UVEITIS PRESENTATION

BY
AMA AMONI
ANASTASHA ASARE
 OBJECTIVES

 Anatomy and physiology of the uvea

 Uveitis and classifications
 Causes
 Management
 complications
APPLIED ANATOMY

• Middle vascular coat of eyeball

• From anterior to posterior:

• Iris
• Ciliary body
• Choroid

• Uveal tract is firmly attached to sclera

only at 3 sites
• The scleral spur
• The exit points of vortex veins
• The optic nerve
APPLIED ANATOMY CONT
 The iris, the ciliary and the choroid are very different tissues; the iris is a
pigmented tissues that controls light entry into the eye. It is also responsible
for metabolism of the anterior segment by diffusion of metabolites through
the aqueous.
 The ciliary body produces aqueous and controls accommodation.
 The choroid is the vascular layer that supplies nutrition to the outer retina.
Therefore, they are affected by varying diseases. However, there are also
similar condition that affect the uveal layer and in particular inflammatory
and some infective conditions.
DEFINITION
 Uveitis is the inflammation of uvea (Iris, Ciliary body and Choroid).
 Latin word uva, meaning grape.
 Uveitis is not limited to the uvea. These diseases also affect the lens, retina,
optic nerve, and vitreous, producing reduced vision or blindness.
 Uveitis may be caused by diseases occurring in the eye or it can be part of an
inflammatory disease affecting other parts of the body.
 It can happen at all ages and primarily affects people between 20 and 60
years old.
 Uveitis can last for a short (acute) or a long (chronic) time.
 The severest forms of uveitis reoccur many times.
 CLASSIFICATIONS OF UVEITIS
 Uveitis is classified by the ocular structures involved.
 The international Uveitis Society Group classification is commonly used (i.e.,
anterior, intermediate, posterior ,and panuveitis).

 In anterior uveitis inflammation involves the iris (iritis), anterior ciliary body
(cyclitis), or both (iridocyclitis).
 Intermediate uveitis (pars planitis): Inflammation comes from the pars plana
of the ciliary body. It is more common in children and young adult and is
bilateral in 80% of cases. It is asymptomatic in many cases. Patients usually
describe
CLASSIFICATION CONT
 Posterior uveitis refers to inflammation involving the choroid (choroiditis),
retina (retinitis), both (chorioretinitis), or retinal vessels (retinal
vasculitis).
 Panuveitis involves all three parts of the uvea.
 Uveitis may extend to involve the cornea (keratouveitis) or sclera
(sclerouveitis).
. CLASSIFICATIONS OF UVEITIS
 .
BASED ON ONSET
 Acute
 Chronic

 BASED ON PATHOLOGY
 Suppurative
 Nonsuppurative
-granulomatous
-nongranulomatous
CAUSES
 Infectious uveitis
-Bacterial (Tubercular, Leprotic, Gonococcal)
-Spirochetal (syphilis, Lyme disease, Leptospirosis)
-Viral (Herpes, HIV, Cytomegalovirus disease)
-Fungal (Candidiasis)
Parasitic uveitis (Toxoplasmosis, Toxocariasis, Onchocerciasis,
Cysticercosis)
 Idiopathic
 autoimune
 Trauma
 Uveitis associated with systemic diseases
-Joint disorders (Ankylosing spondylitis, Juvenile rheumatoid arthritis,
Reiter’s syndrome)
CAUSES CONT

 Lens-induced uvietis (Phacoanaphylactic, Phacotoxic)

ANTERIOR UVEITIS
Inflammation of the uveal tract from the iris up to the plars plicata of ciliary
body. It can be acute or chronic anterior uveitis. In acute uveitis signs and
symptoms are severe than chronic anterior uveitis. In chronic anterior uveitis,
the only significant symptom is often blurred vision
CLASSIFICATION
 Iritis
 Iridocyclitis
 Cyclitis
CLINICAL FEATURES
SYMPTOMS
 Pain: Acute Severe Radiates along V(5th) nerve distribution Worst at night
 Redness: around the limbus due to increase blood supply to the anterior uvea
 Photophobia and blepharospasm (due to reflex b/n sensory fibers of 5th
nerve and motor fibers of 7th nerve(FN) supplying the orbicularis muscle
 Lacrimation due lacrimatory reflex mediated by 5th and 7th nerve
 Diminution of vision a.Turbid aqueous e. Sec. glaucoma b.Vitreous
exudates f.Ciliary spasm exudates in pupillary area
EYELID AND LIMBUS SIGNS

 Lid oedema(mild)
 Ciliary vessel dilatation
CORNEAL SIGNS; Keratitic precipitates
A/C SIGNS

 Cells
 Flare
 hypopyon
 IRIS SIGNS
 Loss of normal pattern
 Muddy in color in active stage & hyper/
hypopigmented
 Iris nodules: Aggregations of lymphocytes and
epithelioid cells.
 Posterior synechia
KOEPPE’S NODULE; BUSSACCA’S NODULE
SLUGGISH PUPILLARY REACTION AND MIOSIS
IRREGULAR PUPIL
LENS SIGNS
 Pigment dispersion on Lens surface
 Fibrin exudates on Lens surface
 Posterior synechiae
INTERMEDIATE UVEITIS
 .
Intermediate uveitis (pars planitis): Inflammation comes from the pars plana
of the ciliary body. It is more common in children and young adult and is
bilateral in 80% of cases.
SYMPTOMS
• It is asymptomatic in many cases.
• Floaters and some burring of vision from inflammatory exudates.
• SIGNS
• Sometimes the vitreous inflammatory cells clump together to form a white
ball which are referred to as SNOW BALL near or collection of white
exudates over the inferior pars plana which is referred to as SNOW
BANKING. On examination of the eye, some inflammatory exudates may be
seen in the peripheral retina
POSTERIOR SYNECHIAE
POSTERIOR UVEITIS
 Posterior uveitis refers to inflammation involving the choroid (choroiditis)
however the retina is frequently affected as well (retinitis), both
(chororetinitis), or retinal vessels (retinal vasculitis).There is often some
inflammation in the vitreous or even anteriorly in the eye
 SYMPTOMS OF POSTERIOR UVEITIS
 Reduced visual aquity due to hazy vitreous
 Dark, floating spots in the vision(blurred vision) due to large exudates clumps
in the vitreous
 Positive scotomas; i.e perception of a fixed large spot in the field of vision
corresponding to the lesions may be notice by patients
 Metamorphopsia(Distorted vision where straight line appear wavy) due to
alteration in retina contour(shape) caused by raised patch of choroiditis
 Micropsia(objects within an affected visual field appear smaller than normal)
due to separation of visual cells
 Macropsia(objects appear larger than normal) due to crowding of rods and
cones
 Photopsia(flashes of light in vision) due to irritation of rods and cones
SIGNS OF POSTERIOR UVEITIS
 Anterior segment; there are no external signs and eye look quite. However,
Fine KP’s biomicroscopy due to associated cyclitis.
 Vitritis (vitreous opacities)
 Exudates between the choroid and the retina which can lead to exudative
retinal detachment
 Retinal/choroidal oedema due to active inflammation
 Vascular sheathing i.e exudates collected around affected vessels
 Disc oedema
 Active patch Choroiditis appears as greyish-yellow or greyish-white raised
area with ill define edges on fundoscopy
 Healed patch choroiditis when active inflammation subsides, the area shows
white sclera below the atrophic choroid and black pigmented clumps at the
periphery of the lesions
MULTIFOCAL CHOROIDITIS

 Choroiditis may be focal multiple or diffuse

 Acute inflammatory lesions

are yellowish and ill defined;
 older lesions are yellowish-
brown and sharply
demarcated.
 MULTIFOCAL CHOROIDITIS
UNIFOCAL CHOROIRETINITIS
. Syphilitic uveitis

 Iridocyclitis in 4% with secondary syphilis  Focal areas of chorioretinal

 1 and bilateral in 50%
atrophy ass with
 Multifocal chorioretinitis
pigmentation.
PANUVEITIS

 Is the inflammation of all layers of the uvea, which includes the iris, ciliary
body and the choroid with no particular site of predominate inflammation.
Clinical presentation of panuveitis involves the summation of signs and
symptoms of anterior, intermediate and posterior uveitis.
CLINICAL MANIFESTATIONS
 Eye pain
 Redness
 Photophobia and lacrimation
 Blurred vision
 Aqueous cell and flare
 The cornea may appear cloudy
 Loss of accommodation or pain on accommodation
 Loss of corneal sensation
 Constricted and sluggish pupillary reaction
 Flashes of light
CLINICAL MANIFESTATIONS
 Hypopyon
 Iris Nodules (Busacca, Koeppe)
 keratic precipitates (Multiple lymphocytic, Mutton-fat KPs)
 Iris atrophy
 Acute rise in IOP due blockage of trabecular meshwork
 Posterior synechiae (Festooned pupil, Seclusio Pupillae, Iris bombe’ and
Occlusion pupillae )
 Ciliary injection
 Hyphema
 Iris becomes oedematous and its colour fades
 Endotheliitis
DIAGNOSIS
 Diagnosis of uveitis includes a thorough examination and the recording of the
patient’s complete medical history.
 Laboratory tests may be done to rule out an infection or an
autoimmune disorder this include FBC, VDRL, Chest X-ray, Mateo's Test, HIV
Test, Toxo IgG and IgM.
DIAGNOSIS
 The eye exams used, include:
 Visual Acuity Test.
 A Slit Lamp Examination.
 Funduscopic with eyes dilated
 Checking intraocular Pressure
NURSING MANAGEMENT
1. Checking of visual aquity
2. History taking
 Acute / chronic
 Recurrent
 Unilateral / bilateral
 Other systemic disease
 Monitoring of visual aquity
 Monitoring of IOP
NURSING MANAGEMENT
4.Hot fomentations are usually soothing and increase the blood flow and reduce
the venous stasis.
5.Education of patient
6.Advice patient to wear dark glasses in preventing photophobia
7.Refer to an ophthalmologist
MEDICAL MANAGEMENT
 Cycloplegics e.g. atropine sulphate 1% to prevent the formation of posterior
synechia and breaks any if formed it also relief ciliary spasms to reduces pain.

 Topical corticosteroid e.g prednisolone, betamethasone or dexamethasone

gives dramatic results in acute nongranulomatous anterior uveitis.
 Subconjunctival injections of corticosteroids are helpful in more severe cases
of anterior uveitis.

 Systemic corticosteroids are very effective in nongranulomatous uveitis e.g

orally administered prednisolone 60 to 80 mg pre day for 2 weeks in adults
and then gradually tapered.
 Antibiotics: specific antibiotics therapy is often needed. Broad-spectrum
antibiotic is recommended when the cause of uveitis is unknown. Topical
antibiotics may be used to prevent secondary infection.

 Nonsteroidal anti-inflammatory drugs (NSAIDs) e.g topical diclofenac

sodium(0.1%) and ketorolac tromethamine (0.5%) are very effective in
inhibiting prostaglandin release and act as anti-inflammatory agents.
 Systemic NSAIDs, aspirin, diclofenac or ibuprofen are useful in relieving pain.
 Immunosuppressive therapy: It may be tried in nonresponsive cases of
uveitis that are already receiving systemic steroids.
COMPLICATIONS
 Cataract
 Secondary glaucoma
 Iris atrophy
 Band keratopathy
 Pthisis bulbi
 Retinal detachment
 Macular scar
 Blindness