diagnosis of uveitis · 2020-07-20 · south street eye clinic ophthalmic surgeons take home...
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Diagnosis of uveitis
Dr. Xia Ni Wu 20 July 2020 Ophthalmologist Uveitis, Medical Retina, General Comprehensive
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South Street Eye ClinicOPHTHALMIC SURGEONS
No financial disclosures
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Aims§ Definition§ Classification & descriptors§ Common uveitic syndromes§ Retinal imaging in uveitis
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What is uveitis?
“uvea” (Latin) meaning grape“-itis” meaning inflammation
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Causes of uveitis
§ Infectiveo Bacteria, fungi, virus, protozoa
§ Immune-mediatedo With or without systemic disease
§ Masquerade, i.e. secondary to another causeo e.g. retinal detachment, lymphoma
§ “Undifferentiated”
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SUN Working Group. Am J Ophthalmol 2005; 140:509-516
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SUN Working Group. Am J Ophthalmol 2005; 140:509-516
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Most uveitides can be characterised by…
§ Anatomic location§ Morphology§ Onset: sudden vs insidious§ Laterality: unilateral vs unilateral alternating vs
bilateral (asynchronous vs simultaneous)§ Course: acute, recurrent, chronic § Host/systemic disease
o Child vs adulto Immunocompetent vs immunocompromised
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Jabs and Busingye. Am J Ophthal 2013; 156:228-236
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Anterior uveitis syndromes
§ HLA-B27-associated anterior uveitis§ Fuchs’ heterochromic iridocyclitis§ Posner-Schlossman syndrome§ Herpetic anterior uveitis§ JIA-associated uveitis§ Idiopathic/undifferentiated
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Anterior uveitis (AU) - symptoms
Acute ChronicRedness NonePain Blurred visionPhotophobiaBlurred vision
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Anterior uveitis - signs
§ Ciliary flush§ Keratic precipitates
o Fine, stellate, mutton-fat (granulomatous)o Inferior (Arlt triangle) vs pan-corneal
§ Anterior chamber cells, flare, fibrin, hypopyon§ Posterior synechiae/pigment on anterior lens capsule§ Pupillary miosis§ Iris nodules§ Iris transillumination§ Anterior vitreous cells§ Increased or decreased intraocular pressure
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Anterior uveitis – chronic signs/complications
§ Band keratopathy§ Pigmented keratic precipitates§ Posterior subcapsular cataract§ Heterochromia§ Peripheral anterior synechiae§ (cystoid macular oedema)
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Fuchs’ heterochromic iridocyclitis
Symptoms SignsLack of symptomsOccasionally floaters/blurred vision
HeterochromiaWhite eyeSmall stellate KPs, diffuse, pan-cornealAC ± anterior vit cellsDiffuse iris atrophy “moth-eaten”Fragile iris vessels “Amsler sign”Koeppe nodulesCataractGlaucoma
Do not get CMO
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Posner-Schlossman syndrome
Symptoms SignsMild discomfortHalos around lightsBlurred vision (slight)
Corneal epithelial oedemaIOP 40-80 mmHgAC minimal reactionFew KPs (1-3)Diffuse iris atrophy in 1/3rd
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Herpetic iritis
Symptoms SignsDiscomfortPhotosensitivityBlurred vision
Hx of HZO rash/cold sores
Corneal anaesthesiaAC cells – mild-to-moderateKPs – stellate, granulomatous, non-granulomatousSectoral/diffuse iris transilluminationIris haemorrhage Raised intraocular pressure
Keratouveitis
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Juvenile idiopathic arthritis-associated uveitis
Symptoms SignsLack of symptomsOccasionally floaters/blurred vision
White eyeAC cellsPosterior synechiaeChronic inflammation - Band keratopathy- Cataract- CMOGlaucoma
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Intermediate uveitis (IU) - symptoms
§ Blurred vision§ Floaters
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Posterior uveitis - symptoms
Can also get associated anterior uveitis § Red eye§ Pain§ Photophobia
Retinitis ChoroiditisFloaters PhotopsiasBlurred vision Coloured swirling lightsReduced field of vision Visual field defects
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Imaging§ Fluorescein angiography
o Vasculitiso Cystoid macular oedemao Optic disc leakage
§ Indocyanine greeno Choroidal lesionso Choroidal vessels
§ Autofluorescenceo RPE dysfunctiono Active areas
• OCT– Cystoid macular oedema– Subretinal fluid– Retinitis/choroiditis– Choroidal thickness– (vitritis)– Disc swelling
• B-scan ultrasound– Scleral thickness (choroidal
thickness)
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Fluorescein angiography (FFA)
Indocyanine green (ICG)
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Autofluorescence
B-scan ultrasound
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OCT
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Take home messages
§ Uveitis is a big topic…but don’t be scared. Look at the SUN. (actually, please don’t)
§ Consider if inflammation is anterior, intermediate, posterior, or panuveitis
§ Anterior uveitis syndromes § OCT findings in uveitis
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Thank you