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Anatomy and PhysiologyUvea consists of : Iris, Ciliary body,

Choroid

Vascular rich Tunica vasculosa

Vascular layer ; the eyes major blood

supply

Primary function : supply

nourishment to the ocular

structure

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Sagittal view of the eye

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IRIS

Dividing aquous humour into Anterior Chamber

and Posterior Chamber

Central iris ( pupil ) control the amount of lightentering the eye

Miosis -- Mydriasis

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CILIARY BODY

Produce Aquous Humor

Contribute the maintenance IOP

Ciliary muscles for Accomodation

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CHOROIDNutrition to the external half of the retina

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UVEITIS The inflammation of the uvea

Causes : infectious, traumatic, neoplastic,autoimmune

Symptoms

1. Blurred Vision

Refractive error associated with macular edem Opacities in the visual axis : inflammatory cells,

fibrin, keratic precipitate (KP)

Second cataract, vitreus debris

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SIGNSCiliary flush : pericorneal injection

Anterior chamber reaction : KP, cells, flare,

fibrin, hypopion, pigment dispersion

Pupillary miosis : iris edem

Iris nodule ( granulomatous uveitis)

Synechia : S.Anterior, S.Posterior

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AQUOUS FLARE

KERATIC PRECIPITATES

PIGMENT DEPOSITS ON THE LENS

POSTERIOR SYNECHIA

KERATIC PRECIPITATES

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Classification

Clinic. And pathologic grounds

- Nongranulomatous

- Granulomatous

Anatomical IUSG ( International Uveitis StudyGroup)

Anterior uveitis

Intermediate uveitis Posterior uveitis

Panuveitis : diffuse uveitis

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Anterior Uveitis IritisIridocyclitiskeratouveitissklero

uveitis

Sterile inflammatory reaction

Some cases of unknown cause after

resolve in 6 week (idiophatic iritis)

Low grade inflammatory associated(idiophatic iritis) : JRA, Fuchs

heterochromatic iridicyclitis

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Intermediate UveitisExternally eye appears quite

Floaters

Chronic Cystoid macular edema

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Posterior uveitisQuite appearancy or with infiltrate

Retinitis, choroiditis, chorioretinitis

Infectious : viral, bacterial, protozoa,

fungal

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Cause of uveitisClinical

Laboratory and medical examination

Ancillary testing

- Fluorosein angiography (FFA)

- USG

- Vitreous biopsy (vitrectomy)

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TreatmentA. MEDICAL THERAPY

1. Cycloplegic

- relieve pain

- break synechia

- prevent synechia

2. Corticosteroid

a. Topical

b. Perioculer

c. Systemic

d. Intravitreal

3. Immunosuppressive

B. SURGICAL

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CORTICOSTEROIDThe mainstay of uveitis therapyPotential side effect

Specific indication

1. Active inflammation in the eye

2. Prevention or treatment cystoid macular

edema

3. Reduction of inflammation of retina,

choroid or optic nerve

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Route administration of steroid

Topical : ED, EO, primary for anterior uveitis

Periocular for intemediate uveitis

Systemic, oral, intravenous for vision threateningchronic uveitis

Intravitreal for chronic uveitis and cystoid macular

edema

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IMMUNOSUPPRESSIVE

INDICATION :

Vision threatening intraocular inflammation

Reversibility of disease process Inadequate response to steroid treatment

Contraindication of steroid (intorelable side effects)

Immunosuppressive : cyclosporine, chlorambucil,

methotrexate

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COMPLICATION OF UVEITIS1. Iris involvement : synechia ( anterior &/posterior),

disturbance of aquous humor flow secondary

glaucoma

The meshwork clogged by inflammatory cells ordebris, IOP increased secondary glaucoma

2. Cataract formation

3. Chronic uveitis macular edema

4. Fibrin of vitreous traction retinal detachment

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SECONDARY GLAUCOMA

POSTERIOR SYNECHIASECONDARY CATARACT

RETINAL DETACHMENT

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