Symptom: Pain

-Level of pain does not predict severity Acute uveitis may have severe pain Chronic may be asymptomatic Boring pain in the eyeball Light causes pain Increased blink rate and blepharospasm Miosis contracts ciliary body=pain Henkind test=shine light in opposite eye to induce pain in affected eye Watery eyes to frank epiphora No other discharge present

Symptom: Photophobia

Symptom: Tearing

Symptom: Vision issues

Acute uveitis=normal to hazy vision Chronic uveitis=vision is worse than symptoms

Signs and symptoms: Lids

Signs and Symptoms: Conjunctiva

Blepharospasm Congestion and edma Erythema Pseudoptosis Lid droop associated with swelling Peri-limbal/circumcorneal flush Inflammation most noticeable around the cornea Cul-de-dacs white and quiet Greatest inflammation infero-temporal Epithelial edema Microcystic edema-chronic or advanced endothelial KP present Stromal edema-CH + AD, HOT acute KP Striate Keratitis=CH+AD, wrinkles that occur 2ndary to corneal edema Develops in recurrent/chronic cases Forms under corneal epithelium Comprised of calcium salts Remove with EDTA chelation Stills Triad in JRA: CAT, BK, Uveitis(CH)

Sign: Edema

Sign: Band Keratopathy

Sign: Cells in the anterior Chamber

Sign: Iris Membranes

Cells in the Aqueous WBC leaked from CB Upward closer to lens Downward closer to endothelium Viewing: Dark, Direct, 45-60 d, 1mm wide, focus from cornea to aqueous Grading: 0-1+:1-5 , 1-2+:5-10 , 2-3+: scattered cells, 3-4+:DENSE cells Non-fibrous membranes may come off collaretes LOOKS like pseudoexfoliation Can clog TM and increase IOP Protein leaks from inflamed vessels More noticeable in chronic granulomatous uveitis May persist/never goes away LOOKS like light in a smoky room IF unsure compare the flare btwn eyes Grading: 0-1+:trace , 1-2+:obvious , 2-3+: hazy aqueous, 3-4+:DENSE/plasmoid aqueous (REFFERED) PLASMOID AQUEOUS o Dense accumulation of FIBRIN CELLS=cloudy strands w/ lumps of PROTEIN MATERIAL o In severe acute uveitis o Cells move slow o Mistaken for lens material Inflammatory cellular deposit on the corneal endothelium Fine o Whitish gray fibrin or epitheloid cells o Adherent to posterior cornea o Less than 0.5mm in size o 3D appearance o CELLS DONT FUSE Granulomatous o CH granulomatous = large o Flat confluent looking o Greasy, waxy, grainy o May accumulate pigment o MUTTON FAT Pigmented

Sign: Flare

Sign: Keratic Precipitates

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Arlts Triangle or Krukenbergs spindle(more glaucoma) Convection current due to temp. difference btwn lens/cornea (2d) Lens is warmer, particles rise Gravity causes cold particles in front of cornea to drop Can also be seen in pigmentary glaucoma

Sign: Hypopion

Sign: Synechiae

Sign: Iris Atrophy

Sign: Iris Granulomas

Noticed in severe acute anterior uveitis Dense accumulation of WBC (usually polymorphonuclear cells) Gravity causes pooling in AC More common in sarcoid, Behcets, endopthalmitis, leprosy, and post surgical uveitis. Anterior synechiae o Peripheral anterior synechiae (PAS) o Fibrous adhesions btwn peripheral cornea and iris o GONIO Posterior synechiae o MORE COMMON o Adhesions btwn pupillary border and anterior lens capsule o Form in all types of uveitis o Especially when theres flare o May occur with iris nodules o Sometimes mistaken for PPM o Seclusio Pupillae (immobile pupil) Occurs in CH uveitis (Fuchs heterochromic, Herpetic uveitis) May decrease iris pigment LOOK for trans illumination defects Smooth velvety appearance (iris may swell, crypts lose definition) DENSE flare May form on pupil border, anterior iris, or angles Associated w/granulomatous disease Fleshy, white, vascularized masses Common in sarcoid Two types of granulomas o Koeppe-small on pupillary border o Bussaca-larger, mid periphery

Sign: Pupil involvment

Sign: Intra-ocular Pressure changes

Sign: Cataracts

Sign: Spillover of cells in the vitreous

Sign: Cystoid Macular Edema (CME)

Reacts normally to sluggish May be miotic (often irregular shape) Pupil may be fixed in seclusion pupillae o May lead to iris-bombe(bowl) o May lead to 2ndary glaucoma Henkind test Early: 3-6mm lower than other eye, due to reduced aqueous prod. Untreated acute/chronic: prolonged hypotony could lead to phtisis bulbi, CH IOP below 5mm at risk. IOP may increase, TM congestion, iatrogenic increase in IOP due to steroid response. Epi-capsular stars pigment debris in acute or CH cases. PSC (posterior sub-capsular)- most common. May be associated with Topical/oral steroids or FUCHs hetero. Mature cataracts- limited to stills disease (RA) May see cells attached to vitreous strands AC cells may spill into vitrous Assc w/posterior uveitis DILATE and look for cause CH endogenous uveitis syndromes May occur if inflammation is chronic

Sign: Bilateral uveitis

In most cases, uveitis becomes bilateral Highly suggestive of ENDOGENOUS and CHRONIC. Especially if granulomatous Record/document all systemic disease UNILATERAL is more common in sarcoid, behcets, foreign body, post surgical