1. Uveitis

2. Uveitis

3. Uveitis Inflammation of the uveal tract

4. Uveitis is a sight threatening disorder, and may be associated with life threatening diseases. Uveitis can be caused by various ocular or systemic infectious, immunological, and malignant diseases.

5. Classification: Anatomical:
Anterior uveitis 75% : inflammation of the iris (iritis), and anterior part of the ciliary body (iridocyclitis).
Intermediate uveitis: inflammation of the ciliary body (cyclitis, pars planatis).
Posterior uveitis : inflammation behind ora serrata; inflammation of the choroid and retina (choroiditis, retinitis, chorio-retinitis, retinal vasculitis).
- Pan uveitis: inflammation of the entire uveal tract.

6. Clinical:
- Acute: sudden, short duration
Chronic: insidious, long duration, sometimes with exacerbation and remission
Recurrent: repeated episodes of uveitis separated by periods of inactivity without treatment.

7. Pathological classification: -Non granulomatous
Small keratic precipitate (KP) Endothelium dusting
-Granulomatous uveitis:
Large KP (muttan fat)
or median size KP Iris nodules Iris granuloma

8. Etiology: - Infections: Viral; CMV, Herpes virus
Bacteria; T.B., T. pallidum, M. leprae
Fungal; candidia
Parasite; toxoplasmosis. toxocara
-Non-infectious:
Systemic:
Arthrits; Ankylosing spondylitis,
Skin diseases: VKH, Behjet disease, Psoriasis
C.N.S. disorders: Multiple sclerosis
Respiratory diseases; Sarcodosis:
G.I.T. diseases: Ulcerative colitis
Genitourinary diseases : Reiter’s disease
Ocular:
Specific ocular; Fuch’s hetrochromic iridiocyclitis
Non-specific idiopathic

9. A- Infectious origin 92(28.9%)
Toxoplasmosis (16.4%)
Presumed Ocular Tuberculosis (8.8%)
Herpes simplex anterior uveitis (1.3%)
Herpes zoster anterior uveitis (0.6%)
Syphilis (0.6%)
Acute retinal necrosis (0.6%)
Presumed toxocarasis (0.3%)
CMV retinitis (0.3%)
B-Non-infectious (37.1%)
Systemic diseases (23.3%)
VKH (12.3%)
Behçet's disease (8.2%)
Ankylosing sponylitis (0.9%)
Juvenile idiopathic arthritis (0.6%)
Multiple sclerosis (0.6%)
Antiphospholipid Syndrome (0.3%)
Sarcodosis (0.3%)
Primary specific ocular disorders (13.8%)
Pars planitis (5.7%)
Punctate inner choroidopathy (1.6%)
Fuchs heterochromic iridocyclitis (1.6%)
Eales disease (1.3%)
Bird shot retinochoroidopathy (0.9 %)
Primary retinal vasculitis (0.9%)
Serpiginous choroidopathy (0.6%)
APMPPE* (0.6%)
Antiphospholipid syndrome (0.3%)
Sympathetic ophthalmitis (0.3%)
Non-specific idiopathic (34%)
Total

10. Anterior uveitis Symptoms: - Pain Photophobia Redness Lacrimation
Blurring of vision

11. Anterior uveitis Signs Reduced visual acuity (V.A.)
Circum-corneal congestion
Cornea: Keratic precipitate. KP: (aggregation of inflammatory cells
on the posterior surface of the endothelium)
small , endothelium dusting (non-granulomatous uveitis)
Large (muttan fat) (chronic, granulomatous uveitis)
Ant. Chamber: cells and flare ( increase protein in the aqueous)
hypopyon (aggregation of inflammatory cells at the
bottom of anterior chamber with fluid level)
Pupil: Miosed (constricted)
Irregular, posterior synechiae (adhesion between the iris and the lens),
Iris: Rubeosis ( iris neo-vascularization).
Iris atrophy (chronic)
Iris nodules and granuloma (chronic, granulomatous uveitis)
Intra-ocular pressure (IOP): may be normal, elevated or
depressed

12. Anterior uveitis
Signs
Reduced visual acuity (V.A.)

13. Circum-corneal congestion
Signs
Circum-corneal congestion

14. Keratic precipitate. KP:
Signs
Cornea:
Keratic precipitate. KP:
aggregation of inflammatory cells on the posterior
surface of the endothelium)
Small , endothelium dusting
(non-granulomatous uveitis)
Large (muttan fat) (chronic,
granulomatous uveitis)
Band keratopathy: deposition of calcium at
Bowmann’s layer

15. -flare ( increase protein in the aqueous)
Signs
Ant. Chamber:
- cells
-flare ( increase protein in the aqueous)
-hypopyon (aggregation ofinflammatory
cells at the bottom of anterior
chamber with fluid level)

16. Pupil: Miosed (constricted) Irregular, posterior synechiae
Signs
Pupil: Miosed (constricted)
Irregular, posterior synechiae
(adhesion between the iris and the lens),

17. Iris: Rubeosis ( iris neovascularization). Iris atrophy (chronic)
Signs
Iris: Rubeosis ( iris neovascularization).
Iris atrophy (chronic)
Iris nodules and granuloma
(granulomatous uveitis)

18. Intra-ocular pressure (IOP): may be normal, elevated or depressed
Signs
Intra-ocular pressure (IOP): may be normal, elevated or depressed

19. Ankylosing Spondylitits
Young adults
Male are affected more
Arthritis; axial skeleton
-sacroiliac joint and
intervertebral joints
90% positive HLA-B27
Acute, Recurrent,
non-granulomatous Anterior Uveitis

20. Juvenile idiopathic arthritis
Chronic arthritis
Age under16 years. Females are affected more commonly
Pauciarticular type (less than 5 joints are involved)
seronegative (for R.F.),
80% positive for ANA
Bilateral, Chronic, non-granulomatous Ant. Uveitis
painless,
Complications:
1- Cataract
2- Band keratopathy .

21. Intermediate uveitis: inflammation of the ciliary body (cyclitis, pars planatis).

22. Intermediate uveitis Symptoms
Floaters (moving shadows in the field of vision caused by vitreous opacities)
Blurring of vision

23. Intermediate Uveitis Signs: Vitreous: cells, snow-balls
No fundus lesions

24. Intermediate Uveitis Causes of intermidiate uveitis 1- Pars planatis:
Most common
Idiopathic
2- TB
3- Multiple sclerosis

25. Posterior uveitis: inflammation behind ora serrata, inflammation of the choroid and retina (choroiditis, retinitis, chorio-retinitis, retinal vasculitis). .

26. Posterior Uveitis Symptoms
Floaters (moving shadows in the field of vision caused by vitreous opacities)
Blurring of vision

27. Posterior uveitis Signs: Vitreous: cells, flare and opacities
fundus lesions may be focal, multi-focal, or geographical lesions
-Choroiditis; yellow, well demarcated patches
-Retinitis; white cloudy patches with indistinct margins
-Old inactive lesion appears as white well defined area of
chorio- retinal atrophy with pigmented borders
-Vasculitis; fluffy haziness surrounding blood columns
vascular sheathening

28. Toxoplasmosis
Toxoplasma gondii is an obligatory, intracellular protozoan parasite Acquired, congenital
- Vitritis.
Retinitis;
Active lesion: creamy-white lesion with indistinct margins
Inactive lesion: white well defined area of chorio- retinal atrophy with pigmented borders

29. Toxoplasmosis Treatment: Antiprotozoal drugs; Clindamycin,
sulphonamides
Steroids

30. Pan uveitis:
inflammation of the entire uveal tract.

31. Pan uveitis
Idiopathic, multisystem disease characterized by recurrent episodes of orogenital ulceration and vasculitis

32. Behçet syndrome Diagnosis:
   1    Recurrent oral ulceration characterized by painful minor or major aphthous lesions that have recurred at least three times in a 12-month period.    2    Plus at least two of the following:  
  •    Recurrent genital ulceration    •    Ocular inflammation.    •    Skin lesions include erythema nodosum, folliculitis, acneiform nodules    •    Positive pathergy test, cutaneous hypersensitivity, which is characterized by the formation of a pustule after 24–48 hours at the site of a sterile needle prick

33. Behjet’s disease Ocular features; Bilateral,
chronic with exacerbation and remission,
non- granulomatous
pan-uveitis
iridocyclitis
Vitritis
Retinitis
Vasculitis; venous occlusion,
neovascularization,

34. Behjet’s disease

35. Pan uveitis Vogt Koyanagi Harada (VKH)
Multi-systemic auto-immune disorder affect pigmented cells in the body. Involves CNS, eyes, and skin

36. Vogt Koyanagi Harada (VKH)
   - Neurological and auditory manifestations
Headache, Tinnitus    -  Integumentary findings, not preceding onset of central nervous system or ocular disease, such as alopecia, poliosis and vitiligo

37. Vogt Koyanagi Harada (VKH)
- Bilateral uveitis
Acute stage:
Multifocal serous detachment of
sensory retina
Bilateral exudative retinal detachment
Chronic stage:
Depigmentation of the fundus; Vitilligo
of the fundus
Dalen Fuchs atrophic spots

38. Presumed Tuberculous Uveitis
According to WHO:
About one third of the world's population, are infected by tuberculosis
10% of infected people are symptomatic
90% have latent TB
TB is endemic in Iraq
TB uveitis develops following hematogenous spread from a primary latent focus and usually occurs without evidence of systemic TB.

39. Presumed TB uveitis -Granulomatous anterior uveitis
Clinical signs include ;
-Granulomatous anterior uveitis
- Focal, multifocal choroiditis, choroidal granuloma,
- Retinal vasculitis.

41. Management of Uveitis:
1- Investigations: Aimed for determining the etiology.
Indications: chronic, recurrent, and granulomatous anterior uveitis
Intermidiate, posterior and pan-uveitis
2-Steriods:
Topical, Side effects of corticosteroids eye-drops:
Flare up of pre-existing eye infection
Predispose for microbial keratitis, e.g. viral keratitis.
Inhibit collagen synthesis of the cornea, and predispose for corneal thinning
Cataract (chronic use)
Open angle glaucoma (chronic use)
Periocular injections of steroids; used in severe ant. , Intermidiate, posterior uveitis
Systemic steroids; used in; severe anterior, Intermidiate uveitis, posterior uveitis
3- Mydriatics: -decrease pain by relieve ciliary muscles spasm
- prevent synechiae, break down synechiae
4- Anti-microbial drugs: in infectious types; Toxoplasmosis, Presumed TB uveitis.
5- Immunomodulator and/or Immunoppressive agents:
In bilateral, severe , vision threatening , steroid sparing, non-infectious
-Cyclosporin; T-cell immunosuppressive agent
-Methotrexate
- Azathioprine

42. Red Eye Symptoms Conjunctivitis Keratitis or corneal foreign body
Acute iritis
Acute Glaucoma
Vision
Not affected
depressed
Redness +
Pain
Foreign body sensation, itching
Pain localized to the eye
Severe pain radiating
Secretion
Watery, mucoid or purulent
watery
Photophobia
absent
mild
marked
Systemic
Sometimes, e.g. adenovirus
none-
50% associated with systemic disorders
Headache, nausea and vomiting

43. Signs
Conjunctivitis
Keratitis or
corneal foreign body
Acute iritis
Acute Glaucoma
Congestion
Conjunctival
Cicumcorneal
Cornea
normal
Ulceration or Suppuration
Keratitic precipitates
Oedema
Anterior chamber
Cells, Hypopyon
Shallow
Pupil
Constricted
Constricted, irregular
Fixed, mid-dilated
Tension
Normal
High, Normal, or Low
High