The uvea consists of 3 elements:
1- Iris
2- Ciliary body
3- Choroid
Inflammation of the iris and ciliary body is called iridocyclitis (anterior uveitis), inflammation of the posterior part of the ciliary body, pars plana, and adjacent areas is called intermediary uveitis (pars planitis), inflammation of the choroid is called choroiditis (posterior uveitis), and inflammation of all elements is called panuveitis.
Clinical Classification:
a) Acute: Symptomatic onset is sudden; Lasts for 6 weeks or less.
b) Chronic: It can last for months or years, progresses with attacks (chronic recurrent uveitis).
Etiological Classification:
• Often the cause is unknown (idiopathic).
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The
etiology of uveitis |
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else |
Autoimmune |
Infections |
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Traumatic uveitis |
Juvenile rheumatoid arthritis |
Syphilis |
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Kawasaki |
Ankylosing spondylitis |
tuberculosis |
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retinal detachment |
Reiter's syndrome |
HSV |
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Fuchs disease |
Ulcerative colitis |
Onchocerciasis |
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gout |
Crohn's disease |
Bacteria (Tbc, Staphylococcus, Brucella, Borrelia, Nocardia,
Bacteria) |
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malignant (masking
syndromes) |
psoriasis |
Viruses (CMV, HSV, EBV, HIV) |
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Retinoblastoma |
Autoimmune |
Fungi (Candida, Histoplasma, Cryptococcus, Aspergillus) |
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Leukemia and lymphoma |
Behcet's disease |
Parasites (Toxoplasma, Toxocara) |
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Metastases |
Vogt-Koyanagi-Harada Syndrome |
unknown |
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Malignant melanoma |
Sympathetic ophthalmia |
Sarcoidosis |
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Multiple nodular arteritis |
idiopathic 50% |
Pathological Classification:
a) Granulomatous:
It is an insidious onset, less pain and photophobia, larger corneal keratic precipitates (mutton fat; sheep fat), chronic course and poor prognosis.
In granulomatous uveitis, inflammatory cells may form clusters in the iris.
Clusters at the pupillary edge are called Koeppe nodules. If it is on the anteripr face of the iris They are called Busacca nodules.
Systemic diseases Systemic infections such as sarcoidosis, autoimmune diseases (MS), syphilis, Lyme and tuberculosis are the leading causes.
b) Non-granulomatous
It is a form with anterior segment involvement, acute course, pain, photophobia and redness are prominent, thin white keratic precipitates in the corneal endothelium, cells and proteins are seen in the anterior chamber, and the prognosis is better.
It is often idiopathic or occurs as a result of diseases related to HLA-B27 (ankylosing spondylitis, etc.), Behçet's disease, Fuchs Heterochromic Iridocyclitis, infections, etc.
Acute Iridocyclitis
It is the most common form of uveitis. (Iris + ciliary body inflammation) v The onset is sudden and nongranulomatous.
Eye pain, hyperemia, lacrimation, photophobia and blurred vision are present.
Cells that pass into the anterior chamber adhere to the corneal endothelium, causing keratic precipitation. Others collapse and level up. This is called a hypopyon.
Adhesions may occur between the iris and the lens and this is called synechia. There is the tindal phenomenon (cell infiltration and deposition of protein and fibrin in the anterior chamber).
Phacoantigenic Uveitis
It is formed by the deterioration of the permeability of the lens capsule, and by the protrusion of antigenic lens proteins out of the lens.
Fuchs uveitis syndrome (fuchs heterochromic iridocyclitis)
Heterochromic chronic non-granulomatous iridocyclitis.
Unilateral iris pigmentation reduction, keratic precipitates and secondary cataracts are seen.
Treatment in uveitis
The first option is topical steroids.
Cycloplegics and mydriatics are used to prevent posterior synechia.
Pilocarpine is contraindicated as it increases the possibility of synechia by causing miosis.
Sympathetic Ophthalmia
It is bilateral granulomatous panuveitis that occurs after injury or intraocular surgery (4-8 weeks).
In the terminology of the disease, the injured or surgical eye is called the sympathetic eye, and the other eye that is immunologically affected independent of this pathology is called the sympathize eye.
In prophylaxis, if the sympathizer eye is enucleated before the development of sympathetic ophthalmia, the other eye is saved.
After trauma to the sympathetic eye
o Iridocyclitis persists.
o There is a ciliary injection (congestion).
o There is lacrimation, pain.
Iris edema, optic neuropathy (papillitis), yellow-white nodules (Dalen-Fuchs nodules) may be seen.
If not treated, the patient may develop complicated cataract and secondary glaucoma.
If it is not taken under control, the eye is lost with phthisis bulbi.
High-dose topical and oral corticosteroid and periocular steroid injections are used in the treatment.
Uveal Tumors
• Malignant melanoma is the most common.
• It is most commonly located in the choroidea (unilateral).
