UveitisDr. Mervat El-

ShabrawyAssociate Prof. of Ophthalmology, FOM,

SCU

Def. : - Inflammation of the uveal tract.

Classifications : The 4 most useful classifications are :-

(1) Anatomical :

Anterior Uveitis

Iritis

Iridocyclitis

Intermediate uveitis

Posterior uveitis

Diffuseuveitis

Cont.

(2) Clinical :

(3) Etiological :

(4) Pathological :

Acute Chronic

Exogenous Endogenous

Granulomatous Non-Granulomatous

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

N.B. Behcet syndrom: - Oral ulcerations. - Genital ulcerations. - Uveitis.

Vogt-Koyanagi-Harada syndrom: - Alopecia. - Poliosis. - Vetiligo. - Uveitis

B- Secondary :

Cornea

Keratitis

Sclera

Scleritis

Lens

SubluxationOr

Dislocation

Retina

R.D.

I.O. tumors I.O.F.B

• 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

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

• 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.

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

1- Pain. 2- Photophobia 3- Lacrimation

4- Blepharospasm 6- Redness of the eye5- Diminution of vision

Painful red eye with blurring of vision

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.

External examination

Conjunctival injection

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.

• 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

• 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:

• Investigations:

Clinically Radiologically Laboratory

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.

(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:

Posterior Uveitis

- Choroiditis - Def. : - Inflammation of the choroid.

Classification:

Suppurative Non-suppurative

Endophthalmitis

Panophthalmitis

Exudative

Granulomatous

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:

Treatment:1) Endophthalmitis:

a- Early cases: Anti-biotics, atropine & corticosteroids.

b- Late cases: Evisceration.

2) Panophthalmitis: - Evisceration.

Cont.

Sympathetic Ophthalmitis

Def. : - Bilateral inflamm. Of the uveal

tract.

Etiology: Unclear. a) Allergic theory: b) Infective theory: c) Mixed theory:

Clinical picture: - Signs & symptoms of iridocyclitis +

trauma in the exciting eye.

Complications: As iridocyclitis.

Treatment: 1) Prophylactic: 2) Curative:

Cont.