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

2. - 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

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

4. 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

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

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

7. 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

8. - 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

9. 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.

10. 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

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

12. 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.

13. 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.

14. 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.

15. 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

16. 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:

17. Investigations:
Clinically
Radiologically
Laboratory

18. 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.

19. - 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:

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

21. 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:

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

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

24. - 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:

25. Thank You