uvea Flashcards
what is uvea
pigmented middle layer of the eyeball
ciliary body, iris, choroid
what is the iris
The iris of the eye is the thin, circular structure made of connective tissue and muscle that surrounds the pupil.
what is ciliary body
The second part of the uvea is the ciliary body. It surrounds the iris and cannot be seen because it’s located behind the opaque sclera (white of the eye).
what is synechia
parts of the iris adhere to the back surface of the cornea or the front of the lens.
why is synechia dangerous
can lead to certain types of glaucoma
causes of synechia
trauma to the eye, iritis or other causes
what is iris coloboma
congenital disorder where a portion of normal iris tissue is missing, causing a misshapen “keyhole” or “cat-eye” appearance to the pupil.
symptoms of iris coloboma
blurred vision, decreased visual acuity, double vision and ghost images.
what do some people with iris coloboma do
prosthetic contact lenses to improve the appearance of the eye and decrease any visual symptoms.
what is uveal melanoma
cancerous growth within the iris, ciliary body or choroid.
what is choroidal nevus
flat, benign pigmented freckle in the choroid.
what is choroideremia
degeneration of the choroid that primarily affects men.
characteristics of choroideremia
night blindness, decreased visual field and (eventually) blindness.
what is iris nevus
freckle (localized concentration of pigment) in the iris of the eye
types of uveitis
anterior - Iris
Ciliary body
posterior - vitreous body, choroid or retina
causes of uveitis
1) infections
- herpes simplex
- herpes zoster virus
- cytomegalovirus
- toxoplasmosis.
Less common
- histoplasmosis
- Lyme disease, syphilis, toxocariasis
- tuberculosis.
fungal
- Aspergillus
- Candida
2) systemic inflammatory disease
- Seronegative spondyloarthropathies (ankylosing spondylitis
- juvenile rheumatoid arthritis, - Reiter’s syndrome, or inflammatory bowel disease).
- Behçet’s disease.
- Sarcoidosis.
- Psoriatic arthropathy.
- Multiple sclerosis.
3) trauma
4) Neoplasia
symptoms of anterior uveitis
- having a red eye with or without pain
- pupil may be irregular and small
- being very sensitive to bright light
- having blurry vision
- seeing “floaters” (specks or moving clouds in your vision) all of a sudden
- no discharge
- red eye - ocular hyperemia
- lacrimation
- ciliary flush
- hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
risk factors of uveitis
personal history of uveitis
aged over 20
HLA-B27
Complications of uveitis
vision loss
visual impairment
paediatric uveitis
- Band keratopathy (calcium deposits in the cornea).
- Cataract (secondary to the disease process or corticosteroid treatment).
- Glaucoma (secondary to the disease process or corticosteroid treatment).
- Cystoid macular oedema (the most common cause of visual impairment in people with uveitis).
- Posterior synechiae (adhesions between the posterior iris and the anterior lens surface).
- Hypotony (low intraocular pressure).
- Macular cyst/hole, macular puckering or macular ischaemia.
- Retinal detachment (exudative and tractional) or retinal scars.
- Choroidal and retinal neovascularization.
- Optic neuropathy or optic atrophy.
- Vitreous opacities and vitreous haemorrhage.
- Phthisis (shrinkage of the globe).
DD for uveitis
acute glaucoma - headache, pain in eye, blurring of vision
Keratitis — presents with a unilateral, painful, photophobic, injected eye.
Scleritis — characterized by severe pain that is worse with eye movement. It is usually associated with headache.
Ocular trauma — for example penetrating eye injury, or embedded foreign body, or acid or alkali burns to the eye.
Ocular ischaemia syndrome
conjunctivitis
superficial corneal injury
subconjunctival haemorrhage
management for non-infectious uveitis
Corticosteroids are used to reduce inflammation and prevent adhesions in the eye
topical ant uveitis
periocular or intraocular - post iveitis
A cycloplegic-mydriatic drug (for example cyclopentolate 1% or atropine 1%) may also be given to paralyse the ciliary body.
This relieves pain and prevents adhesions between the iris and lens.
People with severe or chronic uveitis may also be given systemic immunosuppressive drugs (for example, methotrexate or mycophenolate),
management for infectious uveitis
antimicrobial drug as well as corticosteroids and cycloplegics.
causes of anterior uveitis
Majority of cases are idiopathic.
Often associated with noninfectious systemic conditions:
- Seronegative
- spondyloarthropathies
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Sarcoidosis
- Inflammatory bowel disease
- HLA-B27-associated conditions (e.g., ankylosing spondylitis)
- Behçet disease
- SLE
Infectious causes
- HSV and VZV.
causes of posterior uveitis
Viruses (CMV, EBV, rubella, HSV, VZV) Syphilis Tuberculosis Toxoplasmosis Histoplasmosis Cat-scratch disease (unilateral) Lyme disease
Noninfectious causes include Behçet disease, SLE, IBD, granulomatosis with polyangiitis, and polyarteritis nodosa.
clinical features of post uveitis
Painless visual disturbances
- Floaters/scotomata
- Decreased visual acuity (blurry vision
diagnostics of ant uveitis
Slit lamp examination
- Leukocytes in the anterior chamber
- flare (Protein) in the aqueous humor → vitreous haze
- Keratic precipitates (WBC) on the back of the cornea
- Signs of inflammation of the iris (e.g., red eye, hypopyon)
Conjunctival smear and cytology if infectious cause is suspected
Tonometry
Further workup of any suspected underlying systemic condition
diagnostics of post uveitis
Ophthalmoscopic examination
- Leukocytes in the vitreous humor and vitreous opacity
- Foci of inflammation of the choroid and/or retina
Further workup of any suspected underlying systemic condition
complications of ant uveitis
Cataract
Secondary glaucoma
Posterior synechia
Anterior synechia
complications of post uveitis
Visual field loss due to scarring
Major loss of visual acuity, if macula is affected
recurrent uveitis what do u do
Investigations
CXR, lumbar XR,
autoimmune serology, HLA B27
Bilateral cases or severe cases
► Treatment
- Mydriatic / cycloplegics to
break synechiae, comfort
- Topical steroids, depending
on severity, initally can be ½
hourly - May need sub conjunctival
steroid if very severe
