Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU Uveitis Dr. Mervat El-Shabrawy Associate Prof. of Ophthalmology, FOM, SCU

- Inflammation of the uveal tract. Def. : - Inflammation of the uveal tract. Classifications : The 4 most useful classifications are :- (1) Anatomical : Anterior Uveitis Intermediate uveitis Posterior uveitis Diffuse uveitis Iritis Iridocyclitis

(2) Clinical : (3) Etiological : (4) Pathological : Cont. Acute Chronic Exogenous Endogenous Granulomatous Non-Granulomatous

Vogt-Koyanagi-Harada Irido-cyclitis Def. : - Inflammation of the iris & ciliary body. Etiology : A- Primary: Syndromes of Unknown etiology Infection: Allergy Constitutional Exogenous Bacterial Behcet’s Endogenous Non-bacterial Vogt-Koyanagi-Harada

N.B. Behcet syndrom: - Oral ulcerations. - Genital ulcerations. - Uveitis. Vogt-Koyanagi-Harada syndrom: - Alopecia. - Poliosis. - Vetiligo. - Uveitis

B- Secondary : Cornea Sclera Lens Retina I.O. tumors I.O.F.B R.D. Keratitis Scleritis Subluxation Or Dislocation

Pathology: 3 phases: 1) Vascular Phase: 2) Exudative Phase: - Dilatation & congestion of the blood vessels to bring more leucocytes. 2) Exudative Phase: - Exudation of inflamm. Fluids from dilated vessels. * The result of this exudation: a- Iris & ciliary body: - Edema of iris & C.B. - Loss of iris pattern - Pressure on the nerves - Spasm of ciliary muscles

- Keratic Precipitate (KPs): active & passive. b- Outside iris & C.B. : - Aquous flare. - Collection of exudates in: Angle, pupil, between iris & lens and behind lens. 3) Cellular Phase: - Keratic Precipitate (KPs): active & passive. - Lenticular Precipitates (LPs): - Vitrous opacities, Vitritis

Clinical Picture: usually recurrent. Symptoms: 1) Pain: Dull aching. Why??? -Nerves: Stretch & irritation of nerve ending. - Muscles: Spam of intrinsic muscles & C.M. - Glaucoma: Secondary.

Reflex irritation of the Cont. 2) Photophobia: 3) Lacrimation: 4) Blepharospasm: 5) Diminution of vision: Why??? - Corneal edema. - Aquous flare. - Pupillary memb. - Vitritis - Toxic maculopathy. - Hazziness of the lens. Reflex irritation of the 5th N. endings

Painful red eye with blurring of vision 2- Photophobia 3- Lacrimation 4- Blepharospasm 5- Diminution of vision 6- Redness of the eye

2) Conjunctiva: Conj. & ciliary injections. 3) Cornea: Edema & KPs. Cont. Signs: 1) Lid: Edema. 2) Conjunctiva: Conj. & ciliary injections. 3) Cornea: Edema & KPs. 4) Iris: Muddy. 5) Ciliarry body: Tender. 6) Anterior chamber: - Aquous flare. - Hypopon. - Hyphaema.

External examination Conjunctival injection The pattern of injection can provide useful diagnostic ideas. Clockwise from upper left: “ciliary flush” of intra-ocular inflammation, segmental scleritis of rheumatoid arthritis and other auto-immune diseases, gonococcal conjunctivitis, and contact lens irritation with lid reaction.

8) Lens: - Iris pigment on the capsule (LPs). 7) Pupil: - Constricted. - Irregular. - Sluggish reaction. 8) Lens: - Iris pigment on the capsule (LPs). 9) Intra ocular pressure: raised, 2ry glaucoma. 10) Vitrous: Vitritis. 11) Macula: Toxic maculopathy.

Complications: 1) Cornea: Deep keratitis. 2) Iris: - Post Synaechia. - Atrophy “late” 3) Angle: P.A.S. 4) Lens: Cataract. 5) Cyclitic memb. 6) Secondary glaucoma. 7) Retinitis, optic neuritis & toxic maculopathy. 8) Endophthalmitis or Panophthalmitis in sever cases

Differential Diagnosis: Acute iridocyclitis Acute cong. gl. Corneal ulcer Acute Conjunctivis Gradual Sudden Rapid Onset: - Dull ache. - Watery. - Diminished. - Bursting. - Marked - Pricking. - May be "if central" - Burning - Any type - Not affected Symptoms: - Pain: - Discharge: - Vision: - Edema. - Ciliary inject. - Edema, KPs - Flare, Hypopyon. - Muddy. - Constricted. - T++ - Usually normal. - Edema - Ciliary Inject - Shallow. - Bombē - T+++ - Difficult to be seen - +ve fluorescence. - Flare, hypopyn. - Normal or raised. - Normal - Conj. Injection. - Normal. Signs: - Lid: - Conj.: - Cornea: - A. Ch. - Iris: - Pupil: - Tension: - Fundus:

Investigations: Clinically Radiologically Laboratory

Treatment (1) Local: a) Atropine: - Internal eye rest. - Relaxation of the C.M. - Breaking fresh synaechia & dec. formation. b) Cortisone: - Anti-inflammatory. - Anti-Allergic. - Fibrinolytic. c) Hot Fomentation. d) Dark Glasses.

- In sever resistant cases - (2) General: a) Systemic cortisone: in sever cases. b) Systemic broad spectrum A.B.s. c) Analgesics & anti-inflammatory drugs. - In sever resistant cases - d) Cytotoxic drugs. e) Immunosuppressive drugs. (3) Causal TTT: (4) TTT of complications:

Posterior Uveitis - Choroiditis - Def. : - Inflammation of the choroid. Classification: Suppurative Non-suppurative Endophthalmitis Exudative Granulomatous Panophthalmitis

Panophthalmitis Endophthalmitis Def. - Inflamm. Of all tissues of the eye - Inflamm. Of the internal structures of the eye Def. - Perforated corneal ulcer, post intra-ocular op. & penetrating wounds Etiology: - General: Fever, malaise & headache. - Local: Pain, FTH & loss of vision - Lid: Edema & tender. - Conj. : Injection - Cornea: Cloudy & KPs. - A.Ch: Hypopyon. - Iris: Iritis: - Vision: No P.L. - Limitation of ocular motility - Proptosis. C/P: Symptoms: - Signs: - Atrophia bulbi. Spreading of infection. - Resolution with treatment. - Panophthalmitis. Fate:

Treatment: Endophthalmitis: Cont. Treatment: Endophthalmitis: a- Early cases: Anti-biotics, atropine & corticosteroids. b- Late cases: Evisceration. 2) Panophthalmitis: - Evisceration.

Sympathetic Ophthalmitis Def. : - Bilateral inflamm. Of the uveal tract. Etiology: Unclear. a) Allergic theory: b) Infective theory: c) Mixed theory:

- Signs & symptoms of iridocyclitis + trauma in the exciting eye. Cont. Clinical picture: - Signs & symptoms of iridocyclitis + trauma in the exciting eye. Complications: As iridocyclitis. Treatment: 1) Prophylactic: 2) Curative:

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