Ophthalmology · MU Sofia

54. Inflammatory diseases of the anterior uvea*

Covers the causes of iridocyclitis, with more than a third of cases unidentified, and lists associated systemic conditions such as ankylosing spondylitis, Reiter's syndrome, sarcoidosis and tuberculosis. It then explains the presentation of anterior uveitis, including pain, ciliary flush, photophobia and the slit-lamp signs of keratic precipitates, flare and iris changes, followed by complications, management with cycloplegics and corticosteroids, and a brief note on intermediate uveitis and panophthalmitis.

Inside: 1 section · 7 labelled pictures · 16 flashcards · 4 min

Topic 54 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 573 words (4 min of reading), with 16 flashcards.

In this note

  1. Iridocyclitis aetiology, Clinical presentation, treatment

Iridocyclitis aetiology, Clinical presentation, treatment

Causes: more than a third is unknown. Causes may include:

Ankylosing Spondylitis, Reiter’s Syndrome (by Chlamydia infection). Psoriatic Arthropathy, Inflammatory Bowel Disease, Rheumatoid Arthritis, Herpes, Sarcoidosis Lupus cataract lens Syphilis Tuberculosis (TB) Lyme disease

Anterior uveitis presentation

  1. 1. pain (ciliary spasm)
  2. 2. redness (conjunctival condition, ciliary flush &ciliary congestion 360 degrees perilimbal + circumcorneal unlike red conjunctivitis )
  3. 3. Photophobia( abnormal sensitivity to ambient light due to pain from ciliary spasm and miosis(constriction) ;glare is sensitivity to bright light)
  4. 4. With or without diminished vision ;
  5. 5. DD no pus formation
  • Any inflammation of anterior leads to redness Iritis/irido cyclitis Angle –closure glaucoma Conjunctivitis, keratitis, scleritis, episcleritis

Signs seen in slit lamp

  • inflammation of iris& ciliary body dilated vessels + exudation of fluid/cells
  • corneal endothelium will have keratic precipitates (leucocytes from the ciliary body and iris vessels stick onto the corneal endothelium ) =white precipitates, KP can vary in size, number and shape (base down triangle inferiority (Arlts) The precipitates could also be granulomatous or non-granulomatous
  • the aqueous itself is usually empty but now it has proteins and cells ( flare due to express protein aka tyndall effect and aqueous cells present appear like dust particle)
  • the iris is like a waterlogged sponge so loses its normal architecture crypts are usually seen and surface is reflective but due to exudation they don’t so it appears as muddy and iris nodules might be present seen in granulomatous DD from non-granulomatous )
  • the pupils experience miosis (DD from other red eyes ) and the swelling or iris muscle leads to swelling thus constriction but sluggish reaction and exudation of iris causes it to stick to closest structures posterior synechiae as it sticks to lens-DD, complication pupil block glaucoma )

Complications: Secondary cataract, hypopyon, iris atrophy, band keratopa.

Management of uveitis:

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