Uveitis - Posterior and Panuveitis MCQs

Uveal Effusion Syndrome(Ciliochoroidal Effusion) is an idiopathic disease of the retina and choroid characterized by abnormal accumulation of serous fluid in the outer layer of ciliary body or choroid. Clinical Features: Structurally abnormal sclera(Thick Sclera) Abnormal accumulation of serous fluid in the outer layer of ciliary body and choroid leading to Detachment of Ciliary body(Exudative) Detachment of Choroid(Exudative) Deep Ciliochoridal detachments Detachment of Retina(Exudative) Absence of inflammation or neoplastic disease Eyes maybe nanopthalmic (small) or hypermetropic Phthisis and hypotonia is usually due to ciliary body shutdown from chronic detachment which compromises the blood supply to the ciliary processes Mottling of pigment epithelium( Leopard spots ) may be seen after spontaneous resolution. Reference: Kanski, 7th Edition, Pg no. 484.

Ans. B. Toxoplasmoss On fundoscopic examination, there is diffuse "headtightinthe fogappearance, in congenital toxoplasmosis. This is due to combination of active retinal lesion in the center with depigmentation (the headlight) and severe vitreous inflammation (the fog).

Birdshot chorioretinopathy is an uncommon idiopathic chronic/recurrent bilateral disease which predominantly affects females . Over 95% patients are positive for HLA A29 . The disease involves both the retina and choroid independently. Reference: Kanski, 7th Edition, Pg no. 429, 467.

Infection is the most likely cause of necrotizing retinitis in a HIV patient . The most common causes could be viral or parasitic(Toxoplasmosis). Vitreous biopsy is the most specific way to determine the cause. Option a/d - blood culture and serologic testing do not prove an intraocular infection, they are helpful only in ruling out the possibility of a viral infection. Option b - due to anergy, unreliable Reference: Kanski, 7th Edition, Pg no. 450.

Bilateral granulomatous non suppurative panuveitis after penetrating injury to ciliary body(Danger area of eye) It is thought that the penetrating trauma or surgery activates the afferent phase of an autoimmune reaction. This may be due to the exposure of sequestered ocular antigens to the immune system after trauma or an alteration of the immune tolerance to ocular antigens Occurs between 2 weeks to 3 months after injury, but cases are seen as early as 1 week and late as 10 years also. Symptom - loss of accommodation, photophobia Signs - Retrolental flare(inflammation behind lens) 1 st sign Hence loss of accommodation is the first symptom in this condition Reference: 9th/e kanski chapter 12 trauma pg. 448

Explanation: Inside the eye, the globe is broadly divided into the anterior segment and posterior segment by the lens. The posterior segment, i.e. the part of the eye that lies behind the lens, is bounded internally by the ciliary body anteriorly and retina posteriorly. Structures present in the posterior segment include the retina, choroid, and the optic disc, and the cavity is filled with a transparent gel-like substance called the vitreous humour.

The organisms most commonly responsible for acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) are varicella-zoster and herpes simplex. Rubella and rubeola do not cause acute retinitis in post-natal humans. Borrelia bergdorferi is the causitive organism of Lyme disease. Bartonella henselae is the causitive organism of cat-scratch disease. Mycobacterium tuberculosis and Treponema pallidum may cause retinitis and/or choroiditis, but are not the causitive organisms of acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN). Reference: Kanski 8th edition/439-440

Ciliary body is called as the danger area of eye Reference: 9th/e kanski chapter 12 uveitis pg. 448 sympathetic ophthalmitis