Uvitis/ opthalomology

types of uvitis

1. Haneen Hassan Shaker Group A2 Alkindy college of medicine

2. Uveitis Definition: it is an inflammation of the uveal tract and adjacent structures, most probably the retina . Classification : - Anatomical. - Clinical. - Etiological.  

3. Anatomical Classification

4. Anatomical Classification 1- Anterior uveitis : which is subdivided into: a- Iritis : in which inflammation predominantly affects the iris. b- Iridocyclitis : in which both the iris and anterior part of the ciliary body are equally involved.

5. 2- Intermediate uveitis: I t is characterized by involvement predominantly of the posterior part of the ciliary body ,periphery of the retina and the vitreous .

6. 3- Posterior uveitis: involve the fundus posterior to the vitreous base: a . retinitis b . choroiditis c . vasculitis

7. 4- Pan uveitis: Involvement of the entire uveal tract .

8.   Clinical classification: 1 - Acute uveitis : usually has a sudden, symptomatic onset and persists for up to 3 months . If the inflammation recurs following the initial attack it is referred as recurrent acute uveitis. 2- Chronic uveitis : the onset is frequently insidious and may be asymptomatic. It usually persists for longer than 3 months . Acute or subacute exacerbations on chronic may occur .

9. Etiological classification : 1- Idiopathic : which forms more than 50% of cases of uveitis. 2- Associated with a systemic disease: a- ankylosing spodylitis , Reiter's syndrome, psoriatic arthritis and chronic juvenile arthritis . b- Inflammatory bowel disease: ulcerative colitis, Crohn's disease.. c- Nephritis . d- Non-infectious multi-system disease: sarcoidosis , Behçet's disease . e- Infectious systemic disease: e.g. TB, syphilis.. f- Diabetes . 3- Infections: a- Bacterial: tuberculosis. b- Fungal: Candidiasis. c- Viral: Herpes Zoster. 4- a- Protozoa: Toxoplasmosis. b-Nematodes : Toxocariasis

10. Clinical Features :   Anterior uveitis Symptoms: 1- Acute anterior uveitis: Photophobia, pain, redness , decreased visual acuity and lacrimation. In acute anterior Uveitis, the pain is due to spasm of ciliary muscle, and decrease visual acuity is due to turbidity of aqueous by inflammatory cells 2- Chronic anterior uveitis: asymptomatic until development of complications give rise to mild redness(during severe exacerbation) .

11. Complications of anterior uveitis : 1- Posterior synechiae : 2- Cataract.

12. 3- Glaucoma: inflammatory or secondary angle closure glaucoma. 4- Cyclitic membrane formation which leads to traction and then detachment of the Ciliary body which causing phthisis bulbi .

13. Intermediate Uveitis Symptoms: Initially, floaters (inflammatory cells in anterior vitreous) later , decreased visual acuity due to macular edema (due to associated vitritis ). Signs: Cellular infiltration of vitreous ( vitritis ).

14. Posterior uveitis Symptoms: 1- Floaters (due to cells and flare in the vitreous ). 2- Impairment of visual acuity. Signs: 1- Retinitis: ill-defined, focal, white, cloudy appearance of retina with obscuration of retinal vessels. 2- Vacuities: fluffy white haziness. 3- chorioditis : appear as yellow round nodule .

15. Special investigations for patients with uveitis: 1- X-Ray: - Sacroiliac joint (for ankylosing spondylitis). - Chest x-ray (for TB). - Skull calcification: toxoplasmosis. 2- Skin test: histoplasmosis , 3- Serum tests: ANA (Anti-Nuclear Antibodies) as in chronic juvenile arthritis, toxoplasmosis test (IFAT) and ELISA. 4- HLA-typing : for ankylosing spondylitis

16. Treatment: 1- Mydriatics : Short acting: Tropicamide Cyclopentolate # Both of previous drugs have mydriatic and cycloplegic effects by inhibiting the sphincter muscles of the iris and inhibition of Ciliary body muscles . Phenylnephrine (sympathetic agonist) Long acting: Atropine .

17. 2 - Steroids: - Topical steroids : only for anterior uveitis , because they do not reach therapeutic levels behind the lens. prednisolone acetate, Dexamethasone and betamethasone. Side effects of topical steroids (especially after prolonged use): a- Glaucoma. b- Cataract. c- Corneal complications: they are rare, e.g. bacterial and fungal keratitis and recurrence of herpes simplex keratitis. d- Systemic side effects.

18.   -\ Systemic steroids: prednisolone tablets 3- Immunosuppressive agents : Azathioprine and Methotrexate