Opth

• Uveitis is an inflammatory condition affecting the uveal tract, which affects the iris, ciliary body, & choroid Inflammation of nearby tissues (e.g. retina, optic nerve, & vitreous humour) may also occur
• Iritis is a subtype of uveitis that specifically refers to inflammation confined to the iris update 5/12/24 to make more accurate
• The most common type of uveitis is anterior uveitis in ~78% of cases primarily affecting the iris & ciliary body "[Gueudry, J.; Muraine, M. (January 2018). ""Anterior uveitis"". Journal Français d'Ophtalmologie. 41 (1): e11–e21. doi:10.1016/j.jfo.2017.11.003. PMID 29290458]"
• Uveitis aetiology is split into: Noninfectious = systemic autoimmune diseases, trauma, drug-induced Infectious = e.g. HSV, VZV, CMV; bacterial keratitis, scleritis, syphilis, lyme disease, TBIdiopathic = most common
• Uveitis can result in permenant visual loss of not treated
• Anterior uveitis has a genetic predisposition to HLA-B27 autoimmune conditions ankylosing spondylitis, arthritis w/Corhn & UC, psoriatic arthritis, reactive arthritis
• What is the likely diagnosis in a patient with a history of IBD that presents with a painful, red eye with tearing and decreased visual acuity? Anterior uveitis typically idiopathic but may be associated with systemic inflammatory diseases (IBD, sarcoidosis, and spondyloarthritis)
• What is the typical presentation for anterior uveitis? Painful red eye that is sensitive to light
• A patient presents with a recent history of sarcoidosis. They have redness around the cornea, which does not blanch on pressure. The redness is unilateral. Their iris in injected, and their pupil is small and irregular. The cornea itself appears normal. What is likely occurring? Anterior uveitis HLA-B27 autoimmune conditions can cause anterior uveitis. The presentation is in line with the diagnosis.
• In anterior uveitis the pupil may be irregular & small
• Anterior uveitis can present with significant photophobia
• Uveitis may present with conjunctival redness and hypopyon, which is the accumulation of pus in the anterior chamber [By EyeMD (Rakesh Ahuja, M.D.). - Own work., CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=1229578]
• How does visual acuity change in anterior uveitis? Worsens with severity and duration of inflammation
• What investigation is done for anterior uveitis? Slit lamp biomicroscopy Findings include keratic precipitates, anterior chamber cells & flare in the anterior chamber
• Refer supsected uveitis to eye casualty
• What is the management for noninfectious uveitis? topical corticosteroids topical cycloplegics (cyclopentolate 1% ) corticosteroid = ↓ inflammation + prevents adhesions in the eye cycloplegic-mydriatic = paralyses ciliary body
• What is the management for infectious uveitis? Topical/systemic antibiotics + topical corticosteroid & topical cycloplegics Antimicrobial therapy is targeted for the cause corticosteroid = ↓ inflammation + prevents adhesions cycloplegic-mydriatic = paralyses ciliary body
• Blepharitis is a chronic inflammatory condition of the eyelid margins
• Anterior blepharitis of the anterior margin of the eyelids: Staphylococci Seborrhoeic dermatitis
• Posterior blepharitis refers to inflammation of the posterior margin of they eyelids (meibomian gland dysfunction) The meibomian glands are a set of glands that run along the posterior eyelid margin. They produce lipids secretions which prevent the tear film drying out dysfunction of the meibomian glands leads to irritation and blepharitis.
• Blepharitis symptoms are usually bi-lateral
• Blepharitis may present with crusting of the eyelashes, thickened eyelid margins, and a history of waking with eyelashes stuck together
• Characteristic clinical signs of blepharitis are burning, itching, erythema, & crusting of the eyelids worse in the mornings
• What is the initial management of blepharitis? Warm compresses & eyelid cleansing with massage
• What is the management of blepharitis after conservative management fails? antibiotic eye drops [https://www.nhs.uk/conditions/blepharitis]
• Glaucoma is a progressive optic neuropathy characterised by structural damage to the optic nerve & corresponding visual field loss, most often associated with elevated intraocular pressure
• Glaucoma is has a raised ↑ intraocular pressure, which causes optic nerve damage, leading to progressive peripheralvisual field loss and optic disc cupping or pallor visible on ophthalmoscopy update 5/12/24 to include peripheral visual field loss
• Ocular hypertension can progress into glaucoma
• Primary open angle glaucoma (POAG) is a chronic, progressive optic neuropathy with open anterior chamber angles Often linked to ↑ intraocular pressure
• Primary open angle glaucoma (POAG) develops gradually
• Primary open angle glaucoma (POAG) is typically bi-lateral
• Intra-ocular pressure in primary open angle glaucoma (POAG) is most commonly ↑, but normal-tension glaucoma can also occur NTG is a sub-type of POAG. NTG has a normal IOP.
• What is the hallmark differentiator of primary open angle glaucoma (POAG) vs acute angle closure glaucoma? Open iridocorneal angle on gonioscopy The peripheral iris is NOT covering the trabecular meshwork, allowing the aqueous humour from the anterior chamber of the eye (POAG)
• Primary open angle glaucoma (POAG) risk factors: Family history European or African descent Diabetes mellitus Myopia Corticosteroids use update 5/12/24 to include more accurate and high yield risk factors (specific descent)
• Primary open angle glaucoma (POAG) presents with peripheral visual field loss & ↓ visual acuity
• What are the fundoscopy findings for primary open-angle glaucoma (POAG): Optic disc cupping, optic disc pallor, & bayonetting of vessels Optic disc cupping = cup-to-disc ratio > 0.6 Optic disc pallor = indicating optic atrophy Bayonetting of vessels = retinal vessles may disappear as they make a sharp turn into the cup
• If primary open-angle glaucoma is suspected then refer to a specialist [© NICE [26 January 2022] Glaucoma: diagnosis and management. Available from https://www.nice.org.uk/guidance/ng81/chapter/Recommendations All rights reserved. Subject to Notice of rights NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication]
• What is the first-line management for primary open-angle glaucoma with a IOP of ≥ 24 mmHg? 360° selective laser trabeculoplasty A 2nd one may be needed in the future The procedure improves drainage of aqueous humour by targeting pigmented cells in the trabecular meshwork. This ↓ resistance and allows ↑ outflow of aqueous humour thus ↓ IOP [© NICE [26 January 2022] Glaucoma: diagnosis and management. Available from https://www.nice.org.uk/guidance/ng81/chapter/Recommendations All rights reserved. Subject to Notice of rights NICE guidance is prepared for the National Health Se...
• What is the second-line management of primary open-angle glaucoma (360° SLT unsuitable or need additional treatment)? Prostaglandin analogue (PGA) eyedrops E.g. latanoprost [© NICE [26 January 2022] Glaucoma: diagnosis and management. Available from https://www.nice.org.uk/guidance/ng81/chapter/Recommendations All rights reserved. Subject to Notice of rights NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publ...
• Management for primary-open angle glaucoma following 360° SLT & PGA drops? Beta blocker eye drops (e.g. timolol) Carbonic anhydrase inhibitor eye drops (e.g. dorzolamide) Sympathomimetic eye drops (e.g. brimonidine) If POAG is refractory, consider trabeculectomy [© NICE [26 January 2022] Glaucoma: diagnosis and management. Available from https://www.nice.org.uk/guidance/ng81/chapter/Recommendations All rights reserved. Subject to Notice of rights NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review a...