Uveitis - Part 2

ashleyr2's version from 2018-02-22 18:52

Section 1

Question Answer
most common cause of posterior uveitis in adults?toxoplasmosis followed by retinal vasculitis
pizza pie fundus is seen in what?CMV retinitis
acute self-limited confluent peripheral necrotizing retinitis due to VZV, HSVacute retinal necrosis
whats the pathology of acute retinal necrosis?necrosis occurs from virally induced cytolysis, arteriolar and choriocapillaris occlusion; necrotic cells slough into vitreous leaving large area devoid of retina
describe FA in ARNfocal areas of choroidal hypoperfusion early; late staining
whats the prognosis in ARN?watch fellow eye close bc it develops ARN within 4 weeks
what complication is seen with arn60-90% develop RRD (usually within 3 months)
whats the variant of ARN in AIDS but painless with minimal intraocular inflammation?Progressive outer retinal necrosis
describe the fundus in PORNmultiple discrete peripheral or central areas of retinal opacification/infiltrates (deep with very rapid progression); "cracked mud" appearance after resolution
whats the prognosis of PORN67% become NLP within 4 weeks; RD in 90%
whats the tx for candiasis?IV amphotericin B
choroiditis with multifocal ORANGE nummular lesionspneumocystis choroiditis
what tapeworm causes cysticercosis?pork tapeworm Taenia solium
whats the tx for cysticercosis?vitrectomy for mass lesion or exudative RD

Section 2

Question Answer
what does DUSN stand for?diffuse unilateral subacute neuroretinitis
name 2 worms that cause DUSNdog hookworm (ancylostoma caninum) or racoon nematode (Baylisascaris)
what does the ERG show in DUSN?decreased
whats the tx for DUSNlaser the nematode
whats the treatment for cat scratch disease due to bartonella hensale?doxycycline 100 mg PO BID and rifampin 300 mg PO BID for 4 weeks
whats the second leading cause of corneal blindness in the world?onchocerciasis (river blindness); first cause is trachoma
whats the treatment of onchocerciasis (river blindness)ivermectin, suramin, DEC
uveitis, retinal vasculaitis, a/w diarrhea or steatorrhea and migratory arthalgias?whipples disease = tx with bactrim
what causes whipples disease?tropheryma whipplei (gram positive bacillus), actinomycetes family
what type of bacteria is P.acnesgram positive rod; anaerobic

Section 3

Question Answer
name the 6 white dot syndromes1) acute posterior multifocal placoid pigment epitheliopathy
3) serpiginous
4) birdshot
5) multifocal choroiditis
6) PIC
what 2 HLA is a/w acute posterior multifocal placoid pigment epitheliopathy?HLA-B7 and HLA-DR2
what system problem is a/w APMPPEcerebral vascilitis and flu-like prodrome
fundus shows multiple "creamy yellow-white placoid lesions at level of RPE or choriocapillarisAPMPPE
what does FA show in APMPPE?initial blockage with late hyperfluorescent staining; window defects in old cases
what does FAF in APMPPE show?hyper autofluoresence of acute lesions; hypo of older lesions
what does ICG of APMPPE show?early and late hypofluoresence of placoid lesions
whats the tx of APMPPE?NONE; vision recovers in msot patients to >20/40
is APMPPE unilateral or bilateral?bilateral; men = women
what type of patient is seen in MEWDSage 15-50, female >male, UNILATERAL
fundus shows: granular retinal appearance with small (100-200 uM) white spots in posterior pole at level of RPEMEWDS
what does VF show in MEWDS?enlarged blind spot
what does FA show in MEWDS?early HYPERfluorescence in WREATH-LIKE configuration; lating staining of lesions and optic nerve
what does OCT in MEWDS show?normal OCT in MEWDS
what does ERG in MEWDS show?reduced a wave
whats the prognosis of MEWDSvision recovers over weeks but may be permanently decreased due to pigmentary changes in fovea

Section 4

Question Answer
whats another name for vitiliginous chorioretinitisbirdshot choroidopathy
what HLA is a/w birdshotHLA-A29
what does fundus show in birdshot?cream colored depigmented spots scattered throughout fundus; mild AC reaction, vitritis, retinal vasculitis, disc edema, optic atrophy, CME, CNV
what does FA show in birdshot?perifoveal capillary leakage with CME
what does ERG show in birdshot?diminished scotopic response (ROD dysfunction)
whats the most common cause of vision loss in multifocal choroiditis?CNV
whats the treatment of multifocal choroiditis?steroids

Section 5

Question Answer
pink hypopyon in setting of endopthalmitisthink SERRATIA!
when does acute post-operative endophthalmitis occurs?<6 weeks after surgery; 90% in first week
name 4 orgs that cause acute postoperative endophthalmitisstaph epidermidis, staph aureus, strep, pseudomonas
name 3 orgs that cause delyated post-operative endophthalmitisp. acnes (anaerobic gram positive rod), aspergillus or candida
what percentage of candida septicemia develop endophthalmitis?30% of pts with candida septicemia develop endophthalmitis
what did the EVS (endophalmitis vitrectomy study) study?evaluated the treatment of acute (<6 weeks) postoperative cataract surgery endophthalmitis with immediate vitrectomy vs tap and inject with ceftazidime and amikacin
what did endophthalmiits vitrectomy study find out about IV antibiotics?IV antibiotics were of no benefit in treating acute postoperative endophthalmitis
what VA was indicated for immediate vitrectomy in EVS study?LP or worse: do immediate vitrectomy
based on EVS study, when should you do tap and inject vs vitrectomywhen VA is HM or better: tap and inject. when VA is LP or worse: vitrectomy

Section 6

Question Answer
how long should you wait for do caract surgery in uveitis pts?3 months for cataract surgery
how long should you wait to do corneal transplant in uveitis pts?6 months for corneal transplant
do you place an IOL in JRA patients?no IOL! can develop cyclitis membranes and CB detachments; consider lensectomy with partial vitrectomy
3 diseases that show uveitis and band keratopathyJRA, sarcoidosis, MS
4 conditions that show uveitis and hyphemafuchs heterochromic iridocyclitis, trauma, JXG, HZV
2 conditions that show uveitis and vitreous hemorrhageVKH and POHS
3 conditions that show uveitis and iris atrophyherpetic (diffuse or sectoral), Fuchs, traumatic
uveitis and bells palsy (2 conditions)lyme disease and sarcoidosis
uveitis and genitourinary involvement (3 conditions)reiters syndrome, gonococcal disease, behcets disease

Section 7

Question Answer
what are masquerade syndromes?conditions that present as uveitis
name 6 masquerade syndromes?peripheral RD (Schwartz-Matsuo syndrome) 2) intraocular foreign body 3) Juvenile xanthogranuloma 4) MS 5) malignancies (retinoblastoma, ALL, large cell lymphoma, malignant melanoma) 6) RP
triad of oral ulcer, genital ulcers, inflammatory eye diseasebehcets disease
what HLA is a/w behcets?HLA-B51/B5
whats the treatment of behcets disease systemic steroids, cytotoxic agents (chlorambucil most effective for retinal vasculitis), colchicine (prevents recurrences), cyclosporine, plasmapharesis
sunset fundus, salen fuchs nodules (yellow-white retinal spots)VKH
bilateral diffuse granulomatous panuveitis a/w deafness, tinnitus, vertigo, vitiligoVKH
like VKH but no systemc findings (just ocular findings)haradas disease
describe the 4 stages of VKH1) prodrome: headache, meningismus, seizures, bilateral decrease vision with pain redness and photophobia 2) syndrome: uveitis with serious RDs 3) chronic stage: sunset fundus, dalen fuchs nodules, perilimbal vitilgo 4) recurrent stage: AC reaction, pigment changes
what are dalen fuchs nodules seen in VKH?epitheloid cells btw bruchs membrane and RPE
what causes VKH?inflammation of choriocapillaris and retina
what does FA of VKH show?multiple focal areas of sunretinal leakage "1000 POINTS OF LIGHT"
what does OCT of VKH show?thickened choroid
whats the tx of VKHsteroids (6 months), cyclopegic, immunosuppressive agents
name 3 complications in VKHcataracts, glaucoma (33%), CNV (10%)

Section 8

Question Answer
bilateral granulomatous panuveitis following eye traumasympathetic ophthalmia
what causes sympathetic ophthalmiadue to immune sensitization to MELANIN or melanin-associated proteins in uveal tissue; T-cell mediated (delayed hypersensitivity reaction )
what HLA is a/w sympathetic ophthalmia?HLA-A11 and HLA-DR4
whats the pathology of SO?diffuse lymphocutic infiltration of choroid with ill-defined patchy accumulations of epitheloid (giant) cells that contain phagocutosed uveal pigment
when should you consider enucleation in sympathetic ophthamia?consider enucleation of injured eye within 10-14 days if NLP vision