🔹 1)anatomy:
🔹
The uvea is the vascular layer of the eye, comprises of the iris, ciliary body and the choroid
2)Pathological:
🔹
Granulomatous vs. Nongranulomatous
3)Clinical:
-Infectious(bacterial, viral, fungal, parasitic)
-Noninfectious( known systemic associations, no known systemic associations)
-Masquerade(neoplastic, nonneoplastic)
ANATOMY
Classification:
Anterior
Intermediate
Posterior
Panuveitis
Definitions
🔹🔹
1 Onset Sudden or insidious
🔹🔹
2 Duration An attack may be limited, if 3 months or less in duration, or persistent if longer
3 Acute Sudden onset and limited duration
4 Chronic Persistent inflammation characterized by prompt relapse (in less than 3 months) after
DEFINITIONs 🔹
discontinuation of therapy.
5 Recurrent Repeated episodes of uveitis separated by periods of inactivity without treatment lasting at
🔹🔹
least 3 months
6 Remission Inactive disease for at least 3 months after discontinuation of treatment
7 Resistant
-To steroids if there is no clinical improvement despite 2 weeks of treatment with maximal dose
-To immunosuppressive if there is no clinical improvement despite 3 months of treatment
🔹
🔹Inflammation involving the anterior uveal tract (iris and pars plicata)
Anterior uveitis is the most common form of uveitis
🔷
🔹 Acute Anterior Uveitis: Ciliary (circumcorneal ) injection
🔹
🔹
AAU is the most common form of anterior uveitis
Sudden onset, duration ≤ 3 months
🔹
🔹
Presentation.. Typically sudden onset of unilateral pain, photophobia, and redness.
Visual acuity
External examination..
-Ciliary (circumcorneal ) injection
-Endothelial dusting- keratic precipitates(KPs)
-Aqueous cells.. Indicate disease activity and their number reflects disease severity
-Miosis
-Hypopyon
-Posterior synechiae
🔹
-IOP
Fundus examination
🔹
keratic precipitates(KPs):
Deposits on the corneal endothelium composed of inflammatory cells such as lymphocytes, plasma
Uveitis 🔹
cells and macrophages
🔹 Their characteristics indicate the probable type of uveitis
Inflammation of the 🔹 Smaller in the non-granulomatous inflammation typical of AAU
Medium to large in (classically chronic) granulomatous inflammation in which cell types may include
uveal tract 🔹Large greasy-appearing granulomatous KP are said to have a ‘mutton fat’ appearance
epithelioid and multinucleated cells
🔹
Uveitis in spondyloarthropathies:
The spondyloarthropathies are a group of disorders featuring HLA-B27 positivity and enthesitis as
🔹
common factors
🔹 AAU is by far the most common ocular association and occurs in about 25% of patients with AS
🔹
🔹
Approximately 25% of males with AAU will have AS
Either eye is frequently affected at different times but bilateral simultaneous involvement is rare
🔹 There is often no correlation between the severity and activity of eye and joint involvement
🔹Chronicity occurs in a few patients
HLA-B27-positive AS patients tend to have worse disease across a range of parameters, including earlier
onset and greater intensity of inflammation with an increased frequency of complications
🔷
🔹 Uveitis in Juvenile Idiopathic Arthritis (JIA):
JIA is by far the most common systemic disease associated with childhood anterior uveitis with a
by fatema okoff
Anterior Uveitis 🔹
prevalence of about 1:1000
It is defined as arthritis of unknown aetiology that begins before the age of 16 years and persists for at
least 6 weeks
🔷 Sarcoidosis:
Uveitis is the most common and may be in the form of anterior, posterior or intermediate. Other
🔷
manifestations include KCS, conjunctival nodules, and rarely orbital scleral lesions
Behçet Syndrome:
Ocular complications occur in up to 95% of men and 70% of women. Eye disease typically occurs within 2
years of oral ulceration, but rarely the delay may be as long as 14 years. Conversely, ocular inflammation is
the presenting manifestation in about 10% of cases. Ocular disease is usually bilateral and typically
presents during the 3rd and 4th decades.
🔷
🔹 Vogt-Koyanagi-Harada Syndrome
An idiopathic multisystem autoimmune disease featuring inflammation of melanocyte-containing tissues,
🔹
such as the uvea, ear, and meninges.
Subdivided into:
-Vogt-Koyanagi disease: characterized mainly by skin changes and anterior uveitis.
-Harada disease: neurological features and exudative retinal detachments.
🔷
🔹 Sympathetic ophthalmitis
A bilateral granulomatous panuveitis occuring after penetrating trauma, often associated with uveal
🔹
prolapse, or, less frequently, following intraocular surgery. Usually multiple vitreoretinal procedures
The condition has been associated with specific HLA haplotypes which would suggest that in some
🔹
patients there is a genetic predisposition
🔹 The traumatized eye is referred as the exciting eye, and the fellow eye is the sympathizing eye
65% of cases presented between 2 weeks and 3 months after initial injury and 90% of all cases occur
🔹The incidence is probably 0.2–0.5% after injury and 0.01% following intraocular surgery
within the first year
🔷
🔹 Fuchs Uveitis Syndrome (FUS)
🔹
🔹
Fuchs heterochromic iridocyclitis
Chronic non-granulomatous specific uveitis entity which is usually unilateral
🔹
🔹
Chronic, annoying vitreous floaters are often the presenting symptom.
Gradual blurring of vision secondary to cataract formation is common.
🔹 Color difference between the two eyes.
🔹Absence of posterior synechiea.
Glaucoma is a late manifestation.
🔷Principles of Treatment
🔹
🔹Steroids.(topical, periocular, intraocular, systemic)
🔹
🔹
Mydriatics-Cycloplegic
Antimetabolites
🔹Immune modulators
Biological blockers
Treatment and Complication
🔷
🔹Complication:
🔹
🔹
Band keratopathy
Cataract
🔹
🔹
Glaucoma
Hypotony
🔹Macular oedema
Retinal detachment
🔹
The uvea is the vascular layer of the eye, comprises of the iris, ciliary body and the choroid
2)Pathological:
🔹
Granulomatous vs. Nongranulomatous
3)Clinical:
-Infectious(bacterial, viral, fungal, parasitic)
-Noninfectious( known systemic associations, no known systemic associations)
-Masquerade(neoplastic, nonneoplastic)
ANATOMY
Classification:
Anterior
Intermediate
Posterior
Panuveitis
Definitions
🔹🔹
1 Onset Sudden or insidious
🔹🔹
2 Duration An attack may be limited, if 3 months or less in duration, or persistent if longer
3 Acute Sudden onset and limited duration
4 Chronic Persistent inflammation characterized by prompt relapse (in less than 3 months) after
DEFINITIONs 🔹
discontinuation of therapy.
5 Recurrent Repeated episodes of uveitis separated by periods of inactivity without treatment lasting at
🔹🔹
least 3 months
6 Remission Inactive disease for at least 3 months after discontinuation of treatment
7 Resistant
-To steroids if there is no clinical improvement despite 2 weeks of treatment with maximal dose
-To immunosuppressive if there is no clinical improvement despite 3 months of treatment
🔹
🔹Inflammation involving the anterior uveal tract (iris and pars plicata)
Anterior uveitis is the most common form of uveitis
🔷
🔹 Acute Anterior Uveitis: Ciliary (circumcorneal ) injection
🔹
🔹
AAU is the most common form of anterior uveitis
Sudden onset, duration ≤ 3 months
🔹
🔹
Presentation.. Typically sudden onset of unilateral pain, photophobia, and redness.
Visual acuity
External examination..
-Ciliary (circumcorneal ) injection
-Endothelial dusting- keratic precipitates(KPs)
-Aqueous cells.. Indicate disease activity and their number reflects disease severity
-Miosis
-Hypopyon
-Posterior synechiae
🔹
-IOP
Fundus examination
🔹
keratic precipitates(KPs):
Deposits on the corneal endothelium composed of inflammatory cells such as lymphocytes, plasma
Uveitis 🔹
cells and macrophages
🔹 Their characteristics indicate the probable type of uveitis
Inflammation of the 🔹 Smaller in the non-granulomatous inflammation typical of AAU
Medium to large in (classically chronic) granulomatous inflammation in which cell types may include
uveal tract 🔹Large greasy-appearing granulomatous KP are said to have a ‘mutton fat’ appearance
epithelioid and multinucleated cells
🔹
Uveitis in spondyloarthropathies:
The spondyloarthropathies are a group of disorders featuring HLA-B27 positivity and enthesitis as
🔹
common factors
🔹 AAU is by far the most common ocular association and occurs in about 25% of patients with AS
🔹
🔹
Approximately 25% of males with AAU will have AS
Either eye is frequently affected at different times but bilateral simultaneous involvement is rare
🔹 There is often no correlation between the severity and activity of eye and joint involvement
🔹Chronicity occurs in a few patients
HLA-B27-positive AS patients tend to have worse disease across a range of parameters, including earlier
onset and greater intensity of inflammation with an increased frequency of complications
🔷
🔹 Uveitis in Juvenile Idiopathic Arthritis (JIA):
JIA is by far the most common systemic disease associated with childhood anterior uveitis with a
by fatema okoff
Anterior Uveitis 🔹
prevalence of about 1:1000
It is defined as arthritis of unknown aetiology that begins before the age of 16 years and persists for at
least 6 weeks
🔷 Sarcoidosis:
Uveitis is the most common and may be in the form of anterior, posterior or intermediate. Other
🔷
manifestations include KCS, conjunctival nodules, and rarely orbital scleral lesions
Behçet Syndrome:
Ocular complications occur in up to 95% of men and 70% of women. Eye disease typically occurs within 2
years of oral ulceration, but rarely the delay may be as long as 14 years. Conversely, ocular inflammation is
the presenting manifestation in about 10% of cases. Ocular disease is usually bilateral and typically
presents during the 3rd and 4th decades.
🔷
🔹 Vogt-Koyanagi-Harada Syndrome
An idiopathic multisystem autoimmune disease featuring inflammation of melanocyte-containing tissues,
🔹
such as the uvea, ear, and meninges.
Subdivided into:
-Vogt-Koyanagi disease: characterized mainly by skin changes and anterior uveitis.
-Harada disease: neurological features and exudative retinal detachments.
🔷
🔹 Sympathetic ophthalmitis
A bilateral granulomatous panuveitis occuring after penetrating trauma, often associated with uveal
🔹
prolapse, or, less frequently, following intraocular surgery. Usually multiple vitreoretinal procedures
The condition has been associated with specific HLA haplotypes which would suggest that in some
🔹
patients there is a genetic predisposition
🔹 The traumatized eye is referred as the exciting eye, and the fellow eye is the sympathizing eye
65% of cases presented between 2 weeks and 3 months after initial injury and 90% of all cases occur
🔹The incidence is probably 0.2–0.5% after injury and 0.01% following intraocular surgery
within the first year
🔷
🔹 Fuchs Uveitis Syndrome (FUS)
🔹
🔹
Fuchs heterochromic iridocyclitis
Chronic non-granulomatous specific uveitis entity which is usually unilateral
🔹
🔹
Chronic, annoying vitreous floaters are often the presenting symptom.
Gradual blurring of vision secondary to cataract formation is common.
🔹 Color difference between the two eyes.
🔹Absence of posterior synechiea.
Glaucoma is a late manifestation.
🔷Principles of Treatment
🔹
🔹Steroids.(topical, periocular, intraocular, systemic)
🔹
🔹
Mydriatics-Cycloplegic
Antimetabolites
🔹Immune modulators
Biological blockers
Treatment and Complication
🔷
🔹Complication:
🔹
🔹
Band keratopathy
Cataract
🔹
🔹
Glaucoma
Hypotony
🔹Macular oedema
Retinal detachment
