Chp12 Uveitis_2.ppt

7/21/2019 Chp12 Uveitis_2.ppt

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Uveal Tract

Diseases





OutlineUveal tract is inclined to be affected by autoimmunity 、infection 、 metabolism 、 hematogenousfactor 、 tumor, 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 thesecond.



Uveitis



Outline

• The term uveitis! denotes inflammation of the

uvea 、 retina 、 retinal vasculature and

vitreous.

•Uveitis is a common cause ofblindness, usually affects young

people and associated with systemicautoimmune diseases.



Etiology and mechanism

• inflammation

• Autoimmune factor

• O"idi#e damage

• The metabolites of arachidonic acid• Immunogenetics



Classification

• According to causes ： infective and non$infective

uveitis

• According to clinical %athology ： granulomatous

and nongranulomatous uveitis

• According to anatomy ：anterior 、 intermediate 、 %osterior uveitis and

%anuveitis.



Anterior uveitis

Anterior uveitis consists ofiritis 、 iridocyclitis 、 anterior cyclitis.

classify by %rocess ：

（ & ） acute anterior uveitis ： '(A)*+ %ositive.

（ + ） chronic anterior uveitis ： such as -uchs

heterochromic uveitis 、 glaucomatocyclitic crisis, et

al.

（ 3 ） either acute or chronic: such as

tuberculosis 、 sy%hilis 、 chronic arthritis.





Clinical findings

• ym%toms/

%ain 、 %hoto%hobia 、 tearing 、 blurred

vision.

• igns/

（ & ） ciliary congestion or mi"ed congestion

（ + ） 01/

corneal endothelium in2ury

inflammatory cells and %igments e"istence.



Classification of 01 ：

• tellate 01 ： neutro%hil 、 lym%hocyte and

%lasma cells, ))nongranulomatous uveitis.

• 3edium si#ed 01 ： neutro%hil 、 lym%hocyte

and %lasma cells.))-uchs heterochromic

uveitis and uveitis secondary by her%es sim%le"

virus 4eratitis.

•Mutton fat K ： mac!ophage andepithelioid. ))granulomatous uveitis.



(ocation of 01

• Arlt5s triangle ： the most common " seen in

many ty%es of anterior uveitis

• 1u%illary cornea ： seen in -uchs heterochromicuveitis 、 uveitis due to her%es sim%le" virus

and glaucomatocyclitic crisis.

• diffuse distribution ： seen in -uchsheterochromic uveitis 、 uveitis due to her%es

sim%le" virus .



（ 6 ） -lare in the a7ueous ： It is because of the

damage of blood$a7ueous barrier and %rotein enterinto a7ueous, %resents when anterior

uveitis 、 AC8 、 blunt trauma.

（ 9 ） Cell in the a7ueous ： inflammatory cells

dis%lay uniform gray %articles under slit lam%.

1articularly severe anterior chamber inflammation

may result in layering of inflammatory cells in the

inferior angle （ hy%o%yon ） .



（ : ） Change in iris/ may be edema 、 te"ture

unclear, et al.• the synechia between iris and the anterior

surface of lens is called iris posterior synechiae.

• ;hen %osterior synechiae is e"ensive"

a7ueouscannot outflow " usually %roduce %u%illary

seclusion and forward bulging of the iris " is

called iris bombe.

• ynechia between iris and the %osterior surfaceof cornea is called iris anterior synechiae.







Iris nodules:

①0oe%%e nodules/ gray semitrans%arentnodules %resenting at the iris margin)) nongranulomatous uveitis

②*usacca nodules/ white or graysemitrans%arent nodules %resenting in theiris %arenchyma))granulomatous uveitis

③Iris granuloma ： single %in4 o%a7uenodules %resenting in the iris %arenchyma ))sarcoidosis



（ < ） Change of pupil ： miosis or

irregular due to s%asm of ciliary muscle andcontraction of s%hincter %u%illae muscle.

• The %u%il may be small or irregular due to

the formation of the iris %osterior synechiae.If iris synechiae reach 6<= degree " is

called Seclusio pupillae.

• If fibrous membrane cover the whole %u%il " is called occlusion of pupil.





（） Change of lens/ some %igment may be

de%osit on the surface of lens in uveitis>circular sha%e %igment de%osition often

occur after release of iris %osterior

synechiea.（ ? ） Change of %osterior segment ： Cells

in the anterior vitreous " cystoid macular

edema 、 o%tic edema.



Complications

• Com%licated cataract ： due to the change of

a7ueous content or a%%lication of corticosteroid.

• econdary glaucoma ： inflammatory

cells 、 fibrous e"udation and tissue fragments

bloc4 trabecular meshwor4 # the seclusion and

occlusion of %u%il im%ede a7ueous outflow.• Ocular hy%otension and atro%hy of eyeball ：

ciliary body atro%hy))a7ueous ))IO1



Differential Diagnosis

、 Acute con!unctivitis

" 、 Acute angle closure glaucoma

3 、 intraocular tumor

$

、diffuse u eitis



#reatment

principle

• $ydri asis immediately : prevent iris

posterior synechiae.

• Anti%inflammation in time: prevent tissue

in!ury and complications.



.Cycloplegics ： & 、 "& 、 '& Atropine

① %revent and cure iris %osterior synechiae " %reventcom%lications #

②release the s%asm of ciliary muscle and %hincter

%u%illae muscle " then reducecongestion 、 edema 、 inflammation and %ain.

".Corticosteroids: local and systemic application

3.(SAID



'.#reat primary diseases ：

).#reatment of complications ： Secondary glaucoma/

① ta4e diamo" orally and timolol eyedro%.

② If %u%illary bloc4 e"ist, %erform laser iridotomyor iridotomy in time.

③ If Anterior chamber angle e"tensively adhere " %erform trabeculectomy.

Complicated cataract% when inflammation under

good control " %erform cataract e"traction and

IO( im%lantation.

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Chp12 Uveitis_2.ppt