflammatory cells block aqueous outflow
  • Posterior synechiae cause pupillary block
  • Peripheral anterior synechiae cause angle closure
  • Neovascular glaucoma

what techniques would you use to access the anterior chamber?

  • 60-degree angle
  • Light beam: 3mm long x 1mm wide
  • High magnification
  • Maximum illumination
  • Dark room

what is flare?

  • Pro-inflammatory serum proteins leak into AC and recruit WBC
  • Can coalesce to form fibrin

what is the grading for flare?

  • Masquerade syndromes (lymphoma, leukemia)
  • Infectious keratitis (fungal, pseudomonal)

what are the types of keratic precipitates?

  • stellate KPs
  • Mutton-fat KPs

what are stellate KPs?

  • Non-granulomatous
  • White: neutrophils, lymphocytes, plasma cells
  • Pigmented: iris melanocytes

what are mutton fat KPs?

  • Granulomatous
  • Composed of macrophages and epithelioid cells

what sex and diseases would be seen in patient hx for someone with anterior uveitis?

  • JIA: girls
  • Ankylosing spondylitis: men - Reiter's syndrome: men

what race and diseases would be seen in patient hx for someone with anterior uveitis?

  • Caucasians: HLA-B27 related diseases
  • African Americans: sarcoidosis

what ocular hx would be seen for someone with anterior uveitis?

  • Prior red eye
  • Prior use of "milky" drops
  • History of trauma
  • History of ocular surgery

what systemic hx would be seen for someone with anterior uveitis?

  • Joint pain, lower back pain
  • Skin rashes
  • Oral/genital ulcers

what are the necessary test done for patients with anterior uveitis?

**- BCVA

  • Pupils
  • EOMs
  • Slit Lamp Exam**

why may more frequent dosing of cycloplegics occur in acute anterior uveitis?

  • Duration of cycloplegics in uveitic eye may be shorter due to presence of increased esterases in the AC - more frequent dosing may be necessary
  • cyclopentalate
  • homatropine
  • what is the duration of action for each?

how do topical corticosteroid helps with anterior uveitis?

  • Reduce pain
  • Reduce inflammation
  • Stabilize cell membranes
  • Inhibit release of lysozyme by granulocytes
  • Suppress circulation of lymphocytes
  • Block phospholipase A2, which converts cell membrane phospholipids into inflammatory mediators (leukotrienes and prostaglandins)

what topical steroids are used for anterior uveitis? Maximal efficacy:

  • Difluprednate 0.05% emulsion (Durezol): QID
  • Prednisolone acetate 1% susp (PredForte): usually start with q1h or q2h, then taper once inflammation significantly reduced

when would oral steroids be used for anterior uveitis?

  • Severe anterior uveitis
  • Posterior uveitis
  • Must rule out systemic infection prior to initiating oral steroids

do topical NSAIDs have a big role in anterior uveitis?

  • minimal role

how do oral NSAIDs help with anterior uveitis?

  • Oral: may reduce recurrence of non-granulomatous uveitis Mechanism
  • Inhibit cyclo-oxygenase enzyme
  • Do not inhibit phospholipase A2, which produces leukotrienes responsible for attracting WBC into the AC

when would you use immunomodulators for anterior uveitis? -Considered for non-infectious uveitis that is recalcitrant or non-responsive to steroid treatment

when would you use biologic response modifiers for anterior uveitis?

  • Antibodies and antibody-derived proteins: block activity of bioactive mediators of the immune response Indications
  • Chronic and recurrent

what would treatment of herpes zoster uveitis?

  • Topical steroids with oral antiviral
  • Acyclovir 800mg 5x/day
  • Cycloplegia
  • IOP lowering agents

what would treatment of herpes simplex uveitis be?

  • Topical steroids with oral antiviral
  • Acyclovir 400mg 5x/day
  • Cycloplegia
  • IOP lowering agents

what is syphilis?

  • Multisystem bacterial infection caused by Treponema pallidum bacterium
  • Ocular manifestations occur in acquired and congenital infections
  • Transmission is transplacental or via sexual contact
  • The "great masquerader"

what are the stages of syphilis?

  • Primary: painless ulcer at inoculation site, heals spontaneously 1-2 months later
  • Secondary: treponemal load is largest, generalized rash and lymphadenopathy, occurs

4-10 weeks after primary lesion

  • Latent: occurs within 1+ year after initial infection; can progress to tertiary
  • Tertiary: granulomatous lesions of mucus membranes, cardiovascular damage (coronary arteries and aorta), neurosyphilis

what does anterior uveitis caused by syphilis look like?

  • Granulomatous inflammation of any ocular structure
  • Ocular syphilis usually occurs at least 6 months after primary infection
  • Most ocular involvement occurs during secondary, latent, or tertiary stages

what bloodwork is done for syphilis?

  • RPR or VDRL: screening tests, detect non-treponemal antibodies, present in early infection
  • FTA-ABS or MHA-TP: specific treponemal tests positive after primary infection, used as confirmatory test when screening test is positive

what would treatment for syphilis be?

  • penicillin

what stages of syphilis does uveitis occur?

  • secondary
  • latent: most common
  • Ocular: topical steroids, cycloplegia

what is tuberculosis?

  • Granulomatous infection
  • Primarily affects the lungs
  • Natural history: exposure to TB may lead to
  • Non-infection: 70-90%
  • Infection: 10-30%
  • Latent: never develop TB
  • Active: necessitates treatment; once treated, the patient is cured from the bacterium

what would workup of TB be?

  • Labs: PPD, QuantiFeron Gold blood test
  • Imaging: chest X-ray

what are the non-infectious causes of acute anterior uveitis?

  • Idiopathic: 50% of all uveitis cases
  • Traumatic/postoperative
  • HLA-B27 associated uveitis - Inflammatory/autoimmune systemic disorders
  • Masqueraders

what is HLA-B27?

  • Human cells contain surface markers to allow the body to differentiate native cells from foreign material
  • Human Leukocyte Antigen (HLA) molecules present antigenic peptides to T lymphocytes to initiate immune response
  • HLA-B27 is a specific marker whose genome is located on Chromosome 6
  • Present in 1-8% of the population
  • Predisposes patients to certain autoimmune diseases (seronegative spondyloarthropathies)

what is the strongest known genetic risk factor for the development of acute anterior uveitis?

  • HLA-B
  • 26-fold increased risk of developing AAU
  • Younger patients (20-40), first presentations during young adulthood
  • M > F (2.5:1)

what does anterior uveitis look like for patients with HLA-B27 defect?

  • Acute onset
  • Unilateral
  • Non-granulomatous
  • Recurrent attacks with more severe inflammation
  • More likely to have hypopyon

genitourinary or GI tract

  • Younger males (15-35)
  • Classic diagnostic triad:
  • Arthritis: 98%
  • Urethritis: 74%
  • Conjunctivitis: 58%
  • Anterior uveitis: 3-12%

what does uveitis look like in patients with Rieiter's syndrome?

  • Acute, chronic, or recurrent
  • Non-granulomatous
  • Associated urethral discharge

what would workup for reiter's syndrome be?

  • Labs: HLA-B27, ESR, C. trachomatis
  • ROS: ask about urethritis, arthritis, conjunctivitis
  • Referrals: urologist for urethral cultures and urine analysis, rheumatologist

what disease are included in inflammatory bowel syndrome?

  • crohns
  • ulcerative colitis
  • 60% are HLA-B27 positive

what would symptoms of inflammatory bowel disease be?

  • abdominal pain
  • diarrhea
  • weight loss
  • fever
  • fatigue
  • joint pain

what would workup of inflammatory bowel disease be?

  • Labs: HLA-B