1. Uveal Diseases Umut Aslı Dinç., MD., FEBO
Associate Professor in Ophthalmology
Yeditepe University Eye Hospital

2. Uveal Tract Pigmented, vascular structure
that lies between the sclera&retina
Consists of:
İris
Ciliary body
Choroid

3. Uveal Tract
Supplies most of the ocular vasculature through the anterior and posterior ciliary branches of ophthalmic artery.
Produces aqeous humor
Controls accomodation at near
Supplies aqeous outflow by trabecular meshwork

4. Uveitis Inflammation of the uveal tract and adjacent structures.
Mostly the cause is unknown.

5. Uveitis Classification
Anterior uveitis (iris and ciliary body)
Iritis, anterior cyclitis, iridocyclitis
Intermediate uveitis (pars plana of ciliary body, anterior vitreus and peripheral retina)
Posterior cyclitis, pars planitis
Posterior uveitis (choroid)
Choroiditis, chorioretinits
Panuveitis

6. Uveitis Classification
Acute uveitis
Chronic uveitis

7. Acute Uveitis-Clinical Features
Pain
Redness
Photophia
Epiphora
Blurred vision
Floaters

8. Chronic Uveitis-Clinical Features
Fewer or none of the acute symptoms
Periods of exacerbations and remissions

9. Causes of Uveitis Idiopathic
Infectious (bacterial, viral, fungal, parasitic)
Traumatic
Post-surgery
Tuberculosis
Sarcoidosis
Behçet’s disease
Spondiloartropathies
Inflammatory bowel diseases
Collagen vascular diseases
Medication

10. History taking in uveitis
Present illness
Onset, course, symptoms, laterality
Past ocular history
Previous episodes, treatment, ocular trauma or surgery
Medical history
Systemic disease (sarcoidosis, tuberculosis,
syphilis, Juvenile rheumatoid artritis, AIDS, etc),
maternal infection
Sexual history, intravenous drug abuse
Demograhic data
Age, sex, race

11. History taking in uveitis
Review of symptoms
General-fever, weight loss, malaise, night sweats
Rheumatologic-arthralgias, lower back pain, joint sitffness
Dermatologic-rashes, sores, alopecia, vitiligo, poliosis, insect bites
Neurologic-tinnitus, headache, meningism, paresthesias, weaksness/paralysis
GIS- diarrhea, bloody stools, aphtous ulcers
GUS-dysuria, discharge, genital ulcers, balanitis

12. Uveitis-Clinical Features
Inflammatory cells in the anterior chamber
Keratic precipitates on corneal endothelium
Anterior synechiae (adhesions of iris to cornea)
Posterior synechiae (adhesions of iris to lens)
Inflammatory cells in the vitreous cavity (vitritis)
Sheating of retinal vessels
Optic disc or macular edema
Choroidal or chorioretinal infiltrates

13. Anterior Uveitis
Anterior segment cells
Anterior segment flare

14. Anterior Uveitis Scleral injection Keratic precipitates on corneal
endothelium

15. Anterior Uveitis
Posterior synechiae

16. Anterior Uveitis Idiopathic
Infectious (Herpetic uveitis, Bacteriel uveitis)
Traumatic
Fuch’s heterochromic iridocyclitis
Immune-mediated
Behçet’s disease
Seronegative spondiloartropathies
(Ankylosing Spondylitis, Reactive (Reiter) Arthritis, Psoriatic Arthritis )
Inflammatory bowel diseases (Crohn disease, ulcerative colitis)
Juvenile Rheumatoid Arthritis
Sarcoidosis
Tuberculosis
Toxic (Rifabutin, sulfonamides, cidofovir)

17. Idiopathic anterior uveitis
Most common form of ocular inflammation
No systemic or ocular cause
Relief with topical steroids and cycloplegic drops

18. Fuch’s heterochromic iridocyclitis
Unilateral
Heterochromia (lighter iris color is typical)
Vision loss secondary glaucoma and cataract

19. Fuch’s heterochromic iridocyclitis
Heterochromia due to iris atrophy

20. Herpetic uveitis
Keratitis
Iris atrophy

21. Herpetic zoster uveitis

22. Behçet’s disease Key features Uveitis (anterior, posterior)
Recurrent oral ulcers
Recurrent genital ulcers
Skin lesions
Associated features
Erythema nodosum
Arthritis
İntestinal ulcers
Vascular lesions-thrombophlebitis, arteriel occlusions, aneurysms
CNS involvement

23. Behçet’s disease
HLA-B51
Pathergy test +

24. Seronegative spondiloartropathies
HLA B27 +
Sacroiliac joint radiography

25. Juvenile Rheumathoid Arthritis
Most frequently in RF (-), ANA (+), oligoarticular type
White eye
Band keratopathy
Posterior synechiae
Cataract

26. Sarcoidosis Noncaseating granuloma Anterior and posterior uveitis
Bilateral hilar lymphadenopathy
Pulmonary parenchymal disease
Chest radiography
Serum ACE enzyme

27. Sarcoidosis
Granulomatous reaction with iris nodules and mutton fat keratic precipitates

28. Tuberculosis Caseating granuloma Anterior and posterior uveitis
Chronic inflammation
PPD test
Chest Radiography

29. Tuberculosis
Granulomatous reaction with iris nodules and mutton fat keratic precipitates

30. Intermediate Uveitis Blurred vision and floaters Typically bilateral
Vision loss secondary to cystoid macular edema
Pars planitis... idiopathic type

31. Intermediate Uveitis Vitreous snowballs
Snowbanking (exudation at pars plana)

32. Intermediate Uveitis
Perivascular sheating
Vitreous snowball

33. Posterior Uveitis Vitritis Choroiditis Retinitis Papillitis
Retinal detachment

34. Posterior Uveitis Viral (CMV, VZV, HIV in immunodeficiency) Bacterial
Fungal (candida albicans, histoplasma capsulatum, coccidioides immitis)
Toxoplasmosis
Parasitic (toxocariasis, cysticercosis, onchocerciasis)
Syphilis
Behçet’s disease
Sarcoidosis
Tuberculosis

35. Viral Posterior Uveitis
CMV chorioretinitis

36. Viral Posterior Uveitis
Acute retinal necrosis secondary to HSV infection

37. Viral Posterior Uveitis
HIV chorioretinitis

38. Fungal Posterior Uveitis
Ocular candidiasis

39. Toxoplasmosis Toxoplasma gondii
Transmission by infected raw meat or congenitally via plasenta
Recurrent chorioretinitis and severe vitritis
Toxoplasma IgM, IgG and PCR

40. Congenital Toxoplasmosis
Nonactive chorioretinal scars

41. Toxoplasmosis
“Headlight in fog”

42. Toxocariasis Typical toxocara granuloma Traction of macula, optic disc
Tx: steroids
Severe inflammation when microorganism dies.

43. Sarcoidosis

44. Tuberculosis
Choroidal tubercule

45. Behçet’s disease

46. Syphilis
Usually in acquired syphilis
VDRL, RPR, FTA-ABs+

47. Anti-inflammatory Therapy
Corticosteroids
Topical drops/ periocular injection/ systemic)
Cytotoxic drugs
Antimetabolites (azathioprine, methotrexate)
Alkylating agents (cyclophoshamide, chlorambucil)
Immunomodulator agents (cyclosporin, tacrolimus)
Anti-TNF agents (etanercept, infliximab, adalimumab)

48. Complications of Uveitis
Band keratopathy
Posterior synechiae
Cataract
Glaucoma
Cystoid macular edema
Optic atrophy