Uveal Diseases

LI Yonghua
Department of Ophthalmology, Affiliated First Hospital of Jining Medical Cllege

Uveal tract
 Iris  Ciliary body  Choroid

Uveal Diseases
 Inflammation  Tumor  Congenital abnormality

The term of uveitis
    narrow sense Iritis Cyclitis choroiditis 
  

broad sense
Uveitis Retinitis Retinal vasculitis  Optic neuritis

Classification
 Anatomical site
      Anterior uveitis Intermediate uveitis Posterior uveitis Panuveitis Infectious Non-infectious

 Etiology

classification
 Ill course
      Acute Subacute Chronic old Granulomatous Non-granulomatous

 Pathological change

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Anterior uveitis
 Conception
 Iritis  Anterior cyclitis  Iridocyclitis

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Anterior uveitis
 Symptoms
   Acute in onset Eye redness, pain, photophobia, lachrymation Blurred vision

Anterior uveitis
 Signs
  Injection
• • • • • Ciliary injection or mixed injection Fine dusty KP Mutton fat KP Pigmentary KP Hyaloid KP Aqueous flare Aqueous cells (hypopyon)

Keratic precipitates (KP)

Anterior chamber
• •

Injection

Ciliary injection

mixed injection

Fine dusty KP

Mutton fat KP

Aqueous flare and cells

Hypopyon

Anterior uveitis
 Signs
 Chang of iris
• • Congestion , edema Adhesions
1. Anterior synechia 2. Posterior synechia

Iris nodules
1. Koeppe nodules 2. Busacca nodules

Synechia

Iris nodules

Koeppe nodules

Koeppe nodules and Busacca

nodules

Busacca nodules

Anterior uveitis
 Signs
 Change of the pupil
• • • • miosis Plum blossom pupil Seclusion of pupil Occlusion of pupil

Pupil

normal

miosis

irregular

Plum blossom pupil

Seclusion of pupil

Occlusion of pupil

Anterior uveitis
 Signs
  Lens
• • • • Annular pigment ring Vitreous opaque Cystoid macular edema Papilledema

Posterior segment changes

An annular pigment ring at anterior lens capsule

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Complications of anterior uveitis
 Secondary glaucoma  Complicated cataract  Low IOP and eyeball atrophy

Secondary glaucoma

Complicated cataract

Eyeball atrophy

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Diagnosis
    Case history Main symptoms Signs Assistant testing

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Congestion?

conjunctival

ciliary

mixed

Differential diagnosis
 Acute conjunctivitis  Acute angle-closure glaucoma (acute ACG)

Symptoms

iridocyclitis Slow decrease comparatively usually located in ocular area

Acute ACG

Acute conjunctivitis normal

Vision

Toboggan Ophthalmalgia and migraine Be often accompanied with No

Pain position

slight or not

Nausea and vomit Secretion

No

No

No

A great deal

signs Congestion Cornea KP Anterior chamber Aqueous humor Iris Pupil Intraocular pressure

iridocyclitis Ciliary or mixed clarity offwhite Not shallow Flare and cells Unclear furrow nodule Shrink, irregular Normal or low IOP

Acute ACG Ciliary or mixed opaque pigmentary shallow Flare and exudation Segmental atrophy of iris Dilate, vertical oval shape High IOP

Acute conjunctivitis Conjunctival clarity No Not shallow Normal Normal Normal Normal

Anterior uveitis
      Conception Symptoms and signs Complications Diagnosis Differential diagnosis Treatment

Treatment of anterior uveitis
 Principle
  Mydriasis Inhabit inflammation

Treatment of anterior uveitis
 Main therapy
 Cycloplegics
• Action
1. Prevent synechia formation 2. Reduce discomfort from ciliary spasm

Medication
1. 1%Atropine ? 2. 5%Homatropine √

Corticosteroid eye drops
• • • 0.025%~0.1%Dexamethasone 0.5%Cortisone 1%Prednisolone acetate

Treatment of anterior uveitis
 Other therapy
 Corticosteroid
• • Periocular injection Oral administration Aspirin Indometacin

non-steroid anti-inflammatory drug
• •

 

Etiological treatment Treatment of complications

Intermediate uveitis
     Conception Symptoms and signs Complications Diagnosis Treatment

Intermediate uveitis
 Conception
 Position
• • • Pars plana Vitreous basement Peripheral retina Children or below 30 years

Age

Intermediate uveitis
 Symptoms : slight  Signs
   Change of the anterior segment Change of the vitreous and pars plana Change of the retina

Snow ball opacity and snowbank change

Complications
 Cystoid macular edema  Complicated cataract

Diagnosis
 Typical clinic manifestation
   Snowbank change at pars plana Snow ball opacity in vitreous body peripheral retinal vasculitis

Treatment
 Indication
  The vision has decreased below 0.5 The vision is above 0.5 but there is a lot of vitreous floating Corticosteroid Immunosuppressant Cryotherapy Vitrectomy

 Administration
   

Posterior uveitis
 Conception  Symptoms and signs  Treatment

Posterior uveitis
 Conception
     Vitreous body Choroid Retina Retinal vessel Optic nerve

Posterior uveitis
 Symptoms
     None black shadow floating Flicker sensation Metamorphopsia Scotoma or/and different degree of central vision decrease

Posterior uveitis
 Treatment
  Etiological treatment Inhabit inflammation
• Corticosteroids

Immunosuppressant

Some specific types of uveitis
 Sympathetic ophthalmia  Vogt-Koyanaki-Harada syndrome  Behcet’s disease

Sympathetic ophthalmia
 Conception
 Etiology
• • Perforating injury Intraocular operation Exciting eye Sympathizing eye

Panuveitis
• •

 Onset period
 2 weeks to 2 years

Sympathetic ophthalmia
 Clinical findings
 Exciting eye
• • Relapse of uveitis original inflammation becomes severe

Sympathizing eye
• • • Anterior segment
Same as anterior uveitis

Fundus FFA

Sympathetic ophthalmia

Sympathetic ophthalmia
 Complications
    Complicated cataract Secondary glaucoma Serous retina detachment Optic atrophy

Sympathetic ophthalmia
 Prevention and treatment
   Manage perforating injury of the globe well Eyeball extirpating or not Treatment
• Corticosteroids
1. Topical 2. Intravenous, oral

Mydriasis

Vogt-Koyanaki-Harada syndrome (VKH syndrome)
 Clinical findings
  Premonitory symptoms
• • • • Headache, tinnitus , common cold alike Binocular onset simultaneously, sharp decline of vision Vogt-koyanaki syndrome: resemble acute iridocyclitis Harada syndrome

Ocular manifestation

Extraocular manifestation

Ocular manifestation of VKH sydrome

Extraocular manifestation of VKH syndrome

hoary hair skin leukoderma

Vogt-Koyanaki-Harada syndrome
 Treatment
 The same as that of sympathetic ophthalmia
• Corticosteroids
1. Topical 2. Intravenous, oral

Mydriasis

Behcet’ disease
 Four main signs  Eye: relapsing uveitis  Mouth: recurrent ulcer  Skin: polymorphic dermatosis  Genital: ulceration

 Secondary signs
 Arthritis  impairment of nervous system

Ocular manifestation of Bechet’s disease

Extraocular manifestation of Bechet’s disease
Dental ulcer

Erythema nodosum

Genital ulcer

Behcet’ disease
 Diagnostic criteria
  Recurrent ulcer of mouth Add 2 of 4 signs as follows
• • • • Recurrent genital ulcer or scar Ocular lesion Skin lesion Positive of dermal sensitivity test

Behcet’ disease
 Treatment
  
 

Expectant treatment Corticosteroid Immunosuppressant
Laser therapy Treatment for complications

Uveal tumors
 Malignant melanoma of the choroid
   High malignant degree Monolateral, 50-70 years The most common intraocular malignant tumors in adults

 Malignant melanoma of the choroid
 Diagnosis
• • • • FFA CT MRI Ultrasonic wave

 Malignant melanoma of the choroid
 Treatment
• Early stage
1. Local excision 2. Laser photocoagulation 3. Radiotherapy

• •

Posterior pole : eyeball extirpating Penetrating tumor: evisceration of orbit