Uveal Tract Dise

ases

Outline
Uveal tract is inclined to be affected by autoimmunity
infection metabolism hematogenous factor tu
mor, 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.

Uveitis

Outline
The term uveitis denotes inflammation of the
uvea retina retinal vasculature and vitreou
s.
Uveitis is a common cause of blindnes
s, usually affects young people and as
sociated with systemic autoimmune d
iseases.

Etiology and mechanism

inflammation
Autoimmune factor
Oxidize damage
The metabolites of arachidonic acid
Immunogenetics

Classification
According to causes infective and non-infective
uveitis
According to clinical pathology granulomatous
and nongranulomatous uveitis
According to anatomy anterior intermediat
e posterior uveitis and panuveitis.

Anterior uveitis
Anterior uveitis consists of iritis iridocyclitis a
nterior cyclitis.
classify by process
1 acute anterior uveitis HLAB27 positiv
e.
2 chronic anterior uveitis such as Fuchs he
terochromic uveitis glaucomatocyclitic crisis, et a
l.
3 either acute or chronic: such as tuberculosi
s syphilis chronic arthritis.

Clinical findings
Symptoms:
pain photophobia tearing blurred visio
n.

Signs:
1 ciliary congestion or mixed congestion
2 KP:
corneal endothelium injury
inflammatory cells and pigments existence.

Classification of KP
Stellate KP neutrophil lymphocyte and pl
asma cells, nongranulomatous uveitis.
Medium sized KP neutrophil lymphocyte
and plasma cells.Fuchs heterochromic uve
itis and uveitis secondary by herpes simplex vir
us keratitis.
Mutton fat KP macrophage and epi
thelioid.granulomatous uveitis.

Location of KP
Arlts triangle the most common seen in m
any types of anterior uveitis
Pupillary cornea seen in Fuchs heterochromic
uveitis uveitis due to herpes simplex virus a
nd glaucomatocyclitic crisis.
diffuse distribution seen in Fuchs heterochro
mic uveitis uveitis due to herpes simplex vir
us .

 3 Flare in the aqueous It is because of the d

amage of blood-aqueous barrier and protein enter i
nto aqueous, presents when anterior uveitis AC
G blunt trauma.
4 Cell in the aqueous inflammatory cells dis
play uniform gray particles under slit lamp. Partic
ularly severe anterior chamber inflammation may r
esult in layering of inflammatory cells in the infer
ior angle hypopyon .

 5 Change in iris: may be edema texture u

nclear, et al.
the synechia between iris and the anterior surfac
e of lens is called iris posterior synechiae.
When posterior synechiae is exensive aqueou
s cannot outflow usually produce pupillary se
clusion and forward bulging of the iris is call
ed iris bombe.
Synechia between iris and the posterior surface
of cornea is called iris anterior synechiae.

 Iris nodules:
Koeppe nodules: gray semitransparent no

dules presenting at the iris marginnong

ranulomatous uveitis
Busacca nodules: white or gray semitrans
parent nodules presenting in the iris parench
ymagranulomatous uveitis
Iris granuloma single pink opaque nod
ules presenting in the iris parenchymas
arcoidosis

 6 Change of pupil miosis or irregula

r due to spasm of ciliary muscle and contra
ction of sphincter pupillae muscle.
The pupil may be small or irregular due to t
he formation of the iris posterior synechiae.
If iris synechiae reach 360 degree is calle
d Seclusio pupillae.
If fibrous membrane cover the whole pupi
l is called occlusion of pupil.

 7 Change of lens: some pigment may be

deposit on the surface of lens in uveitis; circ
ular shape pigment deposition often occur a
fter release of iris posterior synechiea.
8 Change of posterior segment Cells
in the anterior vitreous cystoid macular
edema optic edema.

Complications
Complicated cataract due to the change of aq
ueous content or application of corticosteroid.
Secondary glaucoma inflammatory cells fi
brous exudation and tissue fragments block trab
ecular meshwork the seclusion and occlusion
of pupil impede aqueous outflow.
Ocular hypotension and atrophy of eyeball cil
iary body atrophyaqueous IOP

Differential Diagnosis
1 Acute conjunctivitis
2 Acute angle closure glaucoma
3 intraocular tumor
4 diffuse uveitis

Treatment
principle
Mydri asis immediately : prevent iris pos
terior synechiae.
Anti-inflammation in time: prevent tissue
injury and complications.

1.Cycloplegics 1% 2% 4% Atropine
prevent and cure iris posterior synechiae prevent
complications

release the spasm of ciliary muscle and Sphincter p

upillae muscle then reduce congestion edema in
flammation and pain.

2.Corticosteroids: local and systemic application

3.NSAID

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 IO
L implantation.