Uveitis - Symptoms and Causes - NEET PG Ophthalmology

Uveitis is an important topic for the NEET PG exam because it is a common and serious ocular condition that affects the uveal tract, the middle layer of the eye. Understanding the symptoms and causes of uveitis is crucial for medical students and aspiring ophthalmologists as it can help them diagnose and treat the condition effectively, leading to better patient outcomes.

In this blog, we provide you study material on symptoms and causes of uveitis for NEET PG/NExT exam preparation. Read on to strengthen your Ophthalmology preparations.

Overview

• Uvea consists of 3 parts: 
  • Iris 
  • Ciliary body 
  • Choroid 

• Uveitis is classified into 4 types 
  • Anterior Uveitis (70%): M/C 
  • Intermediate Uveitis 
  • Posterior Uveitis 
  • PanUveitis 

ANTERIOR UVEITIS 

• Most common cause: Idiopathic. 
• 2nd M/C cause: HLA B27 (of which ankylosing spondylitis is most common)
• M/C cause of AU in children: JRA / JIA (Juvenile Idiopathic Arthritis). Cells (WBC, neutrophils) are earliest marker of active disease
• KP's (Keratic precipitates) seen in Arlt's Triangle (triangle in inferior part of cornea where all KP’s gets preferentially attached) 
  • Exception: Diffuse KP's (can be attached anywhere in corneal endothelium apart from arlt’s triangle)
  • Cause of diffuse KP’s:  Fuchs Heterochromic iridocyclitis & herpetic uveitis.
• Granulomatous Uveitis (seen in TB, Syphilis and Sarcoidosis)
  • M/C: Mutton Fat KP's along with Koeppe's Nodules and Busacca's Nodules 

INTERMEDIATE UVEITIS 

It is inflammation of Pars plana + vitreous.

• Cause - Idiopathic K/a pars planitis (M/C) 
  • Sarcoidosis (2nd M/C) 
  • Multiple Sclerosis (life threatening) 
• Presenting symptoms: Floaters. Loss of vision (rare): M/C cause is CME . Only and important sign in pars planitis: Snowballs & Snowbanks sign 

Also Read: Abnormal  Pupils - NEET PG Ophthamology

POSTERIOR UVEITIS 

• M/C cause toxoplasmosis (Infectious) 
• Head light in fog appearance 
• Headlight is chorioretinitis and fog is vitritis 

SARCOIDOSIS ASSOCIATED UVEITIS

• Can cause uveitis of all 4 types
• Anterior uveitis is most common 
• Candle wax Drippings (Vasculitis) seen in posterior uveitis in sarcoidosis

PANUVEITIS 

Sympathetic Ophthalmitis

• B/L granulomatous Uveitis following trauma to one eye 
• Exciting eye = Injured eye; Other eye which gets inflamed = Sympathizing eye 
• The trauma has to be penetrating / perforating injuries to ciliary body (dangerous area of eye)
• Damage to ciliary body: Maximum chance of sympathetic ophthalmitis 
• Signs 
  • Dalen Fuchs nodules (whitish patches on the choroid)
  • Mutton Fat KP
  • Retrolental flare (earliest finding of sympathetic ophthalmitis, it is a vitreous flare seen behind the lens) 
• Rx - Enucleation of injured eye within 14 days reduces the chances for the second eye to get infected.

Vogt-Koyanagi-Harada Syndrome (VKH) 

• Bilateral granulomatous pan uveitis with CNS/ Auditory, Skin symptoms without trauma
• CNS manifestations- Encephalopathy, meningeal irritation (headache, neck stiffness; young females)
• Auditory manifestations - Vertigo, tinnitus, deafness 
• Skin manifestations - Alopecia, poliosis, vitiligo 
• Ocular manifestations - B / L granulomatous Pan uveitis with Exudative RD with “Sunset glow” fundus (orange sunset fundus)
• Sugiura's Sign: Perilimbal vitiligo 

FUCHS HETEROCHROMIC IRIDOCYCLITIS (FHI) 

• Rare kind of uveitis 
• Triad of:
  • Heterochromia (Color of iris in both eyes is different) 
  • Diffuse stellate KP's 
  • Cataract 

• Often associated with rubella 
• Patient present with unilateral, chronic, anterior uveitis 
• Not painful, low-grade uveitis, no loss of vision
• Presenting symptoms - Cataract 
• Highest incidence of cataract caused by uveitis, absence of posterior synechiae
• Amsler sign positive - Bleeding on opposite limbus on Paracentesis (180° away from limbus)
• Operate and remove the cataract but avoid steroids as much as possible
• Rubella Antibody present in Aqueous Humor

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