Outline Uveal tract is inclined to be affected by autoimmunity
infection metabolism hematogenous factor tumor, et al. melanin
correlated Ag Choroidal blood flow is slow Ag of retina and lens
cause uveitis Inflammation is the most common reason, tumor is the
second.
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Uveitis
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Outline The term uveitis denotes inflammation of the uvea
retina retinal vasculature and vitreous. Uveitis is a common cause
of blindness, usually affects young people and associated with
systemic autoimmune diseases.
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Etiology and mechanism inflammation Autoimmune factor Oxidize
damage The metabolites of arachidonic acid Immunogenetics
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Classification According to causes infective and non-infective
uveitis According to clinical pathology granulomatous and
nongranulomatous uveitis According to anatomy anterior intermediate
posterior uveitis and panuveitis.
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Anterior uveitis Anterior uveitis consists of iritis
iridocyclitis anterior cyclitis. classify by process 1 acute
anterior uveitis HLAB27 positive. 2 chronic anterior uveitis such
as Fuchs heterochromic uveitis glaucomatocyclitic crisis, et al. 3
either acute or chronic: such as tuberculosis syphilis chronic
arthritis.
Classification of KP Stellate KP neutrophil lymphocyte and
plasma cells, nongranulomatous uveitis. Medium sized KP neutrophil
lymphocyte and plasma cells.Fuchs heterochromic uveitis and uveitis
secondary by herpes simplex virus keratitis. Mutton fat KP
macrophage and epithelioid. granulomatous uveitis.
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Location of KP Arlts triangle the most common seen in many
types of anterior uveitis Pupillary cornea seen in Fuchs
heterochromic uveitis uveitis due to herpes simplex virus and
glaucomatocyclitic crisis. diffuse distribution seen in Fuchs
heterochromic uveitis uveitis due to herpes simplex virus.
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3 Flare in the aqueous It is because of the damage of
blood-aqueous barrier and protein enter into aqueous, presents when
anterior uveitis ACG blunt trauma. 4 Cell in the aqueous
inflammatory cells display uniform gray particles under slit lamp.
Particularly severe anterior chamber inflammation may result in
layering of inflammatory cells in the inferior angle hypopyon
.
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5 Change in iris: may be edema texture unclear, et al. the
synechia between iris and the anterior surface of lens is called
iris posterior synechiae. When posterior synechiae is exensive
aqueous cannot outflow usually produce pupillary seclusion and
forward bulging of the iris is called iris bombe. Synechia between
iris and the posterior surface of cornea is called iris anterior
synechiae.
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Iris nodules : Koeppe nodules: gray semitransparent nodules
presenting at the iris margin nongranulomatous uveitis Busacca
nodules: white or gray semitransparent nodules presenting in the
iris parenchymagranulomatous uveitis Iris granuloma single pink
opaque nodules presenting in the iris parenchyma sarcoidosis
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6 Change of pupil miosis or irregular due to spasm of ciliary
muscle and contraction of sphincter pupillae muscle. The pupil may
be small or irregular due to the formation of the iris posterior
synechiae. If iris synechiae reach 360 degree is called Seclusio
pupillae. If fibrous membrane cover the whole pupil is called
occlusion of pupil.
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7 Change of lens: some pigment may be deposit on the surface of
lens in uveitis; circular shape pigment deposition often occur
after release of iris posterior synechiea. 8 Change of posterior
segment Cells in the anterior vitreous cystoid macular edema optic
edema.
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Complications Complicated cataract due to the change of aqueous
content or application of corticosteroid. Secondary glaucoma
inflammatory cells fibrous exudation and tissue fragments block
trabecular meshwork the seclusion and occlusion of pupil impede
aqueous outflow. Ocular hypotension and atrophy of eyeball ciliary
body atrophyaqueous IOP
Treatment principle Mydri asis immediately : prevent iris
posterior synechiae. Anti-inflammation in time: prevent tissue
injury and complications.
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1.Cycloplegics 1% 2% 4% Atropine prevent and cure iris
posterior synechiae prevent complications release the spasm of
ciliary muscle and Sphincter pupillae muscle then reduce congestion
edema inflammation and pain. 2.Corticosteroids: local and systemic
application 3.NSAID
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4.Treat primary diseases 5.Treatment of complications Secondary
glaucoma: take diamox orally and timolol eyedrop. If pupillary
block exist, perform laser iridotomy or iridotomy in time. If
Anterior chamber angle extensively adhere perform trabeculectomy.
Complicated cataract : when inflammation under good control perform
cataract extraction and IOL implantation.
