Case History & Presentation
What is your TOP differential for a painful red eye with light sensitivity?
Anterior Uveitis
What is your TOP differential for a patient who presents with unilateral IOP of 40-60 mmHg with minimal AC reaction
Possner Schlossman / Glaucomatocyclitic Crisis
What do you prescribe to a patient with Herpetic Anterior Uveitis with Endotheliitis?
BONUS: dosage & frequency of each
Cyclo - synechiae prevention & pain management
Steroid - control inflammation
Anti-Viral - treat underlying condition
What is the timeline of KP improvement?
Within 4 weeks
The visual phenomenon of “halo around lights” likely indicates what?
Elevated IOP
What is the presentation difference between granulomatous vs non granulomatous anterior uveitis?
Fine KP vs Mutton Fat KP
Patient returns for follow up with IOP of 26… what is your next step
Add an IOP lowering drop
- Cosopt BID
What is the timeline of decrease in cells/flare?
Within 3-7 days: begins to subside
Within 1-2 weeks : significant reduction
Within 1 month: 85% clinically significant improvement
What is the role of Erythromycin UNG in the management of anterior uveitis or herpetic endotheliitis?
None
What is corneal endotheliitis?
BONUS: What are the corneal findings?
Inflammation of the endothelial layer
BONUS: corneal edema + KP
The patient returns for follow-up and the only residual symptom is blurry vision. What is the cause of the blurry vision?
Current Management: Steroid, Cyclo, Valtrex
Cyclo
Next step: d/c cyclo
What is the role of taking oral acyclovir for 1 week every month in patients with hx of herpetic uveitis?
BONUS: by what %?
Reduce recurrence (HEDS)
BONUS: 45%
Anterior uveitis typically presents with lower IOP in the affected eye EXCEPT in
Herpetic-Associated Uveitis
What demographics do you expect to see Herpetic Endotheliitis in?
60+ Year Old Men
Very Common in Hispanic Populations
What precautions should be taken when prescribing Valtrex?
Renal Dysfunction
How does your management plan differ if the patient presents with herpetic epithelial keratitis from uveitis?
ONLY anti-virals (HEDS)
No steroids
What are you seeing in this image?
**see image**
BONUS ROUND (DOUBLE POINTS): What is your leading Diagnosis?
Non-granulomatous keratic precipitates
BONUS: Endotheliitis
Russel Bodies and Moth Eaten Iris are characteristics of…
Fuch’s Iridocyclitis
What is normal GFR?
90 mL/min
What is the role of taking oral acyclovir for the prevention of stromal keratitis in patients with epithelial keratitis?
None. (HEDS)