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ANATOMY OF THE UVEARUTH ANTOLIN, MDDOH EYE CENTER
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UVEAL TRACT Main vascular compartmnt o! t" #
Uvea $as %riv% !rom t" Latin $or% uva& 'rap
Locat% (t$n t" sclra an% t" rtina
) parts* Iris
* Ciliar# (o%#
* C"oroi%
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UVEAL TRACT Attac"mnt* +clral spur
* Eit points o! vort vins
* Optic nrv
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EM-RYOLO.Y OF THE
UVEAL TRACT "as t$o componnts/• antrior t"r !ourt"s 0i//, t" stroma1 is !rom t" nural
crst clls, mso%rm
• postrior on !ourt" 0i//, t" muscls an% t" pi'mnt%
pit"lium1 is nurocto%rmal/• T" sp"inctr an% t" %ilator muscls & !rom t" outr lamina o! t" primitiv
optic cup,
• pi'mnt% pit"lium la#r& !rom t" innr la#r o! t" optic cup/
• T"us, t" pupillar# ru2 0mar'in1 in a !ull# %vlop% # rprsnts t"
antrior tip o! t" primitiv optic cup/
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IRI+ Most antrior portion o! t" uva
Masurmnts&* 34mm %m
* )5 to )6mm circum!rnc
*7/8mm t"ic9nss
* iris is t"ic9st nar t" collartt an%t"innst at t" iris root
• musculovascular %iap"ra'm $it" a
cntral opnin', t" pupil ; (loo%
vssls, connctiv tissu an%mlanoc#ts 0pi'mntation1
•Divi%s t" antrior s'mnt o! t"# into ant an% postc"am(rs
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IRI+& ANTERIOR
RELATION+• Antriorl#& A:uous "umor
• ;ostriorl#& lns
• ;rip"rall#& a:uous "umor in t" postrior c"am(r
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IRI+ Macroscopically:*t" antrior sur!ac is
irr'ular, $it" !urro$san% cr#pts/
* T" pupillar# <on islocat% (t$n t"collartt an% t"pupillar# ru2/
*t" rmain%r o! t" irisis call% t" ciliary zone. T" !rin'% iris collarttis locat% approimatl#4 mm !rom t" pupillar#(or%r= an% is t"
t"ic9st portion o! t" iris
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IRI+
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IRI+• Posterior Iris Surface• smoot"r an% mor uni!orm
• 4 la#r%& antrior an% postrior iris pit"lia
• rlativl# s"allo$ !urro$s
• Radial folds:• Contraction folds of Sc!al"e# small sulci t"at tn%s
!rom t" pupillar# aprtur to t" antrior sur!ac o! t" iris
• Structural folds of Sc!al"e# tn%s 3/8mm !rom t"pupillar# (or%r an% is sn (t$n t" ciliar# procsss/
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IRI+& +troma Contains pi'mnt% an% non pi'mnt% clls, colla'n>(rils, (loo% vssls, nrvs an% a matri o! "#aluronicaci%
Di2rnc in color is %u to t" amount o! pi'mntationo! t" stroma* -lu&
* li'"tr pi'mntation
* -ro$n&* "av# pi'mntation
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IRI+& ANTERIOR
;I.MENTED E;ITHELIUM 4 parts&
*Muscular (asal portion&
*ma9s up t" pupillar# %ilator muscl
o
?microns in t"ic9nsso arran'% in an ovrlappin' mannr= @oin% (# ti'"t @unctions
* Epit"lial apical portiono Almost similar to t" postrior pi'mnt pit"lium
o
+parat% !rom t" postrior pi'mnt pit"lium via intrcllularspacs/
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IRI+& ;ostrior
;i'mnt% La#r Continuous $it" t"nonpi'mnt% pit"liumo! t" C- an% $it" t"nurosnsor# rtina
Curvs aroun% t" pupillar#mar'in to !orm t" pi'mntru2
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IRI+& ;ostrior
;i'mnt% La#r
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IRI+& Vssls an% Nrvs +uppli% (# t" ma@or artrial circl$"ic" is !orm% (# t" lon' postriorciliar# artris an% antrior ciliar#
artris
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IRI+& Vssls an% Nrvs Minor artrial 0vascular1circl !orm% (#
anastomoss (t$nartrial an% vnousarca%s at t" r'ion o!t" iris collartt
M#linat% an% nonm#linat% nrv >(rsar prsnt t"rou'"outt" stroma/
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IRI+& Dilator Muscl Driv% !rom t" cto%rm=compos% o! smoot"muscl clls $it"m#o>lamnts an%
mlanosoms Has (ot" paras#mpat"tic0in"i(itor# rol1 an%s#mpat"tic innrvation
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IRI+& Dilator Muscl +#mpat"tic c"ain
3st ON&
H#pot"alamus to T34n% ON&
T3 to sup crvical 'an'lion
)r% ON&
+up crvical 'an'lion to Dilatormuscl
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IRI+& +p"inctr Muscl Also %riv% !rom t"nurocto%rm
Compos% o! circular (an%o! smoot" muscl >(rs
locat% nar t" pupillar#mar'in
;rimar# innrvation is viaparas#mpat"tics !rom CNIII
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IRI+& +p"inctr Muscl ;aras#mpat"tic ;at"$a#
E nuclus to ciliar#'an'lion to iris sp"inctr
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CILIARY -ODY
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CILIARY -ODY Conncts t" antrior an%postrior s'mnts o! t"uva
Ap is %irct% to$ar%s t"
ora srrata -as 'ivs ris to t" iris=also srvs as attac"mnt o!t" C- to t" sclra via t"sclral spur
Ma@or !unctions&* a:uous "umor pro%uction
* lns accomo%ation
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CILIARY -ODY B5 mm $i%
4 parts&* pars plana ?mm $i%=
tn%s !rom ora srrata tociliar# procsss* +a!st postrior sur'ical approac"
to t" vitrous cavit#
* Locat% )?mm !rom t" cornal
lim(us
* pars plicata "as ciliar#
procsss t"at srvs asattac"mnt o! t" <onular>(rs o! t" lns
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CILIARY -ODY
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CILIARY -ODY
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CILIARY -ODY Eac" ciliar# procss is suppli% (# artriols !rom t"ma@or artrial circl
Vnous %raina' o! ac" procss is via 34 vnulslocat% at t" crst
A:uous "umor pro%uction is %pn%nt on t" (loo%o$ $it"in t" capillar# nt$or9 o! t" ciliar# procsss$"ic" is 'ovrn% (# sp"inctr ton, nuronal innrvationan% "umoral vasoactiv su(stancs
Functions&* 3/ !or accommo%ation
* 4/ !ormation o! a:uous "umor
* )/ 9ps t" lns in plac
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CILIARY -ODY Microscopic structurs&* 3/ supraciliar# lamina
* 4/ Ciliar# (o%# stroma surroun%% (# attn%% >(roc#tsrat"r t"an colla'n >(rs
* )/ ;i'mnt% Epit"lium La#r* ?/ Non ;i'mnt% Epit"lium La#r
* 8/ Intrnal Limitin' Mm(ran
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CILIARY -ODY& Histolo'# Dou(l la#r o! pit"lialclls
*Non pi'mnt%& innrla#r= situat%(t$n t" postc"am(r an% t"pi'mnt% pit"lium $onula occludentes%ti&t 'unctions() locat%
alon' t" latral intrcllularspacs nar t" apical (or%ro! t" N;E, maintain t"(loo% a:uous (arrir/
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CILIARY -ODY& Histolo'#• ;i'mnt%&
• outr la#r= (asalla#r is locat% on
t" iris stroma
• Or'anlls 0ER an%.ol'i compl1 vitalin a:uous "umor
pro%uction
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CILIARY -ODY& Histolo'#*PE Pi&+entedEpiteliu+
Location o!-asalLamina
i%t"
NuclusMlanosoms
Cll t#p
Innr-or%rs t"postc"am(r
T"in
Lar'F$
Cu(oi%al0parsplana1Columnar0pars
plicata1
OutrFacs t"iris stroma
T"ic9Mor"omo'nous
Lar'plnt#
Cu(oi%al0t"rou'"out1
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CILIARY -ODY& -loo%
+uppl# Main artrial suppl#!rom t" antrior an%lon' postrior ciliar#artris
*+upr>cial pisclralplus
*Intramuscular plus
*Ma@or artrial circl
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CILIARY -ODY& -loo%
+uppl# Vnous %raina' via t" vort s#stm, intrasclralvnous plus an% pisclral vins
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CILIARY -ODY& NERVE
+U;;LY mainl# %riv% !rom t" paras#mpat"tic >(rs o! CN IIIvia s"ort ciliar# nrvs* G5 to t" ciliar# muscl
* ) to t" iris sp"inctr
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CILIARY -ODY& Ciliar#
Muscl ) la#rs*Lon'itu%inal& outr la#r
attac"% to t" sclralspur
*Ra%ial mi%%l o(li:u
*Circular& innrmostportion
Ciliar# muscl "as also (n lin9%to t" %vlopmnt o! prs(#opia
%u to incrasin' amounts o!connctiv tissu (t$n muscl(un%ls an% loss o! muscllasticit# t"at is rsponsi(l in lnsaccommo%ation/
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CILIARY -ODY& Ciliar#
Muscl
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CILIARY -ODY& Ciliar#
Muscl -"av li9 smoot", non striat% muscl >(rs $it"multipl m#o>(rils, prominnt nuclus, lctron %nsattac"mnt (o%is, mitoc"on%ria, 'l#co'n particls
Ric" in t#p VI colla'n
Muscls insrts into t" sclral spur an% aroun% tips o!o(li:u an% circular muscl >(rs
Innrvation& paras#mpat"tic via ciliar# nrvs
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CHOROID
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CHOROID• postrior portion o! t" uva
•;rovi%s nouris"mnt to t" outr portion o!t" rtina• R'ulats IO;
• Hat %i2usr
•Masurs 7/48mm in t"ic9nss
•
Locat% (t$n t" sclra an% t" rtina=tn%in' !rom t" ora srrata to t" opticnrv
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CHOROID• ) la#rs o! vssls• C"oriocapillaris
• Mi%%l la#r
0+attlr1 o! smallvssls
• Outr la#r0HallrJs1 o! lar'vssls
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CHOROID
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CHOROID• pr!usion coms !rom t"lon' an% s"ort ciliar#artris, pr!oratin'antrior ciliar# artris
•Vnour %raina' via t"vort vins
•-loo% o$ compar% toot"r tissus is "i'"=
o#'n contnt o! vnous(loo% 4) lss t"an t"ato! artrial (loo%
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CHOROID& -ruc"Js
Mm(ran•Lamina situat% (t$n t" R;E an% t" c"oriocapillaris
•Etn%s !rom t" optic %isc mar'in to t" ora srrata
•8 lmnts&
• -asal lamina o! t" R;E• Innr colla'nous <on
• -an% o! lastic >(rs
• Outr colla'nous <on
• -asal lamina o! t" c"oriocapillaris
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CHOROID& -ruc"Js
Mm(ran
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CHOROID& -ruc"Js
Mm(ran•D!cts can %vlop spontanousl# suc" as in m#opia orpsu%oant"oma lasticum or via trauma or inammation
•+u(rtinal novascular mm(rans ma# %vlop !romt"s %!cts t"at can la% to %isci!orm macular c"an'san% ocular "istoplasmosis s#n%rom
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CHOROID&
C"oriocapillaris• Continuous la#r o! lar'capillaris (nat" t" R;E/
• Vssls !acin' t" rtinalsur!ac ar trml# t"inan% contain multipl!nstrations $it" pric#tslin t" outr $all/
• Mi%%l an% outr c"oroi%al
vssls ar not !nstrat%/
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CHOROID&
C"oriocapillaris• mlanoc#ts, macrop"a's, l#mp"oc#ts, mast clls an%plasma clls ar a(un%ant in t" c"oroi%al stroma/
• ;i'mntation %pn%s on t" num(r o! pi'mnt%mlanoc#ts in t" c"oroi% an% R;E
• D'r o! pi'mntation in t" c"oroi% must (consi%r% $"n on is pr!ormin' p"otocoa'ulation(caus it inuncs a(sorption o! lasr nr'#
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CLA++IFICATION,+I.N+ AND
+YM;TOM+ OFUVEITI+
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OVERVIE&• uva consists o! t" mi%%l, pi'mnt%, vascular o! t"#• Iris
• Ciliar# -o%#
• C"oroi%
•Uveitis- 0itis1 inammation 0uva1 uva
• stu%# o! uvitis can ( cat'ori<% into in!ctious an%non in!ctious
• uvitis is !r:untl# associat% $it" s#stmic %isass
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CLA++IFICATION• Uvitis classi>cation is spar"a%% (# t"+tan%ar%i<ation o! Uvitis Nomnclatur 0+UN1 or9in''roup in 4778
•(as% on &• Anatom#& $"at portion o! t" uva is involv%K
• Cours& acutK C"ronicK RcurrntK
• Etiolo'#& in!ctious or non in!ctious
• Histolo'#& 'ranulomatous or non 'ranulomatous
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Anatomical Classi>cation o!Uvitis 0+UN or9in' .roup1Type Pri+ary Site of
In,a++ationIncludes
Antrior Uvitis Antrior C"am(r IritisIri%oc#clitisAntrior c#clitis
Intrm%iatUvitis
Vitrous ;ars ;lanitis;ostrior c#clitisH#alitis
;ostriorUvitis
Rtina or c"oroi% Focal, multi!ocal,%i2us c"oroi%itisC"oriortinitis
Rtinoc"oroi%itisRtinitisNurortinitis
;anuvitis Antrior c"am(r,vitrous, rtina or c"oroi%
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Anatomical Classi>cation o!Uvitis& Antrior Uvitis
• can ran' !rom a :uit loo9in' # $it" lo$ 'ra%inammator# raction to a pain!ul r% # $it" mo%ratto svr inammation
• Iritis: antrior c"am(r onl#
• Iridocyclitis: antrior c"am(r rtrolntal spac
• keratouveitis: corna
• sclerouveitis: sclra an% uval tract
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Anatomical Classi>cation o!Uvitis& Intrm%iat Uvitis
• inammation o! t" mi%%l portion 0postrior ciliar#(o%#, pars plana1
• mani!sts primaril# as oatrs
• !r:untl# appars :uit trnall#
•Vision loss can rsult !rom c"ronic c#stoi% macular %ma0cm1, cataract !ormation
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Anatomical Classi>cation o! Uvitis&;ostrior Uvitis an% ;anuvitis
• involvs t" rtina an%or c"oroi%
• ocular am& !ocal, multi!ocal, %i2us aras o! rtinitis orc"oroi%itis $it" var#in' %'rs o! vitrous cllular activit# an%involvmnt o! t" rtinal vasculatur
• structural complications o! uvitis suc" as macular %ma,rtinal vasculitis, rtinal c"oroi%al novasculari<ation notconsi%r% ssntial in classi!#in' postrior uvitis
•
;anuvitis&• %i2us uvitis
• Associat% $it" s#stmic 0non in!ctious in!ctious1%isass suc" asVH, s#p"ilis an% c#sticrcosis
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ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" RETINITI+
-ocal Retinitis Multifocal Retinitis
To.oplas+osis +#p"ilis
Onc"ocrciasis H+V
C#sticrcosis VV
Mas:ura% s#n%roms CMV
Di2us Unilatral+u(acut Nurortinitis
Candida in!ction
+arcoi%osis
Cat scratc" %isas
Mas:ura% s#n%roms
O C C ++ C O
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ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it"MULTIFOCAL RETINAL LE+ION+
/it Vitreal Cells /itout Vitreal Cells
-ir%s"otrtinoc"oroi%opat"#
Ocular Histoplasmosis+#n%
Multi!ocal c"oroi%itis
an% panuvitis
;unctat Innr
C"oroi%itis+u(rtinal Fi(rosis an%uvitis
;unctat Outr Rtinal Tooplasmosis
Vo't o#ana'i Hara%a Acut Rtinal ;i'mntEpit"litis
+arcoi%osis +u(acut +clrosin';anncp"alitis
st Nil Virus +rpi'inous c"oroi%itis
Cat +cratc" %isas
Mali'nant Mas:ura%+#n%roms
ANATOMICAL CLA++IFICATION
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ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" RETINALVA+CULITI+
Pri+arily Arteritis Pri+arilyPle"itis
Arteritis Ple"itis
+LE +arcoi%osis Tooplasmosis
;ol#artritis no%osa Multipl +clrosis Rlapsin'
pol#c"on%ritis+#p"ilis -"ct 'nr
'ranulomatosis
H+V -ir%s"otC"oroi%opat"#
Cro"n %isas
VV HIV paravirals#n%rom
Frost% (ranc"an'iitis
I%iopat"ic RtinalVasculitis,Anur#sms an%Nurortinitis
Eals %isas
C"ur' +trauss
ANATOMICAL CLA++IFICATION
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ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" FOCALCHORIORETINAL LE+ION
/it Vitreal Cells /itout Vitreal Cells
Toocariasis Tumor
+arcoi%osis +rpi'inous c"oroi%itis
Tu(rculosis
Nocar%ia
Cat +cratc"
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UVEITI+ CLA++IFICATION -A+EDON THE CLINICAL COUR+E
• Acute: su%%n onst an% limit% %uration t"at usuall#rsolvs $it"in $9s to mont"s
• Recurrent: rpat% piso%s sparat% (# prio%s o!inactivit# $it"out tratmnt !or ) mont"s%uration
• Cronic:prsistnt= rlaps occurs in lss t"an )mont"s a!tr %iscontinuin' tratmnt
• Furt"r %ivi%% into
• 'ranulomatous "as l#mp"oc#tic an% plasmain>ltrat
• non 'ranulomatous pit"loi% an% 'iant clls
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+YM;TOM+
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+YM;TOM+ OF UVEITI+• %pn%s on t" part o! t" uval tract a2ct%, onst,%uration• ;ain
• ;"otop"o(ia
• R%nss• -lurr% vision
• ;upillar# miosis irr'ularit#
• Floatrs s"a%o$s caus% (# vitrous clls an% sno$(alls ont" rtina
•
Dcras% visual acuit#• Distur(ancs in vision& p"otopsia, mtamorp"opsia,
scotomata
• n#ctalopia
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+YM;TOM+ OF UVEITI+• Pain and Potopo"ia
• primaril# rlat% to ciliar# spasm/
• ;ain p"#siolo'# can ( plain% (# Paon rQ$"rin t"r is a rtro'ra% r !rom t" Pinam%Q
prip"ral nrvs 0corna an% iris1 to t" (loo% vsslscausin' vaso%ilation or to t" muscls causin'contraction
• C#clopl'ia is t"r!or us!ul in cass o! iritis an% insom cass o! 9ratitis (caus paral#sis o! t" ciliar#
muscl allviats t" pain o! ciliar# spasm
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+YM;TOM+ OF UVEITI+• 0lurred vision
*ma# ( caus% (# clou%# m%ia, alt"ou'" vision iso!tn surprisin'l# 'oo% in t" prsnc o! %nsinammator# raction in t" antrior c"am(r an%
vitrous/* Floatrs ar a mor !r:unt mani!station o! clls
an% %(ris in t" vitrous cavit#/
*Macular %ma, $"ic" !r:untl# occurs $it" (ot"antrior an% postrior uvitis, can pro%uc (lurr%
vision, micropsia, an% mtamorp"opsia/
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+YM;TOM+ OF UVEITI+• Ciliary In'ection
• Ciliar# in@ction, or Pciliar# us",Q is mani!st (# arin' o! %ilat% pisclral vssls ra%iatin' !rom t"lim(us/
• s"oul% ( %istin'uis"% !rom sclritis an% !rompisclritis/ Ovrl#in' con@unctival in@ction ma#mas9 ciliar# us" (ut topicall# appli%nos#np"rin (lanc"s t" ovrl#in' con@unctiva,
allo$in' visuali<ation o! %pr pisclral vssls/
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-AND ERATO;ATHY
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+I.N+
+I.N+ OF UVEITI+
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+I.N+ OF UVEITI+&ANTERIOR CHAM-ER
• (rou'"t a(out (# inammator# rspons to in!ctious,traumatic, noplastic, autoimmun
• c"mical m%iators an% inammator# clls pla# a rol
•
ractions ar usuall# apprciat% in t" antrior c"am(r$"rin t"# can ( %scri(% as• srous
• purulnt 0prsnc o! "#pop#on1
• Fi(rinous 0plasmoi%1
•
san'uinoi% 0"#pop#on H#p"ma1
•
UVEITI+ 0+UN 9i
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UVEITI+ 0+UN or9in'.roup1
• Accor%in' to t" num(r o! clls in >l% 03 3mm slit(am1
1rade Cells in -ield 23 .3++ slit "ea+
7 3
7/8 3 8
3 B 38
4 3B 48
) 4B 87
? 87
UVEITI+ 0+UN 9i
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UVEITI+ 0+UN or9in'.roup1
• Accor%in' to t" ar intnsit#
1rade 4escription
7 Non
3 Faint4 Mo%rat 0iris an% lns
%tails clar1
) Mar9% 0iris an% lns%tails "a<#1
? Intns 0>(rin orplasmoi% a:uous1
+I.N+ OF UVEITI+
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+I.N+ OF UVEITI+&ANTERIOR CHAM-ER
• i! $it" uvitic involvmnt o! C-an% TM, IO; is usuall# lo$ %u to%cras% a:uous pro%uctionor incras% altrnativ outo$
• I! iris is involv%, t" !ollo$in'ma# mani!st• s#nc"ia 0antrior or postrior1
• iris no%uls 0opp, -usacca,-rlin no%uls1
• Iris 'ranulomas
• "troc"romia
• stromal atrop"#
THE ANTERIOR
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THE ANTERIOR+E.MENT
• 9ratic prcipitats
• inammator# clls
• ar
• >(rin
• H#pop#on
• pi'mnt %isprsion
• pupillar# miosis
• iris no%uls
• s#nc"ia (ot" antrior an% postrior
• (an% 9ratopat"#
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+I.N+ OF UVEITI+&INTERMEDIATE +E.MENT
1rade *u+"er of Cells 4escription
7 No clls Clar
7/8 trac 3 37 Trac
3 33 47 F$ opacitis, mil%
(lurrin'
4 43 )7 +i'ni>cant (lurrin'(ut still visi(l
) )3 377 Optic nrv visi(il,no vssls sn
? 377 Dns opacit#o(scurs optic nrv"a%
Consnsus (t$n National Instituts o! Halt" 0NIH1 'ra%in's#stm an% +UN 'roup
&INTERMEDIATE
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&INTERMEDIATE+E.MENT
• A%%itional uvitic c"an's• +no$(all opacitis
sarcoi%osis or intrm%iatuvitis
•
+no$(an9s pars planitis• Vitral stran%s
+I.N+ OF UVEITI+
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+I.N+ OF UVEITI+&;O+TERIOR +E.MENT
• rtinal or c"oroi%al inammator# in>ltrats
• inammator# s"at"in' o! t" artris an% vins
• rtinal %tac"mnt 0u%ativ, tractional,
r"'mato'nous1• rtinal pi'mnt "#prtrop"# or atrop"#
• atrop"# or s$llin' o! t" rtina, c"oroi%, optic nrv"a%
• prrtinal su(rtinal >(rosis
• rtinal c"oroi%al novasculari<ation
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+I.N+ OF UVEITI+• Eyelid and s5in: vitili'o an% no%uls
• Con'unctiva: prilim(al %i2us in@ction= no%uls
• Corneal endoteliu+: ;, >(rin, pi'mnt, (an%
9ratopat"#• Anterior6 posterior ca+"er: inammator# clls= ar=pi'mnt
• Iris: s#nc"ia, atrop"#, no%uls, "troc"romia,
pupillar# miosis
• An&le: ;A+, no%uls, vasculari<ation
• I7P: "#poton# or 'laucoma
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+I.N+ OF UVEITI+
• Vitreous: inammator# clls, traction (an%s
• Pars plana: sno$ (an9in'
• Retina: inammator# clls, cuSn' o! (loo% vssls,%ma, CME, "#prtrop"# clumpin'loss o! R;E=pirtinal vssls
• coroid: inammator# in>ltrats= atrop"#=novasculari<ation
• 7ptic *erve: E%ma= novasculari<ation
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T"an9 #ou3