Term
| Anterior Uveitis is usually sterile (eg. autoimmune / HLA-B27), but if it's infectious it's probably… |
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Definition
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Term
| If a uveitis is posterior, it's usually (infectious / sterile). |
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Definition
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Term
| You can basically diagnose uveitis by doing this one thing. |
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Definition
| Shining light in the good eye to see if there is consentual pain. |
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Term
| Posterior synechiae and cataract are slit lamp findings indicative of what kind of uveitis? |
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Definition
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Term
| Who tends to get pars planitis (vitritis), and where should you check for it? |
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Definition
| Young boys. Check inferior for 'snowbanking'. |
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Term
| 11% of patients with what condition get uveitis? |
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Definition
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Term
| Describe the different stages of Cells and Flare (0, 1+, 2+, 3+, 4+) |
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Definition
0 ) None, 0 cells
1+) Barely detectable; 5 - 10 cells
2+) Iris/lens details still clear; 10 - 20 cells
3+) Iris/lens details hazy; 20 - 50 cells
4+) Fixed, coagulated aqueous with considerable fibrin; 50+ cells |
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Term
What minumum lab tests must you run if a uveitis is...
- bilateral, severe, and/or recurrent
- granulomatous
- involving the posterior segment? |
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Definition
HLA-B27
PPD (TB)
ACE (sarcoid)
VDRL (syphilis)
FTA-ABS (syphilis)
Chest X-Ray (TB, sarcoid) |
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Term
| Anterior vitreous cells is pathognomonic for what classification of uveitis? |
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Definition
| Intermediate Uveitis (aka iridocyclitis) |
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Term
| What are the likely causes of intermediate uveitis (and therefore, what other s/sxs should you ask about)? |
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Definition
69% unknown
22% sarcoid (breathing problems)
8% MS (eye pain on EOMs & neuro sxs)
1% Lyme |
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Term
| Posterior uveitis is typified by what retinal finding? |
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Definition
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Term
| Regarding edema associated with posterior uveitis, what is the most commonly associated? |
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Definition
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Term
| Look to systemic causes when thinking of (anterior / intermediate / posterior) uveitis in particular. |
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Definition
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Term
| Given all the uveitis treatment options, which one did Dr. Y say was critical? |
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Definition
| Corticosteroids (specifically TobraDex or Pred Forte) |
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Term
| What's the short list of uveitis treatment? |
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Definition
sun protection
cycloplegics
corticosteroids
NSAIDS (maybe)
immunosuppressants (if other stuff has been tried)
surgery |
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Term
| What DON'T you give someone with uveitis, even though you'd think it might be able to help break anterior synechiae? |
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Definition
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Term
What will relax a uveitis iris (for comfort) and, more importantly, break synechiae that may have formed from chronic iritis?
What's the third thing that this will do? |
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Definition
| Cycloplegics. They will also stabilize the blood-aqueous barrier. |
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Term
| What's the most popular cycloplegic to use, and what concentration should we lean towards regarding iritis? |
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Definition
| Homatropine (2 and 5% available). Use 5%. |
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Term
| Dosing for uveitis use of homatropine? Scopolamine? |
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Definition
1-2 gtt of 5% (or 2%) BID
1-2 gtt of 0.25% TID |
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Term
| Given 2.5% and 10% concentrations of phenylephrine, which should we use? |
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Definition
| Probably 2.5% since 10% could cause breathing difficulties. |
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Term
| What's the best (and sort of only) option for breaking an anterior synechiae? |
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Definition
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Term
| These are absolutely critical for uveitis treatment. |
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Definition
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Term
| this drop = Nectar of the Gods |
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Definition
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Term
| What are the maximally effective topical steroids? |
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Definition
0.5% loteprednol (Lotemax, combo in Zylet)
0.1% dexamethasone (combo in TobraDex)
1% pred acetate (Pred Forte)
0.5% difluprednate (Durazol) (the really big gun) |
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Term
| If you're worried about steroid responding or glaucoma, what steroid choice should you lean toward? |
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Definition
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Term
| The typical steroid used for uveitis treatment is what, in what concentration, and with what dosing? |
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Definition
| 1 gtt prednisolone acetate 1% q2h (or qh for severe uveitis!) |
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Term
| What do you need to remind your patients to do when you prescribe them a topical steroid? |
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Definition
| Shake the drop (a lot) before instillation. |
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Term
| What generic steroid has caused some problems in the past? |
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Definition
| Generic 1% pred acetate has had sedimentation of the active ingredient clogged into the dropper tip. |
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Term
| What are some possible SEs of topical steroids? |
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Definition
HSK (although could use a steroid for stromal Simplex)
Potentiation of fungal
Stromal melt of compromised Ks
PSC, glaucoma |
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Term
| What steroid drop don't you need to shake? |
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Definition
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Term
| What do Lotamax and Alrex have in common? What's different? |
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Definition
| Both are Loteprednol, but Lotamax can be an ointment rather than a drop. |
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Term
| What steroid creams/ointments should you NOT use on the eye? |
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Definition
Hydrocortisone (1% cream)
Kenalog (0.025%, 0.1% and 0.5% cream) |
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Term
| What are some ophthalmic steroid ointments that are available? |
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Definition
| FML, TobraDex, Maxitrol, Vasocidin, Blephamide, Pred-G |
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Term
| Why doesn't Dr. Y. prescribe Maxitrol ointment? |
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Definition
| Because it's a combo ointment that contains neomycin, which may cause contact dermatitis. |
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Term
| If there is a severe inflammatory uveitis in a patient who cannot instill drops, what other option might you have? |
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Definition
| Injectable steroids via periocular bolus (triamcinolone, dexamethasone), intravitreal (triamcinolone), or implant (Retisert/fluocinolone) |
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Term
| What's the drawback to intravitreal steroid implants? |
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Definition
| Most phakic eyes will get cataracts. Also, half the folks will need IOP-lowering meds and a third will need filtration surgery. (Among other SEs...) |
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Term
When are systemic (oral) steroids indicated regarding uveitis?
What drug is typically prescribed in what dosing? |
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Definition
When there is a posterior uveitis or vitritis (eg. cells in the posterior chamber, pars planitis).
Predisone is typically prescribed, 1 mg/kg/day. (Taper over 3-6 weeks as sxs resolve.) |
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Term
| When it comes to prescribing IOP-lowering meds with topical steroids, what should you not give to a patient with uveitis? |
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Definition
Prostaglandins (will increase inflammation, takes too long)
Pilocarpine (could induce synecheae, can increase blood/aqueous surface area) |
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Term
| Dr. Y. wouldn't prescribe NSAIDs for uveitis because… |
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Definition
NSAIDs will not get rid of cells in the anterior chamber like steroids will.
Note: You should NOT mix NSAIDs together. Just FYI. |
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Term
| When does a uveitis need immunosuppressnts? |
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Definition
| If it's severe, sight-threatening (ie. posterior), and unresponsive to steroids alone. |
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Term
| What are the "biologic" drugs that you can use? |
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Definition
| The -mab (Monoclonal AntiBody) drugs. |
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Term
| When might surgery be indicated in uveitis? |
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Definition
| When there have been permanent, structural changes due to the iritis (eg. cataracts, secondary glaucoma (angle closure), retinal detachment). |
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Term
| You want to hit a uveitis (hard / delicately) with topical treatment. |
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Definition
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