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Uveal Diseases
Umut Aslı Dinç., MD., FEBO
Associate Professor in Ophthalmology
Yeditepe University Eye Hospital
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Uveal Tract
Pigmented, vascular structure
that lies between the sclera&retina
Consists of:
 İris
 Ciliary body
 Choroid
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Uveal Tract
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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
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Uveitis
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Inflammation of the uveal tract and adjacent
structures.
Mostly the cause is unknown.
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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
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Uveitis Classification
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Acute uveitis
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Chronic uveitis
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Acute Uveitis-Clinical Features
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Pain
Redness
Photophia
Epiphora
Blurred vision
Floaters
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Chronic Uveitis-Clinical Features
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Fewer or none of the acute symptoms
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Periods of exacerbations and remissions
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Causes of Uveitis
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Idiopathic
Infectious (bacterial, viral, fungal, parasitic)
Traumatic
Post-surgery
Tuberculosis
Sarcoidosis
Behçet’s disease
Spondiloartropathies
Inflammatory bowel diseases
Collagen vascular diseases
Medication
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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
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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
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Uveitis-Clinical Features
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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
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Anterior Uveitis
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Anterior segment cells
Anterior segment flare
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Anterior Uveitis
Scleral injection
Keratic precipitates on corneal
endothelium
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Anterior Uveitis
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Posterior synechiae
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Anterior Uveitis
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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
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Sarcoidosis
Tuberculosis
Toxic (Rifabutin, sulfonamides, cidofovir)
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Idiopathic anterior uveitis
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Most common form of ocular inflammation
No systemic or ocular cause
Relief with topical steroids and cycloplegic drops
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Fuch’s heterochromic iridocyclitis
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Unilateral
Heterochromia (lighter iris color is typical)
Vision loss secondary glaucoma and cataract
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Fuch’s heterochromic iridocyclitis
Heterochromia due to iris atrophy
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Herpetic uveitis
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Keratitis
Iris atrophy
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Herpetic zoster uveitis
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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
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Behçet’s disease
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HLA-B51
Pathergy test +
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Seronegative spondiloartropathies
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HLA B27 +
Sacroiliac joint radiography
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Juvenile Rheumathoid Arthritis
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Most frequently in RF (-), ANA (+),
oligoarticular type
White eye
Band keratopathy
Posterior synechiae
Cataract
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Sarcoidosis
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Noncaseating granuloma
Anterior and posterior uveitis
Bilateral hilar lymphadenopathy
Pulmonary parenchymal disease
Chest radiography
Serum ACE enzyme
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Sarcoidosis
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Granulomatous reaction with iris nodules and mutton fat
keratic precipitates
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Tuberculosis
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Caseating granuloma
Anterior and posterior uveitis
Chronic inflammation
PPD test
Chest Radiography
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Tuberculosis
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Granulomatous reaction with iris nodules and mutton fat
keratic precipitates
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Intermediate Uveitis
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Blurred vision and floaters
Typically bilateral
Vision loss secondary to
cystoid macular edema
Pars planitis... idiopathic
type
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Intermediate Uveitis
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Vitreous snowballs
Snowbanking (exudation at pars plana)
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Intermediate Uveitis
Perivascular sheating
Vitreous snowball
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Posterior Uveitis
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Vitritis
Choroiditis
Retinitis
Papillitis
Retinal detachment
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Posterior Uveitis
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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
Syphilis
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Viral Posterior Uveitis
CMV chorioretinitis
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Viral Posterior Uveitis
Acute retinal necrosis secondary to HSV infection
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Viral Posterior Uveitis
HIV chorioretinitis
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Fungal Posterior Uveitis
Ocular candidiasis
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Toxoplasmosis
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Toxoplasma gondii
Transmission by infected raw meat or
congenitally via plasenta
Recurrent chorioretinitis and severe vitritis
Toxoplasma IgM, IgG and PCR
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Congenital Toxoplasmosis
Nonactive chorioretinal scars
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Toxoplasmosis
“Headlight in fog”
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Toxocariasis
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Typical toxocara granuloma
Traction of macula, optic disc
Tx: steroids
Severe inflammation when microorganism dies.
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Sarcoidosis
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Tuberculosis
Choroidal tubercule
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Behçet’s disease
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Syphilis
Usually in acquired syphilis
VDRL, RPR, FTA-ABs+
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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)
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Complications of Uveitis
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Band keratopathy
Posterior synechiae
Cataract
Glaucoma
Cystoid macular edema
Optic atrophy
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