Uveal Tract Diseases

OutlineUveal tract is inclined to be affected by autoimmunityinfectionmetabolismhematogenous factortumor, et al.melanin correlated AgChoroidal blood flow is slowAg of retina and lens cause uveitisInflammation is the most common reason, tumor is the second.

Uveitis

OutlineThe term uveitis denotes inflammation of the uvearetinaretinal vasculature and vitreous.Uveitis is a common cause of blindness, usually affects young people and associated with systemic autoimmune diseases.

Etiology and mechanism

inflammation Autoimmune factorOxidize damage The metabolites of arachidonic acidImmunogenetics

ClassificationAccording to causesinfective and non-infective uveitisAccording to clinical pathologygranulomatous and nongranulomatous uveitisAccording to anatomyanteriorintermediateposterior uveitis and panuveitis.

Anterior uveitis Anterior uveitis consists of iritisiridocyclitisanterior cyclitis. classify by process 1acute anterior uveitisHLAB27 positive. 2chronic anterior uveitissuch as Fuchs heterochromic uveitisglaucomatocyclitic crisis, et al. 3either acute or chronic: such as tuberculosissyphilischronic arthritis.

Clinical findings Symptoms: painphotophobiatearingblurred vision.Signs: 1ciliary congestion or mixed congestion 2KP: corneal endothelium injury inflammatory cells and pigments existence.

Classification of KP Stellate KPneutrophillymphocyte and plasma cells, nongranulomatous uveitis.Medium sized KPneutrophillymphocyte and plasma cells.Fuchs heterochromic uveitis and uveitis secondary by herpes simplex virus keratitis.Mutton fat KPmacrophage and epithelioid.granulomatous uveitis.

Location of KPArlts trianglethe most commonseen in many types of anterior uveitisPupillary corneaseen in Fuchs heterochromic uveitis uveitis due to herpes simplex virus and glaucomatocyclitic crisis.diffuse distributionseen in Fuchs heterochromic uveitis uveitis due to herpes simplex virus .

3Flare in the aqueousIt is because of the damage of blood-aqueous barrier and protein enter into aqueous, presents when anterior uveitisACGblunt trauma.4Cell in the aqueousinflammatory cells display uniform gray particles under slit lamp. Particularly severe anterior chamber inflammation may result in layering of inflammatory cells in the inferior anglehypopyon.

5Change in iris: may be edematexture unclear, et al. the synechia between iris and the anterior surface of lens is called iris posterior synechiae.When posterior synechiae is exensiveaqueous cannot outflowusually produce pupillary seclusion and forward bulging of the irisis called iris bombe. Synechia between iris and the posterior surface of cornea is called iris anterior synechiae.

Iris nodules: Koeppe nodules: gray semitransparent nodules presenting at the iris marginnongranulomatous uveitis Busacca nodules: white or gray semitransparent nodules presenting in the iris parenchymagranulomatous uveitis Iris granulomasingle pink opaque nodules presenting in the iris parenchymasarcoidosis

6Change of pupilmiosis or irregular due to spasm of ciliary muscle and contraction of sphincter pupillae muscle.The pupil may be small or irregular due to the formation of the iris posterior synechiae. If iris synechiae reach 360 degreeis called Seclusio pupillae.If fibrous membrane cover the whole pupilis called occlusion of pupil.

7Change of lens: some pigment may be deposit on the surface of lens in uveitis; circular shape pigment deposition often occur after release of iris posterior synechiea.8Change of posterior segmentCells in the anterior vitreous cystoid macular edemaoptic edema.

Complications

Complicated cataractdue to the change of aqueous content or application of corticosteroid. Secondary glaucomainflammatory cellsfibrous exudation and tissue fragments block trabecular meshworkthe seclusion and occlusion of pupil impede aqueous outflow.Ocular hypotension and atrophy of eyeballciliary body atrophyaqueous IOP

Differential Diagnosis

1Acute conjunctivitis2Acute angle closure glaucoma3intraocular tumor 4diffuse uveitis

TreatmentprincipleMydri asis immediately : prevent iris posterior synechiae.Anti-inflammation in time: prevent tissue injury and complications.

1.Cycloplegics 1%2%4% Atropine prevent and cure iris posterior synechiaeprevent complications release the spasm of ciliary muscle and Sphincter pupillae musclethen reduce congestionedemainflammation and pain.2.Corticosteroids: local and systemic application3.NSAID

4.Treat primary diseases5.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 adhereperform trabeculectomy.Complicated cataract: when inflammation under good controlperform cataract extraction and IOL implantation.