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  broad sense
 Iritis  Uveitis

  Retinitis
Cyclitis
 Retinal
 choroiditis
vasculitis
 Optic neuritis
 Classification
 Anatomical site
 Anterior uveitis
 Intermediate uveitis
 Posterior uveitis
 Panuveitis
 Etiology
 Infectious
 Non-infectious
 classification
 Ill course
 Acute
 Subacute
 Chronic
 old
 Pathological change
 Granulomatous
 Non-granulomatous
 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
 Keratic precipitates (KP)
• Fine dusty KP
• Mutton fat KP
• Pigmentary KP
• Hyaloid KP
 Anterior chamber
• Aqueous flare
• Aqueous cells (hypopyon)
 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
 Posterior segment changes
• Vitreous opaque
• Cystoid macular edema
• Papilledema
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)
 Acute
Symptoms iridocyclitis Acute ACG
conjunctivitis

Slow decrease
Vision Toboggan normal
comparatively

usually located Ophthalmalgia

Pain position slight or not
in ocular area and migraine

Be often
Nausea and
No accompanied No
vomit
with

Secretion No No A great deal

 Acute
signs iridocyclitis Acute ACG
conjunctivitis

Congestion Ciliary or mixed Ciliary or mixed Conjunctival

Cornea clarity opaque clarity

KP offwhite pigmentary No

Anterior
Not shallow shallow Not shallow
chamber
Aqueous Flare and
Flare and cells Normal
humor exudation
Unclear furrow Segmental
Iris Normal
nodule atrophy of iris
Dilate, vertical
Pupil Shrink, irregular Normal
oval shape
Intraocular
Normal or low IOP High IOP Normal
pressure
 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
 non-steroid anti-inflammatory drug
• Aspirin
• Indometacin
 Etiological treatment
 Treatment of complications
 Intermediate uveitis
 Conception
 Symptoms and signs
 Complications
 Diagnosis
 Treatment
 Intermediate uveitis
 Conception
 Position
• Pars plana
• Vitreous basement
• Peripheral retina
 Age
• Children or below 30 years
 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
 Administration
 Corticosteroid
 Immunosuppressant
 Cryotherapy
 Vitrectomy
 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
 Panuveitis
• Exciting eye
• Sympathizing eye
 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
 Ocular manifestation
• Binocular onset simultaneously, sharp decline of vision
• Vogt-koyanaki syndrome: resemble acute iridocyclitis
• Harada syndrome
 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