CHAPTER TWELVE
Uvea
Uvea
iris
ciliary body
choroid
• the generic name of the inflammation of uvea.
retina ;retinal vessels and vitreous
• Always in young patient
• Always combine with systemic autoimmune disease
• recurrence is often
• Always blind
Etiology and pathogenesis
• bacteria;
• fungus
• virus
• parasite
• Rickettsia
Autoimmunity
Classification of uvitis
classify in etiology infection or non-infection
classify in pathology granuloma ornon-granuloma uveitis
classify in anatomy anterior,intermediate,posterior and
panuveitis
CLINICAL FEATURES OF UVITIS
Hypotony
Definition
Hypotony means low intraocular pressure (IOP),specifically <10mmHg.
Etiology
Reduced IOP can be caused by any condition that increases aqueous
outflow or decreases aqueous production.
Symptoms
the pressureis <5mmHg. patients may have painand decreased vision.
CLINICAL FEATURES OF UVITIS
Anterior-Chamber Cell and Flare
Definition
Cell and flare refers to the presence of cells and increased protein (flare) in
the aqueous fluid.
Etiology
Aqueous cells and flare are caused by breakdown ofthe blood-aqueous
barrier due to infection,inflammation.
Symptoms
Cell and flare can be caused blurry vision and photophobia ，patients may
also notice pain, tearing,and redness.
CLINICAL FEATURES OF UVITIS
Anterior-Chamber Cell and Flare
CLINICAL FEATURES OF UVITIS
Anterior-Chamber Cell and Flare
CLINICAL FEATURES OF UVITIS
Anterior-Chamber Cell and Flare
CLINICAL FEATURES OF UVITIS
Hyphema
Definition
A hyphema is blood in the AC that forms a layer that is visible with the
naked eye.
Etiology
recurrent or chronic anterior uveitis.
Symptoms
Patients report blurry vision and sometimes pain,photophobia, and
redness.
CLINICAL FEATURES OF UVITIS
Hyphema
CLINICAL FEATURES OF UVITIS
Hypopyon
Definition
A hypopyon is white blood cells in the AC that form a layer that is
visible with the naked eye.
Etiology
A hypopyon is caused by inflammation (uveitis) or infection
Symptoms
Patients commonly experience pain,photophobia,redness,and
blurry vision.
CLINICAL FEATURES OF UVITIS
Hypopyon
Definition
Anterior uveitis refers to inflammation of the iris（iritis) and/or
ciliary body .The inflammation leads to breakdown of the blood-
aqueous barrier and increased vascular permeability with
exudation of inflammatory cells and proteins into the aqueous
fluid.
Anterior uveitis is most commonly idiopathic or autoimmune.
The most common etiology is also age-dependent.
INFECTIOUS ANTERIOR UVEITIS
Herpes simplex and herpes zoster
Lyme disease
Syphilis
Tuberculosis
NON-INFECTIOUS ANTERIOR UVEITIS
• Non-granulomatous
• Idiopathic
• HLA-B27-associated anterior uveitis
Clinical features
Symptoms of anterior Uvitis
①Aching pain in the eye
②Rapid blurring of vision
③Photophobia
④Tearing of the eye
Clinical features
Signs of anterior uveitis
① Redness of the eye ciliary or mixed congestion
Clinical features
Signs of anterior uveitis
② KP (keratitis Precipitate)
Clinical features
Signs of anterior uveitis
③Aqueous flare
Clinical features
Signs of anterior uveitis
④ Hypopyon
Signs of anterior uveitis
changes of iris
①iris edema and muddy
Signs of anterior uveitis
changes of iris
②Posterior synechia of the iris pupil irregular
Signs of anterior uveitis
changes of iris
③iris bombe
Signs of anterior uveitis
changes of iris
④Peripheral anterior synechia of the iris
Signs of anterior uveitis
changes of iris
⑤goniosynechia
⑥iris nodules
Signs of anterior uveitis
changes of pupil
①Miosis Pupil constriction
Signs of anterior uveitis
changes of pupil
②irregular pupil
Signs of anterior uveitis
changes of pupil
③Pupil posterior synechia
Signs of anterior uveitis
posterior segment of eye changed
①vitreous opacity
②Particles in vitreous
③reflective macular edema
HLA-B27-associated anterior uveitis
almost 50% of acute iritis
young men
seronegative spondyloarthropathy.
peripheral arthritis
variable mucocutaneous lesions
Complication
complicated cataract
Secondary glaucoma
Low IOP
Atrophy of eyeball
Treatment
1.Topical steroid
2.mydriatics
3.Etiology therapy:antiinfection
Intermediate Uveitis
Definition
an inflammation of the pars plana,the vitreous and peripheral retina.
Clinical features
Pars plana ciliary part and base of vitreous uveitis
peripheral retinal and choroid involved.
Always <40y.
both eyes
chronic onset
Sometimes have pain and red eye
Intermediate Uveitis
Signs
①Snow like vitreous opacity snow bank in pars plana always in the lower
part as a tongue point to the vitreous
②lesion of retinal and choroid always in the lower part of peripheral
retinitis;retinal vasculitis ,and peripheral retinochoroiditis
Intermediate Uveitis
Diagnosis
dusty figure in visual field
Subposterior capsule cataract
macular edema
FFA can help diagnosis
Intermediate Uveitis
Treatment
Visual acuity > 0.5 no inflammation in anterior segment just
examine after a period of time
Vision < 0.5 active inflammation in the anterior segment give
steroids capsule for half year.
Posterior Uveitis
Definition
any infammation of the posterior segment, including vitritis,retinitis,and
choroiditis
Acute retinal necrosis
Clinical features
• retinal necrosis retinal artiritis and vitreous opacity by herpes simplex
• retinal detachment in the later stage
• Always single eye
• Blur vision macular lesion
• high IOP
Acute retinal necrosis
Posterior Uveitis
Therapy
• antivirus agent
• anti-coagulation
• steroids
• laser
• vitrectomy
Posterior Uveitis
Vogt-Koyanagi-Harada syndrome /disease
Clinical features
Both eye granular panuveitis
vision lose
Fundus as rosy clouds just before sunset
Delen-fuchs nodus
pigment change in skin And hair depigmentation
tinnitus
vitiligo
Posterior Uveitis
Vogt-Koyanagi-Harada syndrome/disease
Clinical features
Four stages
acute stage
Posterior Uveitis
Vogt-Koyanagi-Harada syndrome/disease
Clinical features
Four stages
convalescent stage
Posterior Uveitis
Vogt-Koyanagi-Harada syndrome/disease
Clinical features
Four stages
chronic recurrent stage
Vogt-Koyanagi-Harada syndrome/disease
Imaging
Imaging plays a major role in
the diagnosis of VKHD,
monitoring of the intraocular
inflammation and response to
treatment, as well as the
development of complications.
Posterior Uveitis
Diagnosis
FFA can help diagnosis
Posterior Uveitis
Vogt-Koyanagi-Harada syndrome/disease
Treatment
Systemic corticosteroids + Immunosuppressive agents
Posterior Uveitis
Behcet's disease
Etiology
bacteria
virus infection
autoimmune reaction
Posterior Uveitis
Behcet's disease
Clinical features
Recurent hypopyon uvitis
oral ulcer
skin lesion
genital ulcer
Posterior Uveitis
Behcet's disease
Clinical features
Posterior Uveitis
Behcet's disease
Diagnosis
FFA can help diagnosis
Posterior Uveitis
Behcet's disease
Treatment
Systemic corticosteroids + Immunosuppressive agents + Biological agents
Posterior Uveitis
Sympathetic ophthalmia
following a perforating eye injury inthe region of the ciliary body,bilaterial
uveitis occurs
Etiology
probably related to hypersensitivity of some element of the pigment-
bearing cells in the uvea.
Clinical features
Dalen-Fuchs'nodules
serous retinal detachments
vitritis and papillitis
Posterior Uveitis
Sympathetic ophthalmia
Clinical features
Posterior Uveitis
Sympathetic ophthalmia
Treatment
Systemic corticosteroids + Immunosuppressive agents
Tumors
CHOROIDAL HEMANGIOMA
Clinical features
a vascular tumor
always in young patients
lesion from disc and near macula isolatedas a red ball elevated or scattered
flat ，border is not clear
exudative retinal detachments
glaucoma
congenital blood vessel deformation accompany with face hemangioma
and glaucoma called Sturge-Weber syndrome.
Tumors
CHOROIDAL HEMANGIOMA
Clinical features
Tumors
CHOROIDAL HEMANGIOMA
Diagnosis
B-scan ultrasonography
FFA
Tumors
CHOROIDAL HEMANGIOMA
Treatment
laser photocoagulation
PDT
I-125 plaque brachytherapy
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