1 / 131

Understanding Uveitis: An In-depth Overview of Symptoms and Classification

Explore the anatomical, clinical, etiological, and pathological classifications of uveitis, its pathophysiologic mechanisms, clinical features, and grading systems for aqueous flare and opacification. Learn about uveitis associated with joint diseases like Juvenile Rheumatoid Arthritis and HLA-B27 disorders.

rspaulding
Download Presentation

Understanding Uveitis: An In-depth Overview of Symptoms and Classification

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Uvea & Sclera SINA A. SHOOL MD www.drsinashool.blogspot.com

  2. Uveitis – “inflammation of the uveal tract”

  3. 1) Anatomic classification • Anterior Uveitis: iris & Anterior part of the ciliary body (pars plicata • Intermediate Uveitis: posterior part of the ciliary body (pars plana) • Posterior Uveitis • Panuveitis

  4. Anatomical - Anterior Uveitis • Juvenile Rheumatoid Arthritis • Fuchs’ heterochromic Iridocyclitis • Ankylosing Spondylitis • Reiter’s Syndrome

  5. Anatomical - Intermediate Uveitis • Pars Planitis • Sarcoidosis • Multiple Sclerosis • Lyme Disease

  6. Anatomical - Posterior Uveitis • Toxoplasmosis • Histoplasmosis • Toxocariasis • Serpiginous chorioretinitis • Birdshot retinochoroiopathy

  7. Anatomical - Diffuse Uveitis • Sympathetic Ophthalmia • VKH syndrome • Behcet’s disease

  8. (2) Clinical Classification • Acute Uveitis: sudden, symptomatic onset; persists for <6 weeks • Chronic Uveitis: insidious onset, may be asymptomatic; persists for months

  9. (3) Etiological Classification • Exogenous Uveitis: due to external injury to the uvea or invasion of micro-organisms from the outside • Endogenous Uveitis: caused by micro-organisms or other agents from inside the patient www.drsinashool.blogspot.com

  10. (4) Pathological Classification • Granulomatous Uveitis - epithelioid and giant cells, lymphocytes • Non-granulomatous Uveitis - lymphocytes and plasma cells

  11. (5) Pathophysiologic Mechanisms (Opremcak) • Traumatic • Surgical vs. non-surgical • Infectious • Bacterial, Viral, Fungal, Protozoal, Helminthic, Insect, Animal • Immunologic • Masquerade Diseases

  12. Immunologic • Type I hypersensitivity disorders • Ig E- mediated • Mostly ocular surface disease hay fever, vernal & atopic keratoconjunctivitis • Type II • Antibody dependent cellular cytotoxicity (autoantibodies) • Ocular Cicatricial Pemphigoid; Lens-induced Uveitis

  13. Immunologic • Type III • Immune Complex formation & deposition • Ankylosing Spondylitis, SLE, JRA, Behcet’s disease, PAN, Wegener’s granulomatosis, inflammatory bowel disease, other collagen vascular diseases • Type IV • Cell mediated immune response • Interleukins • Contact dermatitis, Phylectnulosis, , Fuchs HI, Sympathetic Ophthalmia, VKH, Birdshot retinochoroidopathy, Pars Planitis, Leber’s Idiopathic Stellate Neuroretinitis, Sarcoidosis

  14. Masquerade Syndrome • Vascular tumors • Infectious • Congenital anomalies • Metabolic/Degenerations (amyloidosis, retinitis pigmentosa) • Neoplastic Disease (lymphoma, leukemia)

  15. Clinical Features

  16. Aqueous Flare 0 Optically empty 1+ Faint 2+ Moderate- clear iris & lens 3+ Marked- hazy iris & lens 4+ Intense- fibrin with no motion of cells Aqueous cell (1x3 mm beam @ 5-10 °) 0 0 Rare Rare Occasional 1-2 cells Trace 2-4 cells 1+ 5-15 2+ 16-25 3+ 26-60 4+ > 60 cells Grading System for Anterior Chamber Flare & Cell

  17. Limbal Hyperemia= Intraocular Inflammation

  18. Clinical Features

  19. Flare (Vitreous Opacification) 0 Good View of NFL 1+ Clear ON & vessels but hazy NFL 2+ ON & vessels hazy 3+ ON only 4+ No ON Cell (1x3 mm beam in anterior vitreous) Trace 0-10 cells 1+ 10-20 2+ 20-30 3+ 30-100 4+ > 100 cells Grading System for Vitreous Cell and Opacification

  20. Clinical Features

  21. Keratouveitis: with corneal involvement • Sclerouveitis: with scleral involvement • Keratosclerouveitis

  22. Anterior Uveitis • Juvenile Rheumatoid Arthritis • Fuchs’ heterochromic Iridocyclitis • Ankylosing Spondylitis • Reiter’s Syndrome

  23. Anterior Uveitis 1) Uveitis Associated with Joint Disease a) Juvenile Rheumatoid Arthritis (JRA) - chronic, bilateral, non-granulomatous - arthritis of at least 3 mos’ duration in a child less than 16 years - females - insidious onset - uveitis may precede the onset of arthritis

  24. JRA (cont) • types of arthritis: pauciarticular onset <4 joints polyarticular onset > 5 joints systemic onset

  25. Anterior Uveitis 2) Uveitis Associated with Joint Disease(cont) b) HLA-B27-associated - Ankylosing spondylitis - Reiter’s syndrome - Psoriatic arthritis - Inflammatory Bowel Disease (IBD)

  26. HLA-B27-associated Ankylosing Spondylitis • inflammatory arthritis affecting axial skeleton • Fixed flexion deformity due to fusion of spine and sclerosis of sacroiliac joints • Klebsiella & Chlamydial infections

  27. HLA-B27-associated Reiter’s Disease • Triad: urethritis, conjunctivitis, arthritis • Extraarticular features: Mouth ulcers, skin lesions (keratoderma blenorrhagica), penile lesions (circinate balanitis), nail changes, cardiovascular changes, genitourinary lesions

  28. HLA-B27-associated Psoriatic Arthritis - Psoriasis: skin disease due to epidermal hyperproliferation

  29. HLA-B27-associated Inflammatory bowel disease • Crohn’s disease and ulcerative colitis • Gastrointestinal and articular manifestations • Systemic manifestations include skin lesions, oral ulcerations, hepatobiliary disorders, urogenital involvement

  30. Anterior Uveitis 3) Fuch’s Heterochromic Iridocyclitis • unilateral, insidious, third or fourth decade • No symptoms; low grade uveitis • Early cataract • Fine, stellate, evenly distributed deposits on the posterior corneal surface; iris atrophy; telangiectatic vessels in the angle • Synechiae is rare

  31. Fuch’s Heterochromic Iridocyclitis

More Related