Download Posterior Uveitis

Posterior Uveitis
Mehmet Can ERATA
The Anatomy and Physiology of Uvea-1
 What is uvea?
 The uvea (Lat. Uva, grape), also called the uveal layer, coat,
tract or vascular tunic, is the pigmented middle of the three
concentric layers that make up of an eye. The uvea consists of
three parts (from front to back);
 Iris (Anterior uvea)
 Ciliary Body (Intermediate uvea)
 Choroid (Posterior uvea)
The Anatomy and Physiology of Uvea-2
 Iris (Anterior uvea): It separates anterior from posterior
chamber. It also changes the diameter of the pupilla.
 Ciliary Body (Intermediate uvea): It produces aqueous humor
and determines the focus of the eye via the lens.
 Choroid (Posterior uvea):The choroid provides oxygen and
nourishment to the outer layers of the retina so if it is somehow
affected, due to altered oxygenation, vision loss may also occur.
Posterior Uveitis (Choroiditis)
 As you would understand, choroiditis means the
inflammation of this middle pigmented and vascular layer of
the eye.
 Posterior uveitis is the rare form of the disorder BUT correct
and rapid diagnosis is very important as it is the type of
uveitis mostly associated with the loss of vision. The other
two forms are more common, and more frequently result in
acute symptoms, but only rarely cause vision loss.
Sign and Symptoms
 More subtle eye symptoms are important for the diagnosis as
it excludes anterior uveitis and makes us suspect from the
diagnosis. (which symptoms are; eye pain, redness, light
sensitivity and.). We don’t expect to see eye pain because
choroid is not innervated by pain fibers.
 Floaters, small pecks, flakes or clouds that move through the
field of vision and decreased and/or blurred vision.
Causes/Differential Diagnosis
Behçet’s Disease-1
Behçet's disease or Behçet disease, sometimes called Behçet's
syndrome, Morbus Behçet, Behçet-Adamantiades syndrome,or
Silk Road disease, is a rare(but very common in Turkey 20421/100.000) immune-mediated small-vessel systemic
vasculitis that often presents with mucous membrane
ulceration and ocular problems. Behçet's disease (BD) was
named in 1937 after the Turkish dermatologist Hulusi Behçet,
who first described the triple-symptom complex of recurrent
oral aphthous ulcers, genital ulcers, and uveitis.
Behçet’s Disease-2
 As a systemic disease, it can also involve visceral organs such
as the gastrointestinal tract, pulmonary, musculoskeletal,
cardiovascular and neurological systems. This syndrome can
be fatal due to ruptured vascular aneurysms or severe
neurological complications.
 Aside from other rheumatological disorders which causes
anterior uveitis, Behçet Syndrome ,as a cause of posterior
uveitis( as anterior and panuveitis) and major cause of
blindness in Turkey, should be very tightly followed up by
ophthalmology clinics.
Posterior Uveitis-Diagnosis
 Ophthalmoscopy; one or multiple choroiditis foci which are,
in acute phase confluent and white spots. As they heal, they
become yellow-brown and acquire more defined borders.
 It is suggested that only %60 per cent of cases are due to
problems that are intrinsic to the eye itself so underlying
autoimmune disorders and infections should also be
sought/excluded for the diagnosis.
Syphilis
Toxoplasmosis
Behçet’s Disease
Complications of Uveitis
Glaucoma( via iriditis)
Cataracts(via affecting the lens)
Cystoid Macular Oedema (swelling of the retina)
Detached Retina
Posterior Synechiae (iris sticking to the lens)
Posterior Uveitis-Treatment
 The treatment of underlying diagnosis is very important.
Posterior uveitis can be treated with either antibiotics or
steroids depending on the underlying etiology.
References
 http://behcet.medicine.ankara.edu.tr/?page_id=63
 http://rarediseases.org/rare-diseases/posterior-uveitis/
 http://www.allaboutvision.com/conditions/uveitis.htm
 Göz Hastalıkları- El Kitabı/Atlas- Gerhard K. Lang