Uveitis
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UveitisDr. Mervat El-
ShabrawyAssociate Prof. of Ophthalmology, FOM,
SCU
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Def. : - Inflammation of the uveal tract.
Classifications : The 4 most useful classifications are :-
(1) Anatomical :
Anterior Uveitis
Iritis
Iridocyclitis
Intermediate uveitis
Posterior uveitis
Diffuseuveitis
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Cont.
(2) Clinical :
(3) Etiological :
(4) Pathological :
Acute Chronic
Exogenous Endogenous
Granulomatous Non-Granulomatous
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Irido-cyclitis Def. : - Inflammation of the iris & ciliary
body. Etiology : A- Primary:
Infection:
Exogenous
Endogenous
Allergy
Bacterial
Non-bacterial
Constitutional Syndromes of Unknown etiology
Behcet’s
Vogt-Koyanagi-Harada
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N.B. Behcet syndrom: - Oral ulcerations. - Genital ulcerations. - Uveitis.
Vogt-Koyanagi-Harada syndrom: - Alopecia. - Poliosis. - Vetiligo. - Uveitis
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B- Secondary :
Cornea
Keratitis
Sclera
Scleritis
Lens
SubluxationOr
Dislocation
Retina
R.D.
I.O. tumors I.O.F.B
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• Pathology: 3 phases:
1) Vascular Phase: - Dilatation & congestion of the blood vessels to bring more
leucocytes.
2) Exudative Phase: - Exudation of inflamm. Fluids from dilated vessels. * The result of this exudation: a- Iris & ciliary body: - Edema of iris & C.B.
- Loss of iris pattern - Pressure on the nerves - Spasm of ciliary muscles
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b- Outside iris & C.B. : - Aquous flare.
- Collection of exudates in: Angle, pupil, between iris & lens and
behind lens.
3) Cellular Phase:
- Keratic Precipitate (KPs): active & passive.
- Lenticular Precipitates (LPs): - Vitrous opacities, Vitritis
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• Clinical Picture: usually recurrent.
Symptoms:
1) Pain: Dull aching.
Why??? -Nerves: Stretch & irritation of
nerve ending.
- Muscles: Spam of intrinsic muscles & C.M.
- Glaucoma: Secondary.
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2) Photophobia: 3) Lacrimation: 4) Blepharospasm: 5) Diminution of vision:
Why??? - Corneal edema.
- Aquous flare. - Pupillary memb. - Vitritis - Toxic maculopathy. - Hazziness of the lens.
Cont.
Reflex irritation of the 5th N. endings
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1- Pain. 2- Photophobia 3- Lacrimation
4- Blepharospasm 6- Redness of the eye5- Diminution of vision
Painful red eye with blurring of vision
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Signs: 1) Lid: Edema. 2) Conjunctiva: Conj. & ciliary
injections. 3) Cornea: Edema & KPs. 4) Iris: Muddy.
5) Ciliarry body: Tender.
6) Anterior chamber: - Aquous flare.
- Hypopon. - Hyphaema.
Cont.
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External examination
Conjunctival injection
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7) Pupil: - Constricted. - Irregular. - Sluggish reaction.
8) Lens: - Iris pigment on the capsule (LPs).
9) Intra ocular pressure: raised, 2ry glaucoma.
10) Vitrous: Vitritis.
11) Macula: Toxic maculopathy.
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• Complications:
1) Cornea: Deep keratitis. 2) Iris: - Post Synaechia.
- Atrophy “late”
3) Angle: P.A.S.4) Lens: Cataract.5) Cyclitic memb.6) Secondary glaucoma.7) Retinitis, optic neuritis & toxic
maculopathy.
8) Endophthalmitis or Panophthalmitis in sever cases
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• Differential Diagnosis:
Acute iridocyclitis
Acute cong. gl. Corneal ulcer Acute Conjunctivis
Gradual Sudden Rapid Gradual Onset:
- Dull ache.- Watery.
- Diminished.
- Bursting.- Watery.- Marked
- Pricking.- Watery.
- May be "if central"
- Burning- Any type
- Not affected
Symptoms:- Pain:
- Discharge:- Vision:
- Edema.- Ciliary inject.- Edema, KPs
- Flare, Hypopyon.- Muddy.
- Constricted.- T++
- Usually normal.
- Edema- Ciliary Inject
- Edema.- Shallow.- Bombē- T+++
- Difficult to be seen
- Edema.- Ciliary inject.
- +ve fluorescence.- Flare, hypopyn.
- Muddy.- Constricted.
- Normal or raised.- Normal
- Edema- Conj. Injection.
- Normal.- Normal.- Normal.- Normal.- Normal.- Normal.
Signs:- Lid:
- Conj.:- Cornea:- A. Ch.- Iris:
- Pupil:- Tension:- Fundus:
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• Investigations:
Clinically Radiologically Laboratory
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Treatment (1) Local:
a) Atropine: - Internal eye rest.
- Relaxation of the C.M. - Breaking fresh synaechia & dec.
formation.
b) Cortisone: - Anti-inflammatory.
- Anti-Allergic. - Fibrinolytic.
c) Hot Fomentation.d) Dark Glasses.
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(2) General:
a) Systemic cortisone: in sever cases.
b) Systemic broad spectrum A.B.s.c) Analgesics & anti-inflammatory
drugs.- In sever resistant cases -
d) Cytotoxic drugs.e) Immunosuppressive drugs.
(3) Causal TTT: (4) TTT of complications:
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Posterior Uveitis
- Choroiditis - Def. : - Inflammation of the choroid.
Classification:
Suppurative Non-suppurative
Endophthalmitis
Panophthalmitis
Exudative
Granulomatous
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Panophthalmitis Endophthalmitis
- Inflamm. Of all tissues of the eye - Inflamm. Of the internal structures of the eye Def.
- Perforated corneal ulcer, post intra-ocular op. & penetrating wounds Etiology:
- General: Fever, malaise & headache. - Local: Pain, FTH & loss of vision
- Lid: Edema & tender. - Conj. : Injection
- Cornea: Cloudy & KPs. - A.Ch: Hypopyon.
- Iris: Iritis: - Vision: No P.L.
- Limitation of ocular motility
- Proptosis.
C/P:-Symptoms:
- Signs:
- Atrophia bulbi.Spreading of infection.
- Resolution with treatment.- Panophthalmitis.- Atrophia bulbi.
Fate:
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Treatment:1) Endophthalmitis:
a- Early cases: Anti-biotics, atropine & corticosteroids.
b- Late cases: Evisceration.
2) Panophthalmitis: - Evisceration.
Cont.
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Sympathetic Ophthalmitis
Def. : - Bilateral inflamm. Of the uveal
tract.
Etiology: Unclear. a) Allergic theory: b) Infective theory: c) Mixed theory:
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Clinical picture: - Signs & symptoms of iridocyclitis +
trauma in the exciting eye.
Complications: As iridocyclitis.
Treatment: 1) Prophylactic: 2) Curative:
Cont.
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