Anterior Uveitis

Anterior Uveitis

1. Classification

Anatomical Classification:

Clinical Classification:

• Granulomatous

• Non-granulomatous

Symptoms:

• Pain
• Referred along CN V branches

• Redness

• Blurring of Vision
• Due to corneal haze
• Due to aqueous turbidity

• Severe Photophobia

• Irregular pupil

• Lacrimation

Signs:

• Earliest: Aqueous flare
• On Slit lamp examination
• Based on Brownian movement
• Marked in non-granulomatous uveitis

Conjunctiva:

• Circumcorneal congestion

Cornea:

• Corneal haze
• Due to ↑ IOP or toxins

• Keratic Precipitates (KPs):
• Pathognomonic sign of anterior uveitis
• Deposits on corneal endothelium
• Common in Arlt's triangle

Stellate terms	Seen in
Stellate cells	• Cirrhosis • NAFLD • Chronic pancreatitis • Young stella → alcoholic → liver and pancreas
Stellate Keratin Precipitates	• Herpetic uveitis • Toxoplasmosis • Fuchs Heterochromia Iridocyclitis • Young stella → Fucked () by Toxic () Herpes () Guy
Stellate Granuloma	• Cat Scratch Disease • LGV • Leprosy • Syphillis • Stella granny → has a Cat, Lgtv, has leprosy and syphillis
Stellate scar	• Kidney → Oncocytoma, Chromophobe RCC • Liver → Focal Nodular Hyperplasia, Fibrolamellar Carcinoma • Pancreas → Serous Cystadenocarcinoma • Breast → Radial Scar: Premalignant

Fuchs Terms	Notes
Fuchs heterochromia iridocyclitis	Chronic AU ⇒ • U/L Diffuse Iris atrophy + Heterochromia + Posterior SCC • Painless, No redness, No posterior synechiae Positive Amsler's Sign: ◦ Bleeding into Anterior chamber on paracentesis ◦ Without trauma to Iris/Angle ◦ D/t abnormal fragile Iris Stellate Keratin Precipitates ↳ Herpetic uveitis ↳ Toxoplasmosis ↳ Fuchs Heterochromia Iridocyclitis • Young stella → Fucked () by Toxic () Herpes () Guy
Dalens Fuchs	• Seen in Sympathetic ophthalmitis ↳ (granulomatous panuveitis) • Dalen Fucked Granny () sympathetically ()
Foster Fuchs	• In Pathological Myopia • Bleeding at macula • Fucking in Foster () home ↳ Blind child (Pathological myopia) ↳ Bled (Bleeding at macula)
Fuchs Endothelial dystrophy	• Cornea guttata: • Wart-like excrescences on posterior cornea • Fuck her Guts→ endothelial Stages • Stage 1: Central corneal guttata that spreads peripherally • Stage 2: Corneal oedema - beaten metal-like appearance • Stage 3: Bullous keratopathy • Stage 4: Subepithelial scarring and superficial vascularization

 

Anterior Chamber:

• Aqueous cells: Marker of disease activity

• Aqueous flare:
• Turbidity due to protein leak
• Seen via Tyndall effect or Brownian movement
• 1st sign

• Hypopyon
• AU + Hypopyon → Behcet's disease
• Mnemonic:
• Anterior door (AU) + Pus (Hypopyon) → evide → In bus (Behcets)

• Hyphema
• AU + Hyphema →
• Herpetic uveitis
• Toxoplasmosis
• Syphilis
• Mnemonic:
• Anterior door (AU) nte avde blood → Her (Herpes) toxic (toxoplasma) boyfriend had Syphilis (syphilis) → So she killed him → That blood (Hyphema)

Iris:

• Mnemonic:
• girl name Iris → Koppile (Koeppe) swabavam → Marginally (Marginal) get angry
• Brought her pseudo ruby (pseudorubiosis) → to fuck (fuchs) her
• give her herpes (herpes uveitis)
• then throw her in a mud (muddy iris)
• and under the bus (busacca)
• She died → Iris atrophy

• Pseudo-rubiosis:
• Dilated iris vessels

• Muddy iris:
• Acute cases, water-logged appearance

• Iris atrophy:
• Chronic cases
• Sectoral:
• Herpetic uveitis
• cross section of her

• Diffuse:
• Fuchs heterochromic iridocyclitis (FHI)

• Iris Nodules:

Nodule	Location	Found In
Koeppe	Pupillary margin	Granulomatous & Non-granulomatous uveitis
Busacca	Iris stroma	Granulomatous uveitis

 

Compare with

Pupil:

• Miosis: Acute

• Festooned pupil:
• Chronic
• Due to incomplete posterior synechiae
• Irregular dilation

• Fixed pupil: Recurrent
• 360° posterior synechiae
• No aqueous flow → Secondary angle closure glaucoma

• Total Posterior Synechiae (TPS):
• Exudation in posterior chamber
• Iris sticks to lens

• Cyclitic membrane:
• TPS + exudates behind lens
• Covers ciliary processes, equator, posterior lens
• ↓ aqueous secretion → ↓ IOP

• Occlusio pupillae:
• Exudates over anterior pupil

Intraocular Pressure (IOP):

• Acute AU:
• ↑ IOP
• Due to trabecular blockage by cells, proteins, trabeculitis

• Chronic AU:
• ↓ IOP
• Due to cyclitic membrane, ciliary body shutdown

3. Complications

Complicated Cataract (m/c)

Secondary angle closure glaucoma

• m/c in recurrent cases

Band-shaped keratopathy

• Ca deposits in Bowman's layer

• Mnemonic: Band → bend → bow

Cystoid macular edema

• m/c cause of visual loss

• Posterior involvement in AU

4. Treatment

Topical Steroids:

• Prednisolone

• Difluprednate

Antimetabolites:

• Azathioprine
• For recurrent episodes requiring long-term steroids

Cycloplegics:

• Atropine
• Relaxes ciliary muscle → Pain relief
• Breaks posterior synechiae
• Prevents new synechiae

• Atropine is given for Keratitis and Anterior uveitis for pain relief
• But NEVER given in GLAUCOMA (except Malignant glaucoma)

Steroid Side Effects:

• Topical: Glaucoma

• Systemic: Cataract

• CSR

Causes of Anterior Uveitis

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Sarcoidosis Ophthal Findings:

• M/c ocular manifestation: Granulomatous AU

• Candle wax dripping appearance
• (due to perivascular inflammation and sheathing).

• Lander's sign:
• Pre-retinal nodules.

• Saratha from candle wax (candle wax sign) land (Landers sign)

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NOTE: Posterior Uveitis

ㅤ	Infectious chorioretinitis	ㅤ
1	Toxoplasmosis	• Active: "Headlight in a fog" appearance • Chronic: "Punched out" scar. • Eccentric target sign (basal ganglia m/c) Toxic guy () saw a headlight in a fog () and got a punch ()
2	Toxocariasis	• Unilateral vision loss • Leukocoria (white pupillary reflex). • Causes focal chorioretinitis.
3	CMV Retinitis	• Causes focal chorioretinitis. • Pizza pie appearance • Scrambled egg & Ketchup appearance • Brushfield extension CMV → Come we have Pizza, scrambled egg and ketch up, So brush and come
ㅤ	Multifocal chorioretinitis	ㅤ
1	Tuberculosis (TB)	• Conglomerate lesion • MRS → Lipid peak
2	Herpes Simplex Virus (HSV)	ㅤ
3	Syphilis	ㅤ
ㅤ	Non-Infectious Posterior Uveitis	Features
1	Sarcoidosis	• M/c ocular manifestation: Granulomatous AU • Candle wax dripping ↳ d/t perivascular inflammation and sheathing • Lander's sign: ↳ Pre-retinal nodules
2	Birdshot Chorioretinopathy	• HLA-A29
3	Serpiginous Choroiditis	• HLA-B7
4	Behcet's Disease	ㅤ

• Non-Infectious Posterior Uveitis causes
• Saratha (Sarcoidosis) with a bird (Birdshot), snake (Serpiginous) in a bus (Behcets)

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Heerfordt vs Lofgren Syndrome

• Lofgren syndrome:
• Erythema nodosum + B/L lymphadenopathy + AU
• Mnemonic: L.O.F.G.R.I.N
• L: Lymphadenopathy
• O: Ouch (joint pain)
• F: Fever
• GR: Granuloma (non-caseating)
• N: Erythema Nodosum

• Heerfordt syndrome:
• Uveoparotid fever + 7th CN palsy
• Ford caril poyapo → kannilum mugathumn cheekilum kaattadichiu

Fuchs Terms	Notes
Fuchs heterochromia iridocyclitis	Chronic AU ⇒ • U/L Diffuse Iris atrophy + Heterochromia + Posterior SCC • Painless, No redness, No posterior synechiae Positive Amsler's Sign: ◦ Bleeding into Anterior chamber on paracentesis ◦ Without trauma to Iris/Angle ◦ D/t abnormal fragile Iris Stellate Keratin Precipitates ↳ Herpetic uveitis ↳ Toxoplasmosis ↳ Fuchs Heterochromia Iridocyclitis • Young stella → Fucked () by Toxic () Herpes () Guy
Dalens Fuchs	• Seen in Sympathetic ophthalmitis ↳ (granulomatous panuveitis) • Dalen Fucked Granny () sympathetically ()
Foster Fuchs	• In Pathological Myopia • Bleeding at macula • Fucking in Foster () home ↳ Blind child (Pathological myopia) ↳ Bled (Bleeding at macula)
Fuchs Endothelial dystrophy	• Cornea guttata: • Wart-like excrescences on posterior cornea • Fuck her Guts→ endothelial Stages • Stage 1: Central corneal guttata that spreads peripherally • Stage 2: Corneal oedema - beaten metal-like appearance • Stage 3: Bullous keratopathy • Stage 4: Subepithelial scarring and superficial vascularization