www.ophthalclass.blogspot.com has the complete class on uveitis for undergraduate medical students. This presentation is the third in the series and deals with the sequelae and complications of uveitis.

1. Sequelae and complications
of uveitis
DR. ANUPAMA KARANTH
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2. Uveitis
 Fourth leading cause of blindness in the developed
countries
 Complications
Cataract

Glaucoma

Cystoid macular edema

Hypotony

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3. Uveitis
 Inflammation in the uveal tract
 Exudation and cellular infiltration
Iris

Ciliary body

Choroid / retina

 Consequences
Organization of exudates

Fibroblastic activity

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4. Sequelae
 Iris
 Ciliary body
 Lens
 Vitreous
 Choroid / Retina
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5. Iris
 Organization of exudates
Adhesions –Synechiae

Fibrous membranes

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6. Synechiae
 Pupil to lens
Posterior synechiae

 Peripheral iris to cornea
Peripheral anterior synechiae (PAS)

 Posterior surface iris to lens capsule
Total posterior synechiae

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7. Synechiae
 Pupil to lens
 Posterior synechiae
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8. Synechiae
 Pupil to lens
 Posterior synechiae
 Festooned pupil
 360 degrees of posterior synechiae – seclusio pupillae /ring or
annular synechiae
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9. Synechiae
 Peripheral iris to cornea
 Peripheral anterior synechiae (PAS)
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10. Synechiae
 Peripheral iris to cornea
 Peripheral anterior synechiae (PAS)
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11. Synechiae
 Posterior surface iris to lens capsule
 Total posterior synechiae
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12. Posterior synechiae
Entire pupil
Posterior Seclusio
border to lens
synechiae pupillae
(360deg)
Peripheral iris
pushed to Iris bombé Pupil block
cornea
Secondary
angle closure
glaucoma
Iris bombé: ballooning of iris, shallow anterior chamber www.ophthalclass.blogspot.com

13. Iris bombé
Iris bombé: ballooning of iris, shallow anterior chamber www.ophthalclass.blogspot.com

14. Peripheral anterior synechiae
Peripheral Closure of
anterior trabecular
synechiae meshwork
Secondary Block to
angle aqueous
closure drainage
Gonioscopy to visualize angle in every case of uveitis www.ophthalclass.blogspot.com

15. Sequelae…
 Extensive exudation in iris and ciliary body
 ‘Plastic’ iridocyclitis
 Organizes into membranes
Pupil

Retrolental space

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16. Fibrous membranes
 Pupil
 Occlusio pupillae
 Pupil block
 Secondary angle closure glaucoma
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17. Fibrous membranes
 Retrolental space
Cyclitic membrane

Posterior lens, vitreous base and pars plicata

Hypotony

Retinal detachment

Ciliary body atrophy and shrunken eye

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18. Pupil in iridocylitis
 Miotic
 Posterior synechiae
 Festooned pupil
 Seclusio pupillae
 Occlusio pupillae
 Ectropion uveae
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19. Ectropion uveae
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20. Lens
 Iris pigments on lens surface
 Posterior subcapsular cataract
Inflammation and corticosteroid use

Complicated cataract

Breadcrumb appearance

Polychromatic lustre

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21. Lens pigments and cataract
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22. Vitreous in uveitis
 Exudates get organized
 Vitreous membranes, contraction
 Traction on retina
Tractional retinal detachment

Retinal tears and rhegmatogenous retinal detachment

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23. Choroid and retina
 Destruction of retinal pigment epithelium (RPE) and
Bruch’s membrane
Chorioretinal atrophic patch

White of sclera seen through

 Fibroblastic activity
Chorioretinal adhesion

RPE proliferation at edges – pigmented scars

Choroidal neovascular membranes

 Permanent scotomas
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24. Complications
Cataract

Glaucoma

Hypotony

Cystoid macular edema

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25. Causes of glaucoma
 Closed angle
Posterior synechiae

Peripheral anterior synechiae

 Open angle
Cells and protein blockage of trabecular meshwork

Trabeculitis

Corticosteroid induced

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26. Causes of hypotony
 Acute inflammation of ciliary body - temporary
hyposecretion
 Chronic ciliary body damage – permanent hypotony
 Ciliary body traction from a cyclitic membrane
Hypotony more dangerous in chronic uveitis than glaucoma www.ophthalclass.blogspot.com

27. Hypotony – phthisis bulbi (LE)
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28. Cystoid macular edema
 Inflammatory mediators reach the macula
 Common cause of visual loss in uveitis
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29. End stage of inflammatory eye diseases
 Atrophy with shrinkage
Small globe

Structures still recognizable

ATROPHIC BULBI

Eg. Chronic long standing uveitis

 Atrophy with shrinkage and disorganization
Small globe

Structures unrecognizable

PHTHISIS BULBI

Eg. Purulent endophthalmitis

Irreversible blindness www.ophthalclass.blogspot.com

30. Phthisis bulbi
 Clinically, any globe which is
Sightless

Shrunken

Shapeless (‘squared-off’)

Soft

 Associations
Dystrophic calcification eg. band keratopathy

Intraocular ossification

Risk of intraocular malignancy

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