Uveitis
Retinal vasculitis
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Get access- Inflammation of the retinal vasculature
Classification
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Primary ocular disease
- Birdshot chorioretinopathy
- VKH
- Sympathetic ophthalmia
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Secondary to infection or systemic disease
- Infection: herpetic, CMV, HTLV-1, HIV, toxoplasma, TB, lyme disease, cat-scratch, syphilis, Whipple disease
- Systemic: leukaemia, lymphoma, SLE, Behcet’s, sarcoidosis, GPA, PAN, Churg-Strauss, APS
Clinical features
- Reduced vision
- Floaters
- Positive scotomata
- Asymptomatic (especially if peripheral)
- Perivascular sheathing
- Retinal haemorrhages
- Vitritis
- Disc swelling
- CMO
Tests
- FFA: vessel wall staining, leakages, skip lesions, new vessels, disc leakage, petalloid macular leakage, enlarged foveal avascular zone, vascular occlusion, capillary dropout
- Widefield imaging
- Blood panels
Management
- Targeted at the underlying cause, and otherwise as for intermediate uveitis
Susac’s syndrome
“Small infarctions of cochlear, retinal and encephalic tissue” ie. SICRET syndrome)
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Multiple BRAOs
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“Boxcar” segmentation of the blood column seen in peripheral vessels on FFA plus non-perfused arterioles with hyperfluorescent walls
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Triad:
- Encephalopathy: MRI indicated
- Hearing loss: audiogram indicated
- Retinal BRAOs
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Management: steroids
Whipple disease
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Caused by actinomycetes bacterium: Tropheryma whipplei
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Constellation of
- Gastrointestinal symptoms
- Migratory polyarthritis
- Panuveitis
- Retinal vasculitis
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Duodenal biopsy reveals PAS-positive organism in macrophages