1. UVEITIS

2. UVEA – ANATOMY REVIEW
• It is the middle vascular coat of the eye
• It composed of iris, choroid and ciliary body
• It lies between sclera and retina layers of the
eye
• It is the main vascular tissue of the eye

4. IRIS
• It lies most anterior part of uvea
• Made of blood vessels and connective tissues
• Composed of melanocyte and and other
pigmented cells
• Contains central perforation called pupil
• The pupil is made up smooth muscles which
control pupil size ,hence regulate the amont of
light entering the eye
• Dilator papillae(dillate)->sympathetics and
sphincter papillae(constrict)->parasympathetic

5. IRIS

6. CILIARY BODY
• Middle part of the uvea
• It’s triangular in shape
• It produce aqueous humor
• Involved in accomodation
• Contained aqueous drainage

8. CHOROIDS
• Posterior part of the uvea
• Nourishes the outer portion of the retina
• Composed of layers of blood vessels

10. DEFINITION
• Uveitis means inflamation of uvea tracts
• It affects adjacent structure like
cornea,vitreous humor,retina and optic nerve
• It causes visual impairment leading to
blindness

11. CLASSIFICATION OF UVEITIS
Many classification of uveitis are used
Anatomical classification
• Anterior uveitis - This involve the iris [Iritis]
ciliary body [cyclitis] or both [iridocyclitis]
• Intermediate uveitis - predominantly involve
the pars plana; subset of this group is called
pars plinitis

12. • Posterior uveitis - inflammation is mainly
behind the base of vitrous, this may be
subdivided into retinochoroiditis and
chorioretinitis depending on the degree of
retina involvement
• Penuveitis - in defuse or penuiveits the entire
uveal tract is involved

13. CLINICAL CLASSIFICATION
• Uveitis may be:
– acute,
– sub acute,
– chronic,
– Recurrent,
– non recurrent
• depending on the speed of onset and
subsequent course

14. AETIOLOGICAL CLASSIFICATION
EXOGENOUS UVEITIS
• This is caused by the trauma or by the
invasion of the eye with the micro organism
from outside
ENDOGENOUS UVEITIS
• This may be caused by direct invasion or
autoimmune reaction to microorganism from
within the patient

15. • -underlying systemic disease including arthritis
(ankylosing spondylitis)
• infection (tuberculosis) and granuloma (sarcoid)
• -parasitic infestation e.g. toxoplasmosis
• -viral infection e.g. cytomegalovirus
• -fungal infection e.g. candidiasis-idiopathic specific
uveitis cases who have unique features of their own
e.g.
• Fuchs heterochromic cyclitis
• -idiopathic non specific uveitis. These cases have no
identified underlying cause and are the majority of
all cases.

16. PATHOLOGICAL CLASSIFICATION
• Uveitis may be classified as:
– granulomatous.,
– non granulomatous
• depending on the appearance of the keratic
precipitates.
• However there is considerable overlap in the
clinical behavior and the etiological
characteristics between of the two groups.

17. CAUSES OF UVEITIS
1. Causes of anterior uveitis
• Infectious causes
• Non-infectious causes
• Autoimmune
• Malignancies
2. Causes of posterior uveitis
• Infectious causes
• Non-infectious causes
• Malignancies
• Autoimmune

18. CAUSES OF ANTERIOR UVEITIS
INFECTIOUS CAUSES
oSyphilis
oTuberculosis
oHansen’s disease (Leprosy)
oHerpes Zoster
oHerpes Simplex
oOnchocerciasis
oLeptospirosis

19. AUTOIMMUNE CONDITIONS
• Juvenile Idiopathic Arthritis
o Common in children 5 – 6 years of age
o Common cause of bilateral non granulomatous
iridocyclitis
o Girls are affected four times more than boys
• Ankylosing Spondylitis
o 55% of patients with ankylosing spondylitis develop
anterior uveitis
• Fuch’s Heterochromie Iridocyclitis (Fuch’s Uveitis
Sydrome)
o Uncommon, accounts for <5% causes of all causes of
uveitis.
o Insidious onset during third or fourth decade of life.

20. • Lens – induced uveitis (phacogenic)
o Autoimmune disease directed against the lens antigens
• Others Autoimmune conditions:
o Reiter’s Syndrome
o Ulcerative colitis
o Sarcodosis
o Crohn’s disease
o Psoriasis
MALIGNANT CONDITIONS
o Retinoblastoma
o Leukemia
o Lymphoma
o Malignant melanoma
Traumatic Uveits: includes penetrating injuries and retinal
detachment.

21. CAUSES OF POSTERIOR UVEITIS
• Can be grouped into:
1.Infectious causes and
2.Non infectious causes
• Most causes of posterior uveitis are associated
with some form of systemic disease.

22. INFECTIOUS CAUSES
• Viruses:
– CMV,
– Herpes simplex,
– Herpes zoster,
– Rubella
• Fungi:
– Candida,
– Histoplasma,
– Cryptococcus
– Aspergillus
• Bacteria:
– Agents of TB,
– Brucellosis,
– Sporadic and Endemic
Syphilis
– Hematogenous spread
gram positive and
negative pathogens
• Parasites:
– Toxoplasma,
– Toxocara,
– Cysticercus
– Onchocerca

23. NON INFECTIOUS CAUSES
• Autoimmune:
– SLE,
– Wegner’s granulomatosis,
– sympathetic opthalmia,
– retinal vasculitis,
– Behcet’s disease,
– Harade syndrome.
• Malignancies:
– Intraocular lymphoma,
– Malignant melanoma
– Metastatic lesions.

24. SYMPTOMS AND SIGNS OF
UVEITIS
• SYMPTOMS
– Eye redness and
irritation
– Blurred vision
– Eye pain
– Increased sensitivity to
light (photophobia)
– Floating spots before the
eyes
• SIGNS
– Cilliary/Circumcorneal
injection
– Keratic precipitates
– Irregular/sluggish pupil
(reflex sphincter spasm)
– Synechia (iris adherence
with cornea or lens)
– Raised intraocular
pressure

25. Cilliary Injection

26. Keratic Precipitates

27. Synaechiae

28. DIAGNOSIS OF UVEITIS
• Ocular and general medical history and
examination with particular attention to the skin,
joints and the respiratory system.
• The following tests are frequently helpful:
1. Chest X ray for sarcoid and tuberculosis
2. X ray of the lumbosacral spine and
sacroiliac joints for ankylosing spondylitis
3. Serology for syphilis
4. Full blood count
5. ESR
6. Toxoplasma antibodies

29. SLIT-LAMP EXAM
• A slit-lamp consists of a
microscope and a
powerful beam of light.
• If you have uveitis, you'll
have large number of
white blood cells inside
your eye.
• They will appear as a hazy
fluid/keratic precipitates
(clusters of WBCs) when
studied under the slit-
lamp

30. TREATMENT OF UVEITIS
• Treatment of underlying infection should
relieve the inflammation in your eyes.
• Corticosteroids are the main type of
medication used to treat non-infectious
uveitis which can be in form of eye drops,
injections, oral medication.
• Mydriatics (drugs to dilate pupils)
• Immunosuppressant (only when steroids fails)
• Surgery (during cataract complications)

31. TREATMENT OF UVEITIS
• Mydriatics – Atropine, Tropicamide
• Corticosteroids – Dexamethasone, Prednisolone.
• Immunosuppressant – Azathriopine ,
Cyclopentolate hydrochloride
• For underlying disease
• Toxocariasis: Diethylcarbamazapine
• Ocular toxoplasmosis : Pyrimethamine,
Sulfadiazine, Clindamycin
• Ocular TB : Ant TB
• Syphilis : Benzyl penicillin

32. COMPLICATIONS OF UVEITIS
• Fourth leading cause of blindness in the
developed countries
Complications:
1. Cataract
2. Raised eye pressure (Glaucoma)
3. Cystoid macular edema
4. Hypotony
5. Detached Retina

33. CATARACT
• The inflammation inside the eye that's
associated with uveitis can sometimes irritate
the lens of the eye, causing cloudy patches on
the surface of the lens to develop. The cloudy
patches are known as cataracts. They can cause
symptoms such as:
blurred vision
problems seeing clearly at night
colours appearing unusually faint
• Cataracts are usually treated using surgery to
remove the affected lens and replace it with an
artificial one.

35. RAISED EYE PRESSURE (GLAUCOMA)
• Untreated uveitis can cause the iris to stick to the
front surface of the lens. This prevents fluid draining
through the pupil and it increases the pressure inside
the eye.
• The raised pressure inside your eye can damage the
optic nerve and disrupt your normal vision, such as
causing misty vision and rings or halos to appear
around lights. This is known as glaucoma.
• Treatment options for glaucoma include:
• eye drops
• laser treatment
• surgery

37. CYTOID MACULAR EDEMA
• Cystoid macular edema is a complication that can affect
some people with chronic uveitis.
• Prolonged inflammation can result in a build-up of fluid
inside the retina. This can disrupt its ability to function
normally and lead to a painless loss of central vision, i.e.
you'll notice a black spot in your field of vision.
• Cystoid macular oedema can be treated using
corticosteroid eye drops to reduce inflammation inside
the eye and disperse the fluid inside the retina.
• In some cases, a person’s vision will recover once
treatment is initiated. However, this isn't always the case
in severe cases of cystoid macular oedema. Hence the
condition is a leading cause of visual impairment in
people with chronic uveitis.

39. HYPOTONY
• Hypotony is usually defined as an intraocular pressure
(IOP) of 5 mm Hg or less. Low IOP can adversely impact
the eye in many ways, including corneal
decompensation, accelerated cataract formation,
maculopathy, and discomfort. Clinically significant
changes occur more frequently as the IOP approaches 0
mm Hg.
• Inflammation plays a key role in the evolution of
hypotony. It causes increased permeability of the
blood-aqueous barrier and impairs ciliary body aqueous
production
• Hypotony is best managed by correcting the underlying
problem.

40. RETINAL DETACHMENT
• In retinal detachment, the retina pulls away
from the choroid, the layer of blood vessels
that supply the eye with critical oxygen and
nutrients.
• Retinal detachment most often occurs due to
the development of a hole or tear in the
retina. This allows fluid to flow between the
retina and the choroid, resulting in retinal
detachment.
• Retinal detachment will continue to increase
in size if not treated.

42. THE END