Challenges in posterior uveitis-tips and tricks for the retina specialist.

PURPOSE: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.

Effect of "Pink Eye" Label on Parents' Intent to Use Antibiotics and Perceived Contagiousness.

Parents of children who presented for a pediatrics appointment responded to a clinical vignette that described a child with symptoms consistent with acute viral conjunctivitis. In a 2 × 2 randomized survey design, the physician in the vignette either used the term "pink eye" or "eye infection" to describe the symptoms, and either told parents that antibiotics are likely ineffective at treating the symptoms or did not discuss effectiveness. When the symptoms were referred to as "pink eye," parents remained interested in antibiotics, despite being informed about their ineffectiveness. By contrast, when the symptoms were referred to as an "eye infection," information about antibiotic ineffectiveness significantly reduced interest, Mdiff = 1.63, P < .001. Parents who received the "pink eye" label also thought that the symptoms were more contagious and were less likely to believe that their child could go to child care, compared with parents who received the "eye infection" label, Mdiff = 0.37, P = .38.

Branch retinal artery occlusion following radiation therapy to the head and neck: a case report.

BACKGROUND: Previous studies have established that radiation to the head and neck leads to atherosclerosis and stenosis of the carotid artery and subsequent increased stroke risk, but the ophthalmic sequella following cervical irradiation is less well-defined. CASE PRESENTATION: We present a single case of branch retinal artery occlusion (BRAO) in a 55 year-old Caucasian male seen at the University of Michigan in 2008 following unilateral head and neck radiation. CONCLUSION: This case demonstrates that patients receiving radiation to the head and neck may be at increased risk for developing a BRAO secondary to atherosclerotic changes of vessels adjacent to the radiation target. Given this risk, it may be reasonable to obtain carotid artery imaging in patients with a history of cervical radiation who present with sudden or transient visual field defects, even in the absence of other conventional risk factors for atherosclerosis.

The effects of systemic α1-adrenoreceptor antagonists on pupil diameter.

AIM: To assess differences in pupil diameter between men taking systemic α(1)-adrenoreceptor antagonists and controls. SETTING: University of Michigan clinics, USA. METHODS: Male patients over the age of 50 years were recruited from clinics over 3 months and divided into two groups: 18 study patients taking α(1)-adrenoreceptor antagonists (Flomax, Uroxatral, Cardura and Hytrin) and 31 control patients who had never been on them. Those with conditions known to affect pupil diameter were excluded. Pre-dilation pupil diameters were recorded using a pupillometer in mesopic and scotopic conditions. Right eyes were dilated with phenylephrine and tropicamide, and the left eye served as an undilated control. Following dilation, pupil diameters were measured in both lighting conditions. RESULTS: No statistically significant difference was found in pupil mydriasis of patients taking α(1)-antagonists versus controls (mesopic p=0.37, scotopic p=0.67). When considering only those patients taking tamsulosin, the lack of significance remained. The duration of time on the medication did not have a statistically significant effect on pupil mydriasis. Comparison of pupil diameters of patients on tamsulosin with those on non-selective α(1)-antagonists, both before and after dilation, showed no significant difference in pupil mydriasis (mesopic p=0.77, scotopic p=1.00). CONCLUSIONS: The outcomes of this study present an interesting contrast to current literature. Previously, it had been hypothesised that a majority of patients taking α(1)-antagonists would experience preoperative impairment of pupil dilation. The authors found no significant decrease in pupil diameters of patients on α(1)-adrenoreceptor antagonists compared with controls, and no indication that duration or medication subtype had an effect.