DISEASES OF THE

UVEAL TRACT
 UVEAL TRACT
 The middle vascular
layer of the eye, the
uveal tract, is
composed of three
portions: iris, ciliary
body, and choroid.
The primary function
of this tract is to
supply nourishment
to the ocular
structures.
Congenital anomalies of uveal tract.
 Congenital
coloboma (absense
of tissue) of iris,
ciliary body and
choroid may be
seen in association
or independently.
Congenital anomalies of uveal tract.

 Congenital aniridia.
It refers to
congenital absence
of iris.
 Polycoria is a
condition, when
there are more
than one pupil.
 Inflammatory diseases of the uveal tract
 Uveitis is a general
term reffering to
inflammation of the
uveal tract. It may
be divided into iritis,
cyclitis (ciliary body
inflammation),
iridocyclitis and
choroiditis,
according to specific
areas of the uveal
tract involved
 Anatomical classification
includes:
 1) Anterior uveitis. It is inflammation
of the uveal tissue from the iris up to
pars plicata of ciliary body. This term
includes iritis, iridocyclitis and
anterior cyclitis
 2) Intermediate uveitis. It includes
inflammation of the pars plana and
peripheral part of the retina.
 3) Posterior uveitis. It refers to
inflammation of the choroid
(choroiditis).
 4) Panuveitis is inflammation of the
whole uvea.
 Clinical classification
 Acute uveitis
 Chronic uveitis
Morphologically
classification
 Granulomatous uveitis
 Nongranulomatous uveitis
 Etiological classification.

 Exogenous uveitis. Exogenous uveitis

is caused by either external injury to
the uvea by invasion of
microorganisms or other agents from
outside.
 Endogenous uveitis. Endogenous
uveitis is-caused by microorganisms
or other agents from within the
patient.
 Anterior uveitis (iridocyclites).
 The main symptoms of acute anterior
uveitis are
 photophobia,
 pain,
 lacrimation and
 blepharospasm.
Pain is dominating symptom of acute
anterior uveitis. Patients usually complain
of a dull aching throbbing sensation which
is typically worse at night.
 Objective signs of iridocyclitis:
 mild lid
oedema,
 pericorneal or
mixed
injection,
 ciliary pain.
 Corneal signs:
 Keratic
precipitates are
cellular deposits
on the corneal
endothelium.
 Fresh keratic
precipitates tend
to be white and
round. With age
they shrink, fade
and become
pigmented.
 Anterior chamber:
 Changes in aqueous
humour are an early sign
of active inflammation.
 Aqueous flare is the
result of leakage of
proteins into the
aqueous humour
through damaged iris
blood vessels and
necessarily indicative of
active inflammation.
 Anterior chamber:
 Hypopion (sterile pus
in the anterior
chamber). Exudates
settle down in lower
part of the anterior
chamber.
 Hyphaema (blood in
the anterior chamber)
may be seen in
haemorrhagic type of
uveitis.
 Iris.
 Loss of normal
pattern occurs due
to oedema and
water logging of iris
 Iris usually
becomes muddy in
colour during active
phase and may
show
hyperpigmented
and depigmented
areas in healed
stage.
 Iris.
 Posterior synechia are
adhesions between the
posterior surface of iris and
anterior capsule of crystalline
lens. These are formed due to
organisation of the fibrin,
which is profuse in exudates.
Posterior synechia may be
segmental, annular or total.
Segmental posterior synechia
refers to adhesions of iris to
the lens at some points;
annular posterior synechia -
ring synechia are 360°
(seclusio pupillae).
 Pupillary signs
 Total posterior synechia due to plastering of
total of iris with the anterior capsule of lens
(occlusio pupillae).
 Narrow pupil occurs in acute attack of
iridocyclitis due to irritation of sphincter
pupillae by toxins.
 Irregular pupil shape results from
segmental posterior synechia formation.
Dilatation of pupil with atropine at this
stage results in festooned pupil.
 Anterior vitreous may show exudates and
inflammatory cells after an attack of acute
iridicyclitis.
 Complications.
 Complicated cataract.
 Keratopathy (degeneration of the
cornea)
 Secondary glaucoma.
 Retinal complications include
cystoid macular oedema, macula
degeneration and exudative
retinal detachment
 Complications.
 Papillitis (inflammation of the
optic disc)
 Phthisis buibi - is the final stage
of any form of chronic uveitis.

Acute iridocyclitis must be

differentiated from other causes
of acute red eye, especially acute
congestive glaucoma.
 Treatment of iridocyclitis.
 Mydriatic-cycloplegic drugs. Commonly
used drug is 1% atropine sulfate, 2%
homatropine, 1% cyclopentolate eye drops
instilled 2-4 times a day.
 Corticosteroids are very effective. They
reduce inflammation by their anti-
inflammatory effect; being anti-allergic
(dexamethasone, betamethasone,
hydrocortisone or prednisolone). Locally
steroids are used as eye drops 4-6 times a
day, subconjunctival njections.
 Broad spectrum antibiotics (in form of
drops and subconjunctival injection)
 Posterior uveitis. (Choroiditis)
Etiology and pathology are the
same as for uveitis in general.
Choroiditis is a painless condition,
usually characterized by visual
symptoms due to associated vitreous
haze and involvement of the retina.
Symptoms
 floaters and impaired vision

 photopsia

 metamorphopsia
 Posterior uveitis. (Choroiditis)
Signs
 Choroiditis is characterized by yellow or
greyish patches with reasonably well-
demarcated borders.
 The overlying retina is often cloudy and
oedematous.
 In atrophic stage, when active
inflammation subsides, the affected area
becomes more sharply defined and
delineated from the rest of the normal
area. The involved area shows white sclera
below the atrophic choroid and black
pigmented clumps at the periphery of the
lesion.
 Tumours of the uveal tract.

 Benign tumors: neurofibroma,

leiomyoma, benign cysts,
naevus, haemangioma.
 Malignant melanomas are the
most frequently occurring
intraocular tumours in adults.
 Malignant melanomas
 Clinical picture: In
typical cases
examination shows a
pigmented elevated,
oval-shaped mass. The
colour of the tumor is
frequently brown or
black. A secondary
exudative detachment
of the overlying sensory
retina may develop.
 Treatment:
 Enucleation (excision of the globe)
 Radioactive plaques are suitable for small
tumours and medium-size tumours
 Photocoagulation with xenon arc or argon
laser may be used for treatment of
melanomes of choroid
 Partial lamellar sclerouvectomy may be
suitable for certain carefully selected
tumours.
 Exenteration is indicated for melanomas
with extensive extraocular extension