Tag: Uveitis

Uveitis

UVEITIS

Q. 1

Which among the following is the commonest parasitic cause of uveitis?

 A

Toxocara

 B

Amoebiasis

 C

Taenia solium

 D

Oncocercosis

Q. 1

Which among the following is the commonest parasitic cause of uveitis?

 A

Toxocara

 B

Amoebiasis

 C

Taenia solium

 D

Oncocercosis

Ans. A

Explanation:

Toxocariasis is an infestation caused by an intestinal roundworm of dogs (toxocara canis) and cats (Toxocara catis). 
 
Features of ocular toxocariasis:
  • Toxocara chronic endophthalmitis
  • Posterior pole granuloma
  • Peripheral granuloma
Ref: Comprehensive Ophthalmology by AK Khurana, 4th edition, Page 158.

Q. 2

Granulomatous uveitis is seen in:

 A

Vogt-Koyanagi-Harada disease

 B

Fuch’s disease

 C

Bechet’s syndrome

 D

All

Q. 2

Granulomatous uveitis is seen in:

 A

Vogt-Koyanagi-Harada disease

 B

Fuch’s disease

 C

Bechet’s syndrome

 D

All

Ans. A

Explanation:

A i.e. Vogt-Koyanagi-Harada disease

–  Granulomatous uveitis is seen in chronic tuberculosis, leprosy, brucellosis, syphilis, leptospirosis, as well as most viral (esp herpes simplex, herpes zoster & varicella), fungal, protozoal and helminthic infectionsQ. It is also seen in sarcoidosis, sympathetic ophthalmitis, Vogt-Koyanagi-Harada’s disease and phacoanaphylactic (lens induced) uveitis.

Chronic granulomatous uveitis is caused by tuberculosis, syphilis, leprosy, brucellosis, herpes simplex, herpes zoster, varicella, sarcoidosis and phacoanaphylactic uveitis. Chronic nongranulomatous uveitis is associated with juvenile chronic arthritis, chronic iridocyclitis of children and Fuchs hetrochromic iridocyclitis.


Q. 3

Granulomatous uveitis is seen in all of the following except:

 A

Uveitis with ankylosing spondylitis

 B

Sympathetic ophthalmitis

 C

Tubercular uveitis

 D

Uveitis in sarcoidosis

Q. 3

Granulomatous uveitis is seen in all of the following except:

 A

Uveitis with ankylosing spondylitis

 B

Sympathetic ophthalmitis

 C

Tubercular uveitis

 D

Uveitis in sarcoidosis

Ans. A

Explanation:

Ans. Uveitis with ankylosing spondylitis

Quiz In Between


Q. 4

Granulomatous uveitis with involvement of parotid gland is seen in:

 A

Tuberculosis

 B

Syphilis

 C

Mumps

 D

Sarcoidosis

Q. 4

Granulomatous uveitis with involvement of parotid gland is seen in:

 A

Tuberculosis

 B

Syphilis

 C

Mumps

 D

Sarcoidosis

Ans. D

Explanation:

Ans. Sarcoidosis


Q. 5

Commonest cause of endogenous uveitis in India is:

 A

Tuberculosis

 B

Leprosy

 C

Syphilis

 D

Diabetes mellitus

Q. 5

Commonest cause of endogenous uveitis in India is:

 A

Tuberculosis

 B

Leprosy

 C

Syphilis

 D

Diabetes mellitus

Ans. A

Explanation:

Ans. Tuberculosis


Q. 6

The most frequent bacterial agent causing non­granulomatous uveitis is:

 A

Staphylococcus

 B

Streptococcus

 C

Pneumococcus

 D

Influenza bacillus

Q. 6

The most frequent bacterial agent causing non­granulomatous uveitis is:

 A

Staphylococcus

 B

Streptococcus

 C

Pneumococcus

 D

Influenza bacillus

Ans. B

Explanation:

Ans. Streptococcus

Quiz In Between


Q. 7

Uveitis is caused by all except:

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

Klebsiella

Q. 7

Uveitis is caused by all except:

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

Klebsiella

Ans. D

Explanation:

Ans. Klebsiella


Q. 8

Most common cause of anterior uveitis associated with arthritis:

 A

Ankylosing spondylitis

 B

Rheumatoid arthritis

 C

Syphilis

 D

Tuberculosis

Q. 8

Most common cause of anterior uveitis associated with arthritis:

 A

Ankylosing spondylitis

 B

Rheumatoid arthritis

 C

Syphilis

 D

Tuberculosis

Ans. A

Explanation:

Ans. Ankylosing spondylitis


Q. 9

A 10 year boy present with b/l chronic uveitis. Which investigation should be ordered:

 A

Hemogram

 B

X-ray of sacroiliac joint

 C

HIV rest

 D

Mantoux test

Q. 9

A 10 year boy present with b/l chronic uveitis. Which investigation should be ordered:

 A

Hemogram

 B

X-ray of sacroiliac joint

 C

HIV rest

 D

Mantoux test

Ans. D

Explanation:

Ans. Mantoux test

Quiz In Between


Q. 10

The investigation of anterior uveitis of a young boy are:

 A

HLA B 27

 B

X-ray of sacroiliac joint

 C

TORCH agents

 D

a and b

Q. 10

The investigation of anterior uveitis of a young boy are:

 A

HLA B 27

 B

X-ray of sacroiliac joint

 C

TORCH agents

 D

a and b

Ans. D

Explanation:

Ans. a and b


Q. 11

Anterior uveitis is most commonly associated with:

March 2005

 A

HLA DR4

 B

HLA D27

 C

HLA B4

 D

HLA B 27

Q. 11

Anterior uveitis is most commonly associated with:

March 2005

 A

HLA DR4

 B

HLA D27

 C

HLA B4

 D

HLA B 27

Ans. D

Explanation:

Ans. D: HLA B 27

A. Causes of Anterior Uveitis

In more than a third of all cases of anterior uveitis, the exact cause is unknown. Causes may include:

  • Ankylosing spondylitis is a type of arthritis that mainly affects the spine. This can cause recurrent arthritis. It is mostly associated with HLA B27
  • Reiter’s syndrome is an inflammatory arthritis common in young men – often caused by chlamydia infection. It is mostly associated with HLA B27
  • Psoriatic arthropathy is a form of arthritis that nearly a quarter of people with psoriasis may develop. It causes pain, swelling and stiffness in joints. Psoriasis is an immune-related disease of the skin and joints.
  • Inflammatory bowel disease causes inflammation, ulcers and scarring to the wall of the intestine but can affect other parts of the body as well.

Juvenile rheumatoid arthritis (JRA) is a kind of arthritis (inflammation of the joints) in children. Uveitis is the most common eye problem that can develop in children with JRA. Children with JRA may get uveitis before JRA is even diagnosed, or it can occur many years later.

  • Herpes is a common viral infection that causes oral or genital herpes. It mostly affects only one eye, but it can cause recurrent uveitis.
  • Sarcoidosis is a kind of inflammation that can affect many parts of the body. Its cause is unknown.
  • Fuch’s heterochromic iridocyclitis is a chronic kind of iritis. Its cause is unknown. It may cause rapid increase in eye pressure, requiring immediate treatment.

Lupus is a chronic inflammatory disease that affects different parts of the body, including the skin, joints, blood, and kidneys and is related to the body’s immune system.

Intraocular lens surgically implanted to replace a cataract lens. Uveitis can be caused by trauma related to cataract surgery. The presence of artificial lens can cause anterior uveitis.

  • Posner-Schlossman syndrome (PSS) is an uncommon inflammatory eye condition that usually affects one eye at a time.
    It typically affects young to middle-aged adults who develop high pressure inside the eye and mild inflammation.
  • Rheumatoid arthritis is a chronic inflammation of the joints that can cause permanent joint damage and disability.
  • Syphilis is a sexually transmitted disease. It can be cured, but if left untreated, the late stages of the disease can cause heart problems, abnormalities, mental illness, blindness and death. Although on the decline over the past decade, it has seen more cases in recent years.
  • Tuberculosis (TB) is a disease caused by bacteria that usually attacks the lungs.
  • Lyme disease is a disease caused by bacteria that are transmitted to people from the bite of a deer tick. It often causes a “bull’s-eye” rash around the bite, with symptoms such as fever, tiredness, headache, muscle and joint aches.

B. Causes of Intermediate Uveitis

In more than two thirds of all cases of intermediate uveitis, the exact cause is unknown. The remaining third of all cases are thought to be caused by conditions such as:

  • Sarcoidosis can affect many parts of the body. Its cause is unknown.
  • MS (multiple sclerosis) an inflammatory disease that affects the brain and spinal cord
  • Lyme disease, a disease caused by bacteria that are transmitted to people from the bite of a deer tick. It often causes a “bull’s-eye” rash around the bite, with symptoms such as fever, tiredness, headache, muscle and joint aches

C. Causes of Posterior Uveitis

Following is a list of common causes of posterior uveitis. In more than one in ten cases of uveitis, however, the exact cause is unknown.

Toxoplasmosis is an infection caused by a parasite. People may become infected from eating raw or undercooked meats, drinking unpasteurized milk, cleaning cat litter boxes, or working in gardens or playing in sandboxes that contain cat feces.

Cytomegalovirus retinitis (CMV retinitis) is a serious eye infection of the retina. It is a threat to people with weak immune systems, such as people with HIV, people undergoing chemotherapy, and people who have had organ transplants. Without treatment, CMV retinitis can destroy the retina and damage the optic nerve, resulting in blindness.

  • Lupus is a chronic inflammatory disease that affects different parts of the body, including the skin, joints, blood, and kidneys and is related to the body’s immune system.
  • Birdshot retinochoroidopathy may be an autoimmune disease. People with this condition may experience blurry vision, sensitivity to light, floaters, and night blindness. In most people, it affects both eyes. It causes white or yellow lesions scattered around the retina that can damage the retina and affect the vitreous.
  • Sarcoidosis is a kind of inflammation that can affect many parts of the body. Its cause is unknown.
  • Acute retinal necrosis is a condition that often causes retinal detachment and vision loss. Signs may include red eyes, eye pain and hazy/blurry vision.
  • Epstein-Barr virus (EBV) is a virus that infects nearly every adult. When infection with EBV occurs during adolescence or young adulthood, it often causes mononucleosis.
  • Behcet’s disease is a rare, chronic inflammatory disease. The cause of Behcet’s disease is unknown. If often begins when individuals are in their 20s or 30s, although it can happen at any age. Uveitis is very common with people suffering from Behcet’s, which can cause acute uveitis that happens soon after onset of Behcet’s disease.
  • Syphilis is a sexually transmitted disease. It can be cured, but if left untreated, the late stages of the disease can cause heart problems, abnormalities, mental illness, blindness and death. Although on the decline over the past decade, it has seen more cases in recent years.
  • Serpiginous choroidopathy is related to uveitis – a rare condition that affects the part of the uvea called the choroid. It can affect the vitreous body and cause lesions on the retina that result in vision loss.

D. Causes of Panuveitis

As with other kinds of uveitis, the cause of panuveitis is often unknown. Other possible causes include:

  • Sarcoidosis is a kind of inflammation that can affect many parts of the body. Its cause is unknown.
  • Behcet’s disease is a rare, chronic inflammatory disease. The cause of Behcet’s disease is unknown. If often begins when individuals are in their 20s or 30s, although it can happen at any age. Uveitis is very common with people suffering from Behcet’s, which can cause acute uveitis that happens soon after onset of Behcet’s disease.
  • Lupus is a chronic inflammatory disease that affects different parts of the body, including the skin, joints, blood, and kidneys and is related to the body’s immune system.
  • Syphilis is a sexually transmitted disease. It can be cured, but if left untreated, the late stages of the disease can cause heart problems, abnormalities, mental illness, blindness and death. Although on the decline over the past decade, it has seen more cases in recent years.
  • Vogt-Koyanagi-Harada syndrome is an inflammatory condition that involves the eyes and meninges (coverings of the brain). The condition is most common in Asians and American Indians. It often causes uveitis in both eyes and retinal detachments, and can result in serious vision loss and blindness.
  • Tuberculosis (TB)
  • Fungal Retinitis fungal infections can be a problem for people with weakened immune systems, including very premature babies and people with HIV or AIDS

Q. 12

Anterior uveitis is commonly associated with:

 A

Psoriasis

 B

Reactive arthritis

 C

Ankylosing spondylitis

 D

All of the above

Q. 12

Anterior uveitis is commonly associated with:

 A

Psoriasis

 B

Reactive arthritis

 C

Ankylosing spondylitis

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Quiz In Between


Q. 13

Anterior uveitis involve which of the following ocular structure: 

 A

Iris and ciliary body

 B

Retina

 C

Anterior chamber

 D

Lens

Q. 13

Anterior uveitis involve which of the following ocular structure: 

 A

Iris and ciliary body

 B

Retina

 C

Anterior chamber

 D

Lens

Ans. A

Explanation:

Ans. A: Iris and Ciliary Body

Anterior uveitis include iritis, anterior cyclitis and iridocyclitis

Anatomical classification of uveitis

  • Uveitis may be classified anatomically into anterior, intermediate, posterior and panuveitic forms, based on which part of the eye is primarily affected by the inflammation.
  • “Anterior uveitis” (or iridocyclitis) is the inflammation of the iris and anterior chamber.
  • Anywhere from two-thirds to 90% of uveitis cases are anterior in location.
  • Symptoms include red eye, injected conjunctiva, pain and decreased vision. Signs include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates (“KP”) on the posterior surface of the cornea.

“Intermediate uveitis” (pars planitis) consists of vitritis – inflammatory cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana.

“Posterior uveitis” (or chorioretinitis) is the inflammation of the retina and choroid.

“Pan-uveitis” is the inflammation of all the layers of the uvea.

Systemic disorders associated with uveitis

  • Ankylosing spondylitis
  • Behcet’s disease
  • Chronic granulomatous disease
  • Enthesitis
  • Inflammatory bowel disease
  • Juvenile rheumatoid arthritis
  • Kawasaki’s disease
  • Multiple sclerosis
  • Polyarteritis nodosa
  • Psoriatic arthritis
  • Reactive arthritis
  • Sarcoidosis
  • Systemic lupus erythematosus
  • Vogt-Koyanagi-Harada syndrome
  • Whipple’s disease
  • Lyme disease

Infectious causes

  • Uveitis may be a (normal) immune response to fight an infection inside the eye.
  • While representing the minority of patients with uveitis, such possible infections include:
  • Brucellosis
  • Herpes simplex
  • Herpes zoster
  • Leptospirosis
  • Lyme disease
  • Toxocariasis
  • Toxoplasmosis

Uveitis Syndromes

  • Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
  • Birdshot retinochoroidopathy
  • Fuchs Heterochromic Iridocyclitis
  • Multifocal Choroiditis and Panuveitis Syndrome

Masquerade syndromes

  • Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory.

The following are some of the most common:

Anterior segment

– Intraocular foreign body

– Juvenile xanthogranuloma

– Leukemia

– Retinal detachment

– Retinoblastoma Posterior segment

– Lymphoma

–  Multiple sclerosis

–  Retinitis pigmentosa

–  Retinoblastoma

Symptoms

  • Redness of the eye
  • Blurred vision
  • Sensitivity to light (photophobia)
  • Dark, floating spots along the visual field
  • Eye pain

Treatment

  • Uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids.
  • But before administration of corticosteroids, corneal ulcers are ruled out, typically by a Florescence Dye test.
  • In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used.
  • In some cases an injection of PSTTA (posterior subtenon triamcinolone acetate) may also be given to reduce the swelling of the eye.
  • Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis.

Q. 14

All of the following has HLAB27 associated with uveitis except ‑

 A

Ankylosing spondylitis

 B

Reiters syndrome

 C

Behcets syndrome

 D

None of the above

Q. 14

All of the following has HLAB27 associated with uveitis except ‑

 A

Ankylosing spondylitis

 B

Reiters syndrome

 C

Behcets syndrome

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Behcets syndrome

A few examples of HLA-associated diseases with uveitis are as follows :

i) HLA-B27 : Acute anterior uveitis associated with ankylosing spondylitis and also in Reiter’s syndrome.

ii) HLA-B5 : Uveitis in Behcet’s disease.

iii) HLA-DR4 and DW15 : Vogt Koyanagi Harada’s disease.


Q. 15

Recurrent non-granulomatous uveitis is seen in‑

 A

Vogt koyanagi-Harada syndrome

 B

Posner-Schlossman syndrome

 C

Tuberculosis

 D

Sarcoidosis

Q. 15

Recurrent non-granulomatous uveitis is seen in‑

 A

Vogt koyanagi-Harada syndrome

 B

Posner-Schlossman syndrome

 C

Tuberculosis

 D

Sarcoidosis

Ans. B

Explanation:

Ans. is `b’ i.e., Posner-Schlossman syndrome

Glaumatocyclic crisis

Glamatocyclitic crisis (Posner – Schlossman syndrome) is a unilateral recurrent non- granulomatous iritis that is associated with an elevated ocular pressure during the attacks. This self- limiting condition tends to occur in persons during the third to sixth decade and the visual fields, the optic nerve head, and anterior chamber angle are normal. A mild inflammatory reaction is very rarely present as evidenced by a few keratic precipitates on the posterior surface of the cornea. The cause of the glaucoma remains unknown, but a trabeculitis is suspected. Many patients (55%) subsequently develop open angle glaucoma.


Q. 16

A female presented with breathlessness, arthralgia and blurring of vision with granulomatous anterior uveitis. What is the most probable etiology

 A

Tubercular uveitis

 B

HLA-B27 related uveitis

 C

Intra-ocular lymphoma

 D

Ocular sarcoidosis

Q. 16

A female presented with breathlessness, arthralgia and blurring of vision with granulomatous anterior uveitis. What is the most probable etiology

 A

Tubercular uveitis

 B

HLA-B27 related uveitis

 C

Intra-ocular lymphoma

 D

Ocular sarcoidosis

Ans. D

Explanation:

Ans. d. Ocular sarcoidosis

Quiz In Between



Uveitis

UVEITIS


UVEITIS

  • Uveitis refers to the inflammation of uveal tissue.

ANATOMICAL CLASSIFICATION

1. Anterior uveitis:

  • It is inflammation of the uveal tissue from iris upto pars plicata of ciliary body.

Subdivided into:

  1. Iritis, in which inflammation predominantly affects the iris.
  2. Iridocyctitis in which iris & pars plicata part of ciliary body are equally involved.
  3. Cyclitis, in which pars plicata part of ciliary body is predominantly affected.

2. Intermediate uveitis:

  • includes inflammation of the pars plana & peripheral part of the retina & underlying ‘choroid’.
  • It is also called ‘pars planitis’.

3. Posterior uveitis:

  • It refers to inflammation of the choroid (choroiditis).
  • There is associated infammatory of retina & hence the term ‘chorioretinitis’  is used.

4. Panuveitis:

  • It is inflammation of the whole uvea.

Causes of Anterior Uveitis

AUTOIMMUNE

  • Ankylosing spondylitis (HLA-B27)
  • Reiter’s syndrome (HLA-B27)
  • Psoriasis
  • Sarcoidosis
  • Bechet’s disease (HLA-B5)

INFECTIONS

  • Syphilis
  • TB
  • Leprosy
  • HSV
  • Herpes zoster

MALIGNANCY

  • Retinoblastoma
  • Leukemia
  • Lymphoma
  • Malignant melanoma

OTHER

  • Idiopathic
  • Trauma
  • Fuch’s heterochromatic
  • iridocyclitis

Causes of Posterior Uveitis (Chorioretinitis)

  INFECTIOUS

  1. Virus
  2. Bacteria
  3. Fungi
  4. Parasite
  •  CMV, HSV, Rubella, Rubeola (Measles)
  • TB, Syphillis, Lyme’s disease
  • Candida, Histoplasma, Cryptococcus, Aspergillus
  • Toxoplasma, Onchocerca
  NON INFECTIOUS

  1. Autoimmune
  2. Malignancy
  3. Unknown etiology
  • Bechet’s disease (HLA-B5), SLE
  • Intraocular lymphoma, Leukemia
  • sarcoidosis

CLINICAL CLASSIFICATION OF UVEITIS

 1. Acute uveitis: 

  • Sudden symptomatic onset & the disease lasts for about six weeks to 3 months.

 2. Chronic uveitis:

  • It frequently has an insiduous & asymptomatic onset.
  • Persists longer than 3 months to even years & is usually diagnosed when it causes defective vision.

NON-GRANULOMATOUS UVEITIS

GRANULOMATOUS UVEITIS

  ACUTE

  • Idiopathic
  • Pyogenic : Staphylococcus, Streptococci
  • HLA-B27 associated: Ankylosing  spondylitis
  • Reiter syndrome
  • Bechet disease
  • Psoriatic arthritis, Reiter’s syndrome
  • Rheumatoid arthritis
  • Glaucomatocyclitic crisis (Ponser-Schlossman syndrome)

 

  ACUTE

  • Rare
  CHRONIC

  • JRA (Juvenile rheumatoid arthritis)
  • Chronic iridocyclitis of children
  CHRONIC

  • Sarcoidosis
  • Syphilis
  • Tuberculosis
  • Leprosy
  • Brucellosis
  • Vogt-Koyanagi-Harada’s disease

Exam Important

  • Anterior uveitis involve Iris and ciliary body.
  • Uveitis is caused by T.B., Staphylococcus,Streptococcus.
  • Commonest parasitic cause of uveitis is Toxaplasma.
  • Most common cause of anterior uveitis associated with Ankylosing spondylitis.
  • Most common etiological variety of uveitis is Allergic.
  • Recurrent non-granulomatous uveitis is seen in Posner-Schlossman syndrome.
  • Granulomatous uveitis with involvement of parotid gland is seen in Sarcoidosis.
  • HLA-B5 → Uveitis in Behcet’s disease.
  • Anterior uveitis is most commonly associated with HLA B 27.
  • Anterior uveitis is commonly associated with Psoriasis, Reactive arthritis & Ankylosing spondylitis.
  • The Uveitis associated with vitiligo & auditory defects occurs in Vogt-Koyanagi syndrome.
  • The investigation used in evaluation of anterior uveitis → HLA B 27, X-ray of sacroiliac joint & TORCH agents.
  • The investigation used in evaluation of posterior uveitis  →  Mantoux test.
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