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UVEITIS

DEFINITION
Inflammation of Uveal Tract (Iris, Cilliary body, Choroid)
CLASSIFICATION OF UVEITIS
Based on anatomy (the portion of the uvea involved)
Clinical course (acute, chronic, or recurrent)
Etiology (infectious or noninfectious)
Histology (granulomatous or nongranulomatous)
ANATOMICAL CLASSIFICATION OF
UVEITIS
ANTERIOR UVEITIS
Definition
Intraocular inflammation involving the anterior uvea (iritis, cyclitis,
iridocyclitis)
Symptoms

Acute Chronic
-pain -decreased vision
-redness -exacerbations and remission with few
-photophobia acute symptoms
-consensual photophobia
-lacrimation
-decreased vision
ETIOLOGY OF ANTERIOR UVEITIS
Acute Chronic

• Idiopathic • JIA (Juvenile


• HLA B27 assoc. Idiopathic Arthritis)
(Ankylosing • Sarcoidosis
spondylitis, Reiter’s • Herpes
syndrome, Psoriatic simplex/Herpes Zoster
Arthritis) • Syphilis
• Lens induced • Tuberculosis
• Post operative
Signs
Ciliary injection
Keratik Precipitate (Fine KP, small non granulomatous
KP, granulomatous KP)
Iris nodules (Koeppe, Busacca, Berlins nodules)
Anterior chamber cells & flare
Synechia
Low or elevated IOP
Band keratopathy
MANAGEMENT
History and review system
Laboratory work up
Cycloplegic
Steroid
 Topical
 Periocular injection of steroids
 Systemic

Immunosuppresant &/ immunomodulator


Systemic management based on etiology
INTERMEDIATE UVEITIS
Definition
Chronic inflammation, recurrent often, located in vitreous body
Idiopathic (pars planitis) or related to other systemic disease
CLINICAL FEATURES

Symptoms Signs

• Painless floaters • Vitreous cells


• Decreased vision • Snowbank (white
• Minimal photophobia exudative material
• Aged 15 – 40 y.o over the inferior ora
• Usually bilateral serata and pars
plana)
• Snowball (cellular
agregates floating in
inferior vitreous)
Snowballs

Snowbank

Snowballs and snowbank in pars


Vitritis planitis
MANAGEMENT
History and review system
Systemic work up (Chest x rays, PPD, ACE level, RPR, FTA-ABS, antibody
toxoplasmosis, lyme disease, cat scratch dis’s)
Cycloplegic
Steroids
 Topical
 Subtenon
 systemic

Transcleral cyclocryotherapy to area snowbanking


Pars plana vitrectomy
POSTERIOR UVEITIS
CLINICAL FEATURES
Symptoms
Blurred vision
Floaters
Pain, redness, photophobia typically absent unless AC
reactions is present
SIGNS
Cells in vitreous and/or anterir
chamber
Choroiditis, retinitis, vasculitis,
cystoid macular edema (CME)
MANAGEMENT
Complete history and systemic review
Systemic work up (Chest x rays, PPD, ACE level, RPR, FTA-ABS, antibody
toxoplasmosis, lyme disease, cat scratch dis’s)
Systemic management based on etiology
Costicosteroids
 Topical
 Systemic
 Intraocular (triamcinolon 4 mg subonjungtiva)
Antimetabolit (Azathioprine, Methotrexate)
Imunomodulator (Cyclosporine, Tacrolimus)
Cycloplegic