Uveal Disease. Wen Xu. What are these?. Uveitis. Description:. Definition:
It denotes inflammation of the choroid(choroiditis),ciliary body(intermediate uveitis,peripheral uveitis,or pars planitis),or iris(iritis).However,common usage includes inflammation of the retina(retinitis), retinal vasculature(retinalvasculitis),and optic nerve(opticneuritis)
It usually affects people 20-50 years of age and account for 10-15% of cases of legal blindness in developed countries. It is often combined with autoimmune diseases and characterised by its severe complications and recurrency
(1)Externalcauses: infectiousdisorders (global penetration,intraocular foreign body, intraocular surgery and so on),noninfectious disorders (chemical burns,thermal burns,mechanical trauma or toxic stimulus).
(2)Secondarycauses: secondary to inflammation of the global itself or adjacent tissues or toxic stimulus from intraocular disorders.
(3)Internalcauses: infectious disorders (bacteria, viruses, fungi,parasites,protozoas),noninfectious disorders (combined with immunal or systemic disorders such as lens-induced uveitis,sympathetic ophthalmia and Behcet’s disease)
(5)Oxidative damages(from free radical reactions)
(1)Location-classified: anterior uveitis,intermediate uveitis,posterior uveitis and diffused uveitis
(2)Clinical features: suppurative uveitis andnonsuppurative uveitis
(3)Pathology: granulomatous uveitis and nongranulomatous
(4)Etiology: infectious uveitis and noninfectious uveitis
pain,photophobia,tearing and blurred vision.
(1)ciliary or mixed congestion
(2)keratic precipitates, KP
(7)vitreous and fundus changes
Episcleral vascular congestion around limbus.
mutton fat KP
Residual pigment on the
surface of lens when the
closed pupil opens again.
Cystoid macular edema or papilloedema cannot be seen frequently,but severe vision damage may occur once they happens.
1.Typical clinical findings:
symptoms and signs
2.Systemic disorders history:
joint disease like juvenile rheumatoid arthritis and ankylosing spondylitis,Fuch’s heterochromic iridocyclitis,lens-induced uveitis and etc.
blood sedimentation accelerates, HLA-B27 histocompatibility antigen test (+), specific pathogen and etc.
PACG acute iridocyclitis acute conjunctivitis
Symptoms severe eye pain slight eye pain foreign body sensation
headache photophobia burning
nausea、vomiting tearing mucus or pus-like discharge
Vision Markedly blurredSlightly blurred No effect on vision
Congestionmixed ciliary or mixed conjunctival Cornea steamy edema、opacity transparent normal
pigmentary KPhoar KP
Pupil dilated and fixedmiosis normal
vertical oval irregular shapes
Anterior shallow、aqueousnormal or deepnormal
Chamber slight opacity aqueous opacity
IOP Markedly elevatednormal normal
Treatment myotica mydriatic agents anti-inflammatories
lower IOP anti-inflammatories antivirals
1.cycloplegics:①prevent and seperate the posterior synechia of iris in case the complications occur. ② reduce discomfort from ciliary spasm. The first line is Homatropine drops or ointments; when severe inflammation occurs,our first choice comes to 1% Atropine, then change into Homatropine or tropicamide.
2.corticosteroids:Care should be taken to rule out an corneal epithelial defect in case of infection. Short-term systemic medicines and periocular injections areallowed when there is papilledema or macular edema.
3.nonsteroidal anti-inflammatory drugs (NSAIDs):aspirin or local drops4.antimicrobials:when caused by infection.
6.treat the accompanied systemic disorders.
8.other therapies:foment,and etc.
9.treat the complications and sequelae:anti-glaucoma surgeries,cataract surgeries under good control of the imflammation.
(1)anteriorsegment is general normal, but if significant, there may exist the manifestations of anterior uveitis like KP, aqueous flare, aqueous imflammation cells, posterior synechia of iris and etc.
(3) There may exist macular edema and optic neuritis、peripheral retina vasculitis、vacular white sheath and etc.
(4) Systemic disorders: Mutiple sclerosis, infection,Behcet’s disease,imflammatory bowel disease and etc.
(1) complicated cataract
(2) secondary glaucoma
(3) macular edema
(5)retinal or choroidal detachment
symptoms and signs
drops、sub-Tenon’s sac injection or take orally
CsA. Pay attention to the toxicity and side-effects
typical vitreous、retinal and/ or choroidal diseases; systemic disorders;fundus fluorescein angiography or ICGA;laboratory tests and other ancillary tests to determine the cause or type
anti-infectious treatment; corticosteroids;other immunosuppressants; surgeries
contain both the manifestations of anterior and posterior uveitis
do as anterior and posterior uveitis
according to history, clinical manifestations,fundus fluorescein angiography, ncurolympy test
clinical manifestations,laboratory tests, PCR, biopsy
antivirals(Gancyclovir, Acyclovir), anticoagulants (heparin,small doses of aspirin), corticosteroids, laser coagulation or surgeries
tumor history and fundus features
Chemotherapy for concurrent metastatic disease is usually effective against the choroidal component. In the absence of other metastases, local radiotheraphy is the treatment of choice. Enucleation of eyeball is of no use