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https://upload.medbullets.com/topic/120501/images/hypopyon.jpg
Snapshot
  • A 54-year-old woman is referred to the emergency department from her primary care physician's office due to decreased visual acuity and ocular pain. Past medical history is notable for a decreased donor liver transplant and is currently on tacrolimus and mycophenolate mofetil. Ophthalmology was consulted, and examination was notable for perilimbal erythema, hypopyon, and decreased visual acuity. She is started on intravenous ganciclovir and topical corticosteroids.
Introduction
  • Overview
    • inflammation of the uvea
  • Epidemiology
    • incidence
      • most cases are idiopathic
    • risk factors
      • human leukocyte antigen (HLA-B27)
      • immunodeficiency
  • Pathophysiology
    • inflammatory response to the anterior or porsterior segment of the uvea
  • Associated conditions
    • infections
      • herpes simplex and zoster virus
      • cytomegalovirus
      • toxoplasmosis
      • syphilis
      • tuberculosis
      • cat-scratch disease
      • West Nile virus
    • systemic immune-mediated diseases
      • spondyloarthritis (e.g., ankylosing spondylitis)
      • sarcoidosis
      • juvenile idiopathic arthritis
      • psoriatic arthritis
      • inflammatory bowel disease
      • Behcet syndrome
      • Sjogren syndrome
    • syndromes restricted to the eye
      • pars planitis
      • immune recovery uveitis
      • idiopathic
      • sympathetic ophthalmia 
  • Prognosis
    • chronic uveitis is higher risk for developing visual loss
Anatomy
  • Organ
    • uvea
      • can be divided into 2 portions
        • anterior uvea
          • iris
          • ciliary body
        • posterior uvea
          • choroid
Presentation
  • Symptoms
    • anterior uveitis
      • infectious
        • visual impairment
      • traumatic iritis (traumatic uveitis) 
        • after trauma
        • visual impariment
        • conjunctival injection
        • eye pain
        • photophobia
        • blurry vision
        • sluggish pupil
    • posterior uveitis
      • visual impairment
  • Physical exam
    • anterior uveitis
      • perilimbal erythema
      • miosis
      • ocular pain
      • leukocytes in the anterior chamber of the eye (hypopyon) 
    • posterior uveitis
      • more likely to be painless
      • leukocytes in the vitreous humor
      • chorioretinal inflammation
Studies
  • Diagnosis is made with slit lamp examination
Differential
  • Conjunctivitis
    • differentiating factors
      • inflammation confined to the conjunctiva
  • Episcleritis
    • differentiating factors
      • vision is not affected
      • episcleral discoloration secondary to vasodilatation
        • without edema or thinning of the sclera
Treatment
  • Medical
    • antiviral therapy
      • indication
        • first-line for uveitis caused by a viral disease
    • topical corticosteroids 
      • indication
        • anterior uveitis
        • first-line for noninfectious anterior uveitis
    • systemic corticosteroids
      • indication
        • first-line for posterior uveitis
        • bilateral uveitis unresponsive to topical corticosteroids
Complications
  • Band keratopathy
    • calcium deposition in the corneal epithelium
  • Posterior synechiae
    • the iris is adhesed to the lens
  • Intraocular hypertension
  • Cataract
 

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