diseases of the uveal tract

1. UVEAL TRACT DISORDERS
• The uveal tract comprises of iris, ciliary body and the
choroid.
• The outer layers of the retina derive their blood supply from
the choroid
• Uveitis is the inflammation of uveal tract

2. CLASSIFICATION OF UVEITIS
Anatomical classification
• Iritis is inflammation of iris.
• Iridocyclitis is inflammation of iris and anterior part of the
ciliary body.
• Intermediate uveitis - inflammation of the posterior part of
the ciliary body and peripheral choroid.

3. • Posterior uveitis/chorioretinitis - inflammation of the
choroid and the retina posterior to vitreous base
• Panuveitis – inflammation of the entire uveal tract
Clinical classification of uveitis
• Acute uveits – sudden onset and up to 3 months
• Chronic uveitis persists for more than 3 months and it’s of
gradual on set and may be asymptomatic.

4. Aetiological classification
Classification according to causes
Infections
• Bacterial - include T.B, leprosy, syphilis, pyogenic bacteria
• Fungal infection – candidiasis, cryptococcus, histoplasmosis,
aspergillus.
• Parasites - Toxoplasma gondii, Toxoplasma canis, Pneumocystis carina,
onchocerciasis, cysticercosis.
• Viral - HZ/Varicella, CMV, Herpes simplex, congenital rubella.

5. Uveitis associated with systemic diseases or non
infective/immunological.
• Sarcoidosis
• Ankylosing spondylitis
• Ulcerative colitis
• Reiter's syndrome
• Juvenile arthritis
• Bahcet disease
• Traumatic: penetrating/surgical trauma, lens induced

6. Clinical features of uveitis
Anterior uveitis
Symptoms
• Photophobia, pain, redness, decreased vision, and
lacrimation.
Signs
• Decreased visual acuity
• Circumcorneal/ciliary injection
• Keratic precipitates are cellular deposits on corneal
endothelium

8. Signs cont’d
• Small irregular pupil that adheres to lens or cornea
• Aqueous flare is due to scattering of light by proteins that
are released in aqueous by damaged iris vessels.
• Aqueous cells are indicative of active inflammation, the cells
can be the observed with a slit lamp
• Hypopyon-pus in anterior chamber
• Iris nodules are features of granulomatous inflammation
- Koeppe nodules are small and are seen at pupil border
- Busacca nodules are located a way from pupil

9. Complications of uveitis
• Synechiae are adhesions between iris and lens
• Secondary glaucoma/inflammatory exudates clogging the
trabecular meshwork.
• Pupil block glaucoma/iris bombe bowing forward of the iris
• Phthisis bulbi - lowering of intraocular pressure due to decreased
production of aqueous
• Cataract
• Retinal membrane formation
• Retinal detachment/tractional RD
• Band keratopathy

12. Intermediate uveitis
• Symptoms: floaters and impaired visual acuity
• Signs: cells in vitreous and few in anterior chamber
• Absence of inflammatory lesion in the posterior fundus

13. • Posterior uveitis may be asymptomatic, mild redness and perception of
floaters.
• Signs: vitreous cells, flare and opacities
- Choroiditis: there are deep yellow or grey patches with fairly well
demarcated borders
- Inactive lesions are white well defined areas with pigmented borders
• Retinitis: retina is white, cloudy and retinal vessels are not seen clearly
• Vascularitis frequently affects retinal veins, white haziness surrounding
vessels

14. • Choroiditis - Pneumocystis, cryptococcus
• Retinitis - CMV, varicella, toxoplasmosis
CMV retinitis - Arterial occlusion
- Haemorrhages
- Retinal necrosis
Congenital rubella - pigmentary retinopathy, cataract
microphthalmos, iritis and glaucoma

15. Treatment
• Investigations
• Steroid-antibiotic eye drops like gentadex, dexa N, Tobradex
• Subconjuctival injection of triamcinolone and
methylprednisolone for chronic uveitis
• Systemic steroids like prednisone
• Atropine eye drops once or twice a day
• Immunosuppressive agents i.e., azathioprine, methotrexate
and cyclosporin