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Uveal Tract Diseases
UVEAL TRACT DISEASES
U-1 Associated anatomic structure
U-2 Uveitis
U-3 congenital anomaly & tumor
Ciliary body
lens
pupil
Zonule
retina
choroid
iris
sclera
U-1 Anatomy

anatomy: iris, ciliary body, choroid
 physiology:
vasular layer of the eye
blood supply and flow speed
retaining of the immunity cells is very easy
 similar to lymph node , “immune center”
 “antigen bank” : anterior & posterior uveal tract,
lens, vascular, pigment epithelium, optic nerve…
 the incidence of the immunity diseases ↑
 Inflammations (
uveitis) and uveal tumors
comprised the vast majority of diseases
affecting uveal tract
 Some
associated with systemic diseases
U.2. Uveitis
“Uveitis” denotes inflammation of the choroid
(choroiditis), ciliary body (intermediate uveitis),
or iris (iritis).
etiology
 1.infections: bacteria, virus, fungi,
parasites…
 2.non-infections
(1) exogenous: physical or chemical injury
allergic reactions to external antigens
(2) endogenous:
classification of uveitis
according to
anatomy location (clinical)
(1)anterior
(2)intermediate
(3)posterior
(4)panuveitis
cause of diseases : infections and noninfections
pathology : granulomatous and nongranulomatous
U.2-1. Anterior uveitis

most common, usually unilateral and acute in oneset
 Acute iritis and iridocyclitis
 last for two to six weeks . Some patients have only
one or two attacks in a lifetime, and others have
multiple episodes.
1.symptoms
(1) pain
(2) photophobia
(3) blurred vision
2.signs
(1)ciliary or mixed congestion
(2)aqueous flare: blood-aqueous barrier
high concentration of plasma proteins
Tyndall's sign
particularly severe hypopyon
(3) keratic precipitates (KP)
small ( dust, nongranulomatous); large
(mutton fat, granulomatous); pigment;
stellate ( translucency).
(4) Pupil may be small (miosis) or irregular
(5) iris nodule
Koeppe's nodules at iris margin
Busaca nodules at iris stroma
Berlin’s nodules in the anterior chamber angle
(6) Anterior or posterior synechiae
(7) corneal sensation
(8) intraocular pressure
Koeppe nodules
Multiple bussaca nodules
arrows (large) showing the ciliary congestion typical of acute anterior uveitis
Smaller arrows show areas of the iris adherent to the lens (posterior synechiae
differential diagnosis



(1)acute conjunctivitis
(2)acute angle-closure glaucoma
(3)keratitis
How can differentiate the
acute conjunctivitis from
acute angle-closure glaucoma,
and acute iridocyclitis

Table 1
acute conjunctivitis
acute iridocyclitis
acute angle-closure G.
incidence
extremely common
common
uncommon
discharge
moderate to copious
none
none
vision
no effect
slightly blurred
markedly blurred
pain
none
moderate
severe
Conjunctival more toward fornics
injection
mainly circumcorna
mainly circumcorna
cornea
clear
usually clear
steamy
pupil size
normal
small
moderately dilated and
fixed
pupilary light normal
response
poor
none
IOP
normal
elevated
normal
treatment of iridocyclitis
corticosteriods and cycloplegics:
topical therapy 0.1% dexamethasone;
1% prednisolone acetate,
or systemic therapy prednisone
homatropine 5%
 anti-prostaglandins : aspirin or indomethacine
 anti-infective therapy: virus, tuberculosis,

syphilis
 complications: secondary G; complicated
cataract.

U.2-2. Intermediate Uveitis

Also called pars planitis
 cause is unknown, infection, allergy, or autoimmunity?
 Commonly occurred in youth (late teens or
early adult years), often bilateral, men
commonly than women
Intermediate uveitis

Symptoms: floaters, blurred vision
pain, photophobia, and redness are usually absent
 Signs: vitritis vitreous condensates,free-floating as
“snowballs”
layered over the pars plana and ciliary body as
“snowbank”
 Comlications
cystoid macular edema,
retinal vasculitis
optic nerve head neovascularization
Macular edema

diagnosis and differentiation

treatment
posterior sub-Tenon injection of triamcinolone
oral prednisone
steroid-sparing agents
concurrent therapy for specific infectious cause
U.2-3. posterior uveitis

Include retinitis, choroiditis, retinal vasculitis,
and optic neuritis
 Most associated with some form of systemic
disease by infectious or noninfectious
posterior uveitis
symptoms
 floaters,
 reduced vision,
 scotomas
 Ocular injection: Redness of the eye is absent in conditions that
affect only the posterior segment. Thus, it is rare in
toxoplasmosis and absent in histoplasmosis.
 Pain: atypical, but can occur in endopthalmitis, posterior
scleritis and optic neuritis.
posterior uveitis
signs





Anterior uveitis: granulomatous
nongranulomatous
Vitritis : Vitreous opacity, cells may be seen with sliplamp microscope.
Morphology and location of lesions: retina, choroid,
optic nerve
Mode of onset: acute and sudden
slow and insidious
Trauma: history of trauma is important in patients with
uveitis to rule out intraocular foreign body
posterior uveitis

complications
detachment of the retina
 treatment
a) Corticosteroids
b) Concurrent therapy for specific infectious
cause
c) Vitrectomy
d) immunosuppressant
Female, 56 ys
Female, 31 ys
U.2-4 panuveitis ( diffuse uveitis)

Uniform cellular infiltration of both the anterior
and posterior segments
 Tuberculosis, sarcoidosis, syphilis, sympathetic
ophthalmia, Vogt-Koyanagi-Harada syndrome,
Behcet’s disease
Endophthalmitis
U.3.Some special types of uveitis
U.3-1.sympathetic ophthalmia
rare but devastating bilateral
granulomatous uveitis that comes on 10
days to many years following a perforating
eye injury.
 injured , or exciting eye becomes
inflamed first;
 the fellow, or sympathizing eye
secondarily
 interval : 2 weeks--2 years


symptoms photophobia,
redness,
blurred vision

signs diffused uveitis
Severely injured sightless eye is
enucleation within 10 days after injury

U.3-2.Vogt-Koyanagi-Harada syndrome






age: 30-50;
bilateral eyes;
pigment epithelial disturbance
acute or sub-acute
headache, meningitis, dysaudia, vitiligo, alopecia
-Koyanagi: anterior ; -Harada: posterior segment
treatment

In acute stage, ectrosis with a large dosage of
corticosteroid should be used, 2~3days intravenous
drop can almost inhibit choroidal exudation, then to
diminish dosage gradually, a week later to change to
oral administration; the method is to select intermittent
administrationwhich may lighten the reduction of
adrenocortical function, the lowering velocity should
be decided according to the ill state of each case after
careful observation, commonly till 3~6months to stop
administration;
White Choroidal Infiltrates (Arrow) Seen in VKH
Syndrome with Very Pink Optic Nerve Head
Localised Retinal Detachment
Total Retinal Detachment, Where Whole Retina is Grey in Colour
Scarring When Choroidal Granulomas Subside
vitiligo
U.3-3.Behcet’s disease
recurrent uveitis, bilateral eyes; orogenital
ulcerations and skin lesions,
age: 20-40 years, sex: male＞female
U.4-3-2.clinical featurs of Behce't disease
1.ocular
sign :
*posterior ( more common ): retinal vasculitis
hemorrhage ; edema; focal areas of retina necrosis;
ischemic optic neuropathy; complicated cataract,
secondary G. , and optic atrophy
*anterior: acute iritis or chronic ; iridocyclitis with a
transient hypopyon
 2.recurrent orogenital ulceration;
 3.multi-morpho lesions of the skin
 4.arthritis
 5.damage in the nerve system
Fig-U.8
U.3-4.acute retinal necrosis syndrome
U.4-4-2.clinical featurs of ARN
Herpes
simples virus
periorbit pain, scleritis, anterior uvitis
vitreous exudate
necrosis retinitis: multifocal yellow patches
from peripheral to posterior polar
active retinal vasculitis
after 4-6 weeks, 75% retinal detachment
Cytomegalovirus retinitis
prognosis of ARN
may be blindness due to retinal detachment
diagnosis and differential diagnosis
(1)clinical features
(2)laboratary examination
treatment of ARN
(1)acyclovir 5mg/kg /d in V. tid, 7-10 days
 (2)anti-coagulation agents: heparin
 (3)corticosteroids
 (4)laser photocoagulation
 (5)Chinese herbs

U.3-5.Fuch's heterochromic iridocyclitis
U.4-5-1.clinical features :
chronic, young or middle-aged, M＞F
(1)iris: diffuse atrophy;
(2)KP: fine, whiteness;
(3)light aqueous flare
(4)fundus: normal
(5)complicated cataract and secondary G.
U.4-5-2.treatment of the complications
Fuchs
U.4.congenital anomaly and tumors
of the Uveal tract
Iris Melanoma
Choroidal Melanoma
Choroidal naevus
Malignant Melanoma