Disease of Uveal Tract

Lu Chen

1
Choroid
 The choroid is the posterior segment of the uveal t
ract, between the retina and the sclera.

 It is composed of three layers of choroidal blood

vessels: large, medium, and small. The deeper ves
sels are placed in the choroid, the wider in their lu
mens.
Choroid
 The internal portion of the choroid vessels is kno
wn as the choriocapillaris.

 Blood from the choroidal vessels drains via the fo

ur vortex veins, one in each of the four posterior q
uadrants.
Choroid
 The choroid is bounded internally by Bruch's me
mbrane and externally by the sclera.
 The suprachoroidal space lies between the choroid
and the sclera.
 The choroid is firmly attached posteriorly to the m
argins of the optic nerve. Anteriorly, the choroid j
oins with the ciliary body.
 Uveitis
General description
Includes:
1 、 retina (retinitis), retinal vasculature (retinal
vasculitis), and intraocular optic nerve (papillitis)

2 、 inflammation of the cornea (keratitis), sclera

(scleritis), or both (sclerokeratitis)
Etiology and Pathogenesis
1. Infectious factor
2. Non-Infectious factor
Exogenous
Endogenous
3. Oxidizing injury
4. Metabolite of arachidonic acid
5. Heredity
 Classification
There is not ideal classification now.

1. Etiology

2. Pathological change

3. Anatomical site

4. Course of illness
Anterior uveitis

the inflammation involves in the iris as

well as cilliary tissue before the cilliary
corona,it is the most common and consists of
iritis,iridoyclitis,anterior cyclitis
 Clinical findings

Symptoms

1. Pain

2. Photophbia

3.Blurred vision
Sign

1.Ciliary or mixed injection

it is an important sign of anterior uveitis.

2.Aqueous flare

this is the sign of inflammation in active

stage,also as an important index of anterior
uveitis.
3.Keratic precipitates(K.P)

Its quantity has relation to inflammatory

severity.
 The shape of Kp manifests the
characteristic of inflammatory cells in
aqueous humor, related to the cause of
iridocyclitis
a. Fine dusty KP

it is white punctate shaped,composed of

lymphocyte and plasmocyte,difficult to be found
without use of slit-lamp microscope,commoly
seen in non-granulomatous uveitis.
b. Mutton fat KP

it is white,like small balls of “mutton fat”.

c. Pigmentary KP

Small pigmentary particles attach to the

corneal endothelium,the pigment may come from
pigmentary cells of the uvea,also may come from
release of melanin in the cells due to ruptrue of
the cells.
d. Hyaloid KP

it suggests that the patient had suffered from

iridocyclitis before.
4. Change of the iris

the iris becomes dark and gloomy,with

unclear furrow due to hyperemia and edema.

Koeppe’s nodular
Busacca’s nodular
Koeppe’s nodular
Busacca’s nodular
5.Change of the pupil

the pupil becomes small.

plum blossom pupil

Seclusion of pupil
Occlusion of pupil
plum blossom pupil
Occlusion of pupil
Seclusion of pupil
6.Vitreous opaque

in cyclitis,inflammatory cells may ooze to

the anterior part of the
vitreous,particle,flocculent or cloudy opacity
may be seen.
Complications

1. Complicated cataract

2.Secondary glaucoma

3.Low IOP(Intraocular pressure) and atrophy

Diagnosis

1. Symptoms and sign

2. History

3. Laboratory testing
Differential diagonsis

1.Acute conjunctivitis

2.Acute angel-closure glaucoma

Treatment

1.Cycloplegic

Homatropine ointment 1%,2%,or 4% 1-2

times/day

Mydricain (a mixture of 1% arropine, 0.1%

adrenaline,1% curtacain) 0.1-0.2ml
subconjunctival injection
The purpose of using cycloplegic:

a. To break the posterior synechiae

b. Anesthesia ciliary body to reduce pains

Treatment

2. Glucocorticosteroid

Topical therapy with 1% prednisolone

acetate 1-2 drops every 1-2 hours while
awake.
Treatment

3. NSAID(topial therapy)

4. Corticosteroid

severe caeses
sub-Tenon injection or oral
Treatment

5.causal treatment

arthritis,  Syphilis…

6.Treatment of complications

Cataract and glaucoma.

collaboration with an internist, rheumatologist, or

oncologist.
Vogt-koyanagi-harada syndrome
(VKH syndrome)

it is the bilateral, granulomature panuveititis,

often accom panied with meninges
stimulation,disturbance of audition and vitiligo.
Etiology

It is an autoimmune disease and is close to

HLA-DR4,HLA-DRw53
Clinical findings

1.premonitory symptom

Headache,tinnitus,audition decrease,and
allergy of scalp
Clinical findings

2.severe bilateral iridocyclitis

Clinical findings

3.Bilateral diffused choroiditis,retinal

edema,and serous retinal detachment.

4.Lesion out of eyes:alopecia,vitiligo,etc.

Complications

1.complicated cataract

2.Secondary glaucoma

3.Serous retinal detachment

Diagnosis

History + clinical findings +FFA

FFA examine:there are many scrappy leakage

spots,which quickly expand.
scrappy leakage spots
Treatment

1.To first suffering

oral prednisone

2.To recrudescent patients

immunosuppressants

3.Treat complications
Behcet disease

behcet disease is a syndrome involved

ineyes,oral cavity,skin,and genitalia.
Etiology

It is an autoimmune disease and has a close

relation to bacteria and herpes simplex virus
Clinical findings

1.Lesion of the eyes

Clinical findings

2.Oral ulcer
Clinical findings

3.Lesion of the skins

Clinical findings

4. Ulcers of genitalia

Pain and scars left

Clinical findings

5.Others

Arthritis impairment of nervous system and

so on
Diagnosis

The diagnosis criteria made by bechet

disease research institution of Japan is:
A:completeness type----4 signs(uvetitis,oral
ulcer,ulcer of genitalia,lesion of skins) all
appear.
Diagnosis

B:incompleteness type----2 or 3 of 4 signs

appear.
Treatment

Same as the uveitis