ANATOMY AND CLINICAL COORELATIONS OF UVEAL TISSUE

1. UVEA- Layers, nerve supply vascular
supply, functions and clinical correlation
Moderator:- Presenters:-
Dr. Sanjeev Bhattarai Mr. Bipin Koirala
Ms. Anita Poudel
B.Optometry 19th Batch3/27/2018 1

2. Presentation Layout.
• Introduction
• Embryology of uveal tract
• Congenital anomalies of uveal tract.
• Iris :Anatomy and nerve supply
• Ciliary body: Anatomy and nerve supply
• Choroid: Anatomy
• Blood supply of uveal tracts
• Clinically applied aspects.
• Refrences3/27/2018 2

3. UVEA
• Derived from Latin word UVA which
means grapes
• Middle vascular coat of eye ball
• 3 parts Anterior to Posterior
1.IRIS
2.CILIARY BODY
3.CHOROID
• Structurally functionally and
developmentally indivisible structure
3/27/2018 3

4. Uveal Attachments:-
Uvea is firmly attached with sclera
especially at 3 sites..
1. Scleral spur
2. Exit point of vortex veins
3. Optic nerve
3/27/2018 4

5. Embryology of uvea
IRIS CILIARY BODY CHOROID
2.Sphincter/dilator:-
Neuroectoderm
3.Stroma and blood
vessels:-
Vascular layer of
mesenchyme at ant.
Region of optic cup.
1.Epithelia:-
Neuroectodermal
& convolution of
epithelium will give
ciliary processes
2.Stroma and blood
vessels:-
Vascular layer of
mesenchyme
surrounding the
optic cup.
1.Mainly derived from
the inner vascular
mesenchyme
surrounding optic
cup.
2.Melanocytes of
choroid are derived
from neural crest
cells..
1.Epithelia:-
Neuroectoderm
3/27/2018 5

6. Milestones in the development
of uvea
9th week of gestation Ciliary body begins to appear
12th week of gestation Sphincter pupillae appears
4th month of gestation Ciliary process fully formed
5th month of gestation Iris and choroid are formed
6th month of gestation Dilator muscle begins to
form and
Sphincter fully differentiated
Post natal period Dilator reaches adult
proportion by 5 year of age
3/27/2018 6

7. Coloboma (absence of tissue ) of uveal tract.
1. Typical coloboma
 It seen in inferonasal quadrant and
occurs typically due to incomplete
closure of embryonic fissure.
 It is of two types.
1.Complete coloboma 2. Incomplete Coloboma
3/27/2018 7

8. Complete coloboma Incomplete coloboma
Extends from pupil to
optic nerve with sectoral
gap occupying (1/8)
retina and uvea.
May involve iris alone, iris
and CB Or Iris CB and
partially choroid i.e doesn’t
reach optic nerve.
3/27/2018 8

9. 2. Atypical coloboma
 Seen in positions other than inferonasal quadrant.
 Incomplete in nature and not related to closure of
fetal fissure.
Typical vs Atypical coloboma in figure
TYPICAL COLOBOMA ATYPICAL COLOBOMA
3/27/2018 9

10. Congenital anomalies of uveal
tract
• Corectopia
a.Eccentrically placed pupil
b.A/w local eye condition like as
high myopia , ectopia lentis
3/27/2018 10

11. True vs pseudo
Polycoria????
• Polycoria
• Multiple openings seen in iris
• May be congenital a/w/a
acquired.
3/27/2018 11

12. • Aniridia
a. A.k.A iridermia
b. Absence of iris
c. May be both congenital a/w/a
acquired (penetrating trauma)
d. In congenital cases A/w
amblyopia ,nystagmus ( ) vision
3/27/2018 12

13. • Persistent pupillary m/m
a. Represents the reminant of
vascular sheath of lens.
b. Attached to colarette and also
might be found free floating in
AC or attached to anterior lens
surface.
Does PPM
affect
Vision??
3/27/2018 13

14. • Heterochromia of iris
a. Usually congenital anomaly in which variation in iris color
is seen & it can be acquired condition also.
b. 3 Types
Complete
heterochromia
Sectoral
heterochromia
(segmental)
Central
heterochromia
1.A.k.A heterochromia
iridium.
2.Color of one iris
completely differs
from another.
1. A.k.A
heterochromia
iridis
2. A part of iris has
different color
than remaining
part.
1.Central & peripheral
part of iris has
differing color
2.True color of iris
belongs to
peripheral part .3/27/2018 14

15. Complete
heterochromia
Sectoral
heterochromia
Central
heterochromia
Clinical figures in different heterochromia of iris
3/27/2018 15

16. • Derived from Greek word which
means Rainbow or colored halos.
• Anterior most part
• Dimensions:-
a. Diameter:-12mm
b. Circumference:- 38mm
• Pupil:- slightly below and nasally
placed with respect to center of iris
Average pupillary diameter is 3-4mm
-
IRIS:-
3/27/2018 16

17. IRIS CONTINUE………
• Macroscopic structure
1. Anterior surface
 Highly textured but in deeply
pigmented iris texture is masked by
pigments.
 Can be divided to ciliary and pupillary
parts by zig zag line called Collarette.
3/27/2018 17

18. Anterior surface contd..
 Collarette is nearly 1.6 mm away from pupillary
margin
 It is thickest region of IRIS (0.6mm)
 It represents attachment site of pupillary m/m
3/27/2018 18

19. .
Anterior surface continue…
Ciliary zone Pupillary zone
• Part b/w iris root and
colarette.
• Radial streaks.
• Crypts
1. Central crypts
2. Peripheral crypts
• Contraction furrows
• Part b/w colarette and
pupillary frill.
• Smooth & flat compared to
ciliary part.
• Pupillary frill is the fringe of
black pigment at pupillary
margin.
1. anterior end of optic cup.
2.well visualized during
pupillary miosis
3.forward extension of
posterior epithelia
3/27/2018 19

20. 2.Posterior surface
• Dark brown or black in color
• Smooth on naked eye view but has
furrows and folds on magnified view.
Folds and furrows in posterior
surface.
I. Schwalbe’s contraction folds
II. Schwalbe’s structural furrows
III. Circular furrows
IV. Pits3/27/2018 20

21. Microscopic structure of iris
• 4 layers anterior to posterior :-
Anterior limiting m/m
Stroma of iris
Anterior epithelium
Posterior pigmented epithelium3/27/2018 21

22. Microscopic Structure Contd..
Anterior Limiting layer
 Condensed part of stroma and connective tissue.
 Consists of fibroblasts and melanocytes.
 It is Absent in crypts and thin at furrows.
 Thickest at pupillary portion and peripheral ciliary part
3/27/2018 22

23. Contd….
 Fibroblasts forms a thin sheet of stellate cells
with interlacing processes extending root to
pupillary frill.
 3 Types of cellular junctions are found b/w cells.
a)Gap junction
b)Tight junction
c)Intermediate junction(zonulae
adherents)
3/27/2018 23

24. Microscopic contd..
 Iris stroma
1. Bulk of iris
2.Loose collagenous network with in
mucopolysaccharide ground
substances
3.Composed of
a) Sphincter pupillae
b) Dilator pupillae
c) Blood vessels and nerveS
d) Cellular elements3/27/2018 24

25. Sphincter pupillae:-
• Forms 1mm broad circular
band in the pupillary part
of iris.
• Lies deeply in stroma and
has 0.1-0.17 mm
thickness.
3/27/2018 25

26. Dilator pupillae
• Lies in posterior part of
stroma in the ciliary portion
of iris.
• Basal process of ant epithelia
gives rise to dilator muscle.
WHY DO CHILDREN
POORELY REACT TO
MYDRIATICS???3/27/2018 26

27. Mechanism of pupil constriction and dilation
• Parasympathetic control
SHORT
CILLIARY
NERVE
EWN
3RD CN
SUP..
DIVISON
INF .
DIVISON
BRANCH
TO
IO
MUSCLE
CILLIARY
GANGLION
SPHINCTER
PUPILLAE
&
CILLIARY
MUSCLE
PUPIL
CONSTRICT
3/27/2018 27

28. MECHANISM CONTD…
• Sympathetic control.
long
ciliary
nerve
Posterior
hypothalamus
Ciliospinal
center of
budge
Cervical
ganglion
Ophthalmic div.
of trigeminal
nerve
Ciliary
ganglion
Dilator
muscle
Pupil
dilates
3/27/2018 28

29. Blood vessels
• Bulk of iris stroma.
• Branches of circulus arteriosus
major.
• Some vessels are even branches
of anterior ciliary blood vessels
• Courses can be identified by
fluorescence angiography.
3/27/2018 29

30. BLOOD VESSELS CONTD..
• Endothelial cells are inter linked by two types of cellular
junctions :-
• Peculiarities of iris vessels:-
a)Tight junctions
b)Gap junctions
a)Absence of internal elastic lamina
but (muscularis +ce).
b)Non-fenestrated capillary
endothelium.
Beside this
pericyte cells are
also present
around the
endothelium
3/27/2018 30

31. Cellular elements..
• Melanocytes
 Oval shaped pigment granules.
• Fibroblasts
 Most common type of cells.
3/27/2018 31

32. Cellular elements contd..
• Clump cells
a. Large rounded cells.
b. Filled with pigments and inclusion
granules.
c. Usually found in pupillary part (around
sphincter muscle.
3/27/2018 32

33. • Mast cells
a) Posses villous process.
b) Filled with inclusion granules.
3/27/2018 33

34.  Anterior epithelial layer
a) Anterior continuation of pigmented epithelium
of ciliary body.
a) Lacks melanocytes.
 Posterior pigmented epithelium:-
a) Anterior continuation of non pigmented
epithelium of ciliary body.
b) Derived from the internal layer of optic cup.
3/27/2018 34

35. • Iridodialysis(coredialysis)
1. Condition in which iris tears away from
its attachment to CB
2. Occurs due to blunt trauma , penetrating
injury, complication of intraocular surgery,
cataract extraction etc.
3. Causes to form D- SHAPED pupil3/27/2018 35

36. • Iridodonesis
a)Vibration of iris during eye
movement.
b)A/w lens dislocation
subluxation , aphakia etc.
3/27/2018 36

37. • Ectropion uveae
a)Presence of iris pigment on
anterior iris surface.
b)May be congenital or may be a/w
neurofibromatosis and rubeosis
irides
c)At high risk of secondary
glaucoma.
How is it
different from
ectropion
pupillae????
3/27/2018 37

38. • Iris nodules
It is of two types:-
Koeppe’s nodules Busacca’s nodules
At margin of pupil At collarette and mid
periphery
Epithelioid cell + lymphocytes Inflammatory nodules
T.B,SARCOIDOSIS,
granulomatous uveitis
Granulomatous anterior
uveitis
Deposition of epithelioid cells
& mononuclear cells without
tissue destruction in iris.
3/27/2018 38

39. • Iris atrophy
1. Areas of degeneration of iris or even hole
in iris.
2. Usually seen in iridocyclitis.
3. Even distorted pupil might also be seen.
3/27/2018 39

40. • Iridotomy (corectomy).
a)Removal of a part of iris.
b)Commonly used in iris
melanoma & angle
closure glaucoma.
c) Nd-YAG laser is commonly
employed for this.
Is there any
difference b/w
Iridotomy and
Iridectomy??
3/27/2018 40

41. • Iris neovascularization (Rubeosis iridis)
 Medical condition in which new blood
vessels are seen in iris surface.
New vessels are superficial and fragile
leading to hyphema.
Usually occurs due to ischemic response.
3/27/2018 41

42. CILIARY BODY
3/27/2018 42

43. CILIARY BODY
• Middle part of uvea with
triangular shape in cut section.
• It is forward continuation of
choroid at oraserrata.
• Its anterior part contributes in the
formation of angle str.
3/27/2018 43

44. Pars plicata Pars plana
1.A.k.A corona cilliaris
2.It is ant 2mm part with ciliary
processes..
3.Ciliary muscle(+), ciliary
process for aqueous production
1.A.k.A orbicularis cilliaris
2.Remaining posterior smooth
part 3mm nasal 5mm temporal.
3.Viterous base gains attachment
in pars plana.
• Ciliary body can be divided into 2
parts:-
1. pars plana(1/3)
2.pars plicata(2/3)
3/27/2018 44

45. Figure showing pars plicata and pars plana
3/27/2018 45

46. Microscopic structure:-
• Microscopically 5 layers are present.
1.Supracilliary lamina
2. Stroma of ciliary body
3. Layer of pigmented epithelium
4. Layer of non pigmented epithelium
5.Internal limiting m/m3/27/2018 46

47. 1. Supra ciliary lamina
2. Stroma of ciliary body
a) Anterior condensed part of ciliary stroma.
b) presence of pigmented collagen.
c) It is anterior continuation of suprachoroidal
lamina.
d) Anteriorly continues to anterior limiting
m/m of iris.
a) Bulk of ciliary body.
b) Consists of vascular stroma , ciliary muscle
pigment cells, fibroblasts, collagens .
Stromal size
increases
with ageing.
3/27/2018 47

48. Stroma cont.…
I. Vascular stroma
a. Circulus arteriosus major lies just
in front of circular muscle.
b. Formed by anastomosis b/w
long posterior ciliary artery and
anterior ciliary artery sending
branches to iris and ciliary body.
II. Ciliary muscle(To be discussed later)3/27/2018 48

49. 3) Layer of pigmented epithelium.
 Forward continuation of RPE and anteriorly continues to
anterior pigmented epithelium of iris.
4) Layer of non pigmented epithelium.
 Forward continuation of sensory retina which stops at
oraserrata.
 Consists of cuboidal & columnar cells.
 Anteriorly continues to posterior epithelia of iris.
5) Internal limiting m/m.
 It is ant. Continuation of internal limiting m/m of retina
and lines the layer of non pigmented epithelium.
3/27/2018 49

50. Ciliary muscle
• Triangular shaped and occupies
outer part of ciliary body.
• Non striated muscle and
has 3 types of fibers.
• All 3 fibers helps in accommodation slackening suspensory
ligament.
a)Longitudinal fibers
b)Radial fibers
c)Circular fibers
3/27/2018 50

51. Longitudinal fibers Circular fibers Radial fibers
1.A.k.A Meridional
fiber.
2.Has tendinous
origin at scleral spur
and runs posteriorly
to insert into
Suprachoroidal
lamina.
3.Draws choroid
forward and also
helps in aqueous
outflow by opening
spaces of trabecular
meshwork.
1. Lies anterior and
in the inner part
of ciliary body .
2. Nearest to Lens
and parallel to
limbus.
3. And primarily
behaves as
sphincter.
1. Arises on midpoint
of ciliary body.
2. They are obliquely
placed becomes
continuous with
circular fibers.
3. Radial fibers also
acts as similarly as
circular fibers
3/27/2018 51

52. Nerve supply of ciliary muscle
• Ciliary muscle is supplied by parasympathetic system
from ciliary ganglion through short ciliary nerve.
• Small percent of nerve supply to ciliary muscle is also
contributed by sympathetic system supplying through
cervical ganglion and long ciliary nerve from cervical
sympathetic trunk.
• Sensory branches are supplied via nasociliary nerve wiz.
part of Ophthalmic division of trigeminal nerve supplying
Ciliary Muscle, cornea , iris.3/27/2018 52

53. Blood supply to ciliary muscle
Blood supply to anterior and
inner part is by major arterial
circle.
Blood supply to outer and
posterior part by intra muscular
arterial circle which is formed by
penetrating branches of anterior
ciliary artery.
3/27/2018 53

54. Flowchart description of nerve supply to ciliary body
Parasympathetic Sympathetic Sensory
EWN
3RD
CN
ACCESORY
GANGLION
SHORT
CILIARY
NERVE
CERVICAL
SYMPATHETIC
TRUNK
SUPERIOR
CERVICAL
GANGLION
CILIARY
BODY
LONG CILIARY
NERVE
LONG
CILIARY
NERVE
NASO
CILIARY
NERVE
TRIGEMINAL
GANGLION
3/27/2018 54

55. Ciliary process
 Whitish finger like projection
arising from pars plicata
 70-80 in number
 2mm length and 0.5mm
diameter.
 Highly vascular but lacks ciliary
muscle.
 Are site of aqueous production.3/27/2018 55

56. Ultra structure of ciliary process.
• Composed of 3 basic structures
1.Capillaries
network
2.Stroma of
ciliary process
It Occupies center part of processes.
Each capillary posses thin fenestrated endothelium
Endothelium is lined by basement along with mural
cells.
very thin
Separates capillary network from epithelium
Composed of mucopolysaccharides, protein
collagen fibers and wandering cells
3/27/2018 56

57. 3 . Two layers of epithelium:-
a. Outer pigmented epithelium.
b. Inner non pigmented epithelium.
 Arranged with apical surfaces in apposition.
 Outer pigmented epithelium has numerous melanin
granules.
 Inner non pigmented epithelium has mitochondria ,
zonulae occludents along with lateral surface
interdigitations creating
Blood aqueous barrier.
3/27/2018 57

58. Microscopic structures
• Ciliary process • Epithelial layers
3/27/2018 58

59. Blood aqueous barrier:-
• Formed by tight junction (ZO & ZA) between cells
of inner non pigmented epithelium of ciliary body.
• Non fenestrated capillary endothelium of iris also involved.
• It’s not an absolute barrier because small sized and even
water soluble may penetrate it at much slower rate eg.
Urea , glucose etc.
• Lipid solubility will highly increase substance penetration.
3/27/2018 59

60. • Cyclodialysis.
 It is the separation of ciliary body
from scleral spur attachment.
 Creates direct connection b/w AC
and supra choroidal space
 Due to separation of longitudinal
fibers from scleral spur.
 Can be viewed by Gonioscopy or
USG.
3/27/2018 60

61. Cycloplegia:-
 It is paralysis of ciliary muscle
 May occur due pharmacological cause or sometimes
due to trauma or certain conditions leading to ciliary
nerve damage.
 Anti-muscarinic agents or parasympatholytic drugs
causes pharmacological cycloplegia.
3/27/2018 61

62. Choroid
Choroid ,the Posterior most part of
the uveal tract
Extends from the optic disc to ora
serrata
The inner surface: smooth, brown
and lies in contact with RPE
The outer surface: rough and
attached to sclera
Thickness estimated to be 100
micrometer anteriorly and 220
micrometer posteriorly
Thickest at the macula
3/27/2018 62

63. 3/27/2018
63
 Choroid is tightly adherent to the optic disc.
 Loosely at points where vessels and nerves enter.
 Choroid is attached to the sclera by the strands of
connective tissue.
 It has the highest blood flow per unit wt of any
tissue in the body , about 20 to 30 times greater
than that of the retina.

64. 3/27/2018 64
Microscopic structure
It consists of four layers:-
1) Suprachoroidal lamina
(Lamina fusca)
2) Stroma of the choroid
3) Choriocapillaries
4) Bruch’s membrane
(Basal lamina or lamina vitrae)

65. 3/27/2018 65
1) Suprachoroidal lamina (lamina fusca)
 Made of condensed collagen fibres , melanocytes and
fibroblasts.
 Continues anteriorly with supraciliary lamina.
 Space between this m/m and sclera: suprachoroidal
space (contain long & short posterior ciliary arteries
and nerves).
 10 to 34 μmin thickness

66. 3/27/2018 66
 The lamellae runs from sclera
ant to choroid . They are
shorter posteriorly where they
are more adherent to each
other and to the sclera ,hence
the Detachment of choroid
takes place anterior to
equator

67. 2)Stroma of choroid
Consists of loose collagenous tissue with some elastic and
reticular tissue.
Stromal cells consists of:
 Melanocytes
 Fibrocytes
 Macrophages
 Mast cells
 Plasma cell
3/27/2018 67

68. Main bulk is formed by vessels & arranged in two layers:-
a. Haller’s layer:-outer layer of large vessels.
b. Sattler’s layer:- inner layer of medium vessels.
3/27/2018 68

69. 3) Choriocapilllaries
 Is fed by arterioles derived from
the short posterior ciliary artery
 Nourishes RPE & outer layers of
sensory retina
 Density greatest at macula
 Divided into non-overlapping
lobules
3/27/2018 69

70. 3/27/2018 70
Bruch’s membrane
 Innermost layer of choroid.
 Lies between choriocapillaries and pigment epithelium of
the retina.
 2 to 4 μm thickness.

71. 3/27/2018 71
Consists of five layers;
• Basement m/m of the RPE.
• An inner collagen layer.
• A middle elastic layer.
• An outer collagen layer.
• The basement m/m of the
choriocapillaris

72.  Drusens : Bruch's m/m
becomes thickened with
increasing and produces
hyaline excrescences.
• They are yellow deposits
between the RPE and Bruch's
m/m.
3/27/2018 72

73. 3/27/2018 73
• Choroidal thickness can be
visualized by EDI-OCT , SS-
OCT

74. 3/27/2018 74
 Diurnal fluctuation in CT , highest mean thickness
in 9Am and lowest in 5Pm.
 CT with defocus : is found to be thickened with
myopic defocus and become thinner with
hyperopic defocus

75. 3/27/2018 75
Gyrate atrophy
• Inborn error of amino acid
metabolism ( ornithine) ,
progressive patches of atrophy of
choroid and RPE
Pt. initially develops
• Nyctalopia
• Myopia
• followed by redn in peripheral vision
• Constriction of visual field
• Leading to the complete loss of at
around 4th, 5th decade of life

76. 3/27/2018 76
Choroideremia
• Rare chorioretinal dystrophy
• Male are predominantly affected due to
X-linked etiology
• Pts becomes symptomatic during 1st
decade of life
a) Nyctalopia
b) Progress to peripheral region
c) Sparing the central vision

77. Blood supply of the uvea
Long posterior ciliary artery.
Short ciliary arteries.
Anterior ciliary artery.
3/27/2018 77

78.  Short posterior ciliary artery:
Arise as two trunk from the
ophthalmic artery
Pierce the sclera round the optic nerve
Supply the choroid in
segmental manner
3/27/2018 78

79. Long posterior ciliary artery
Two in no(nasal and temporal)
Pierce sclera obliquely , run forward in the
suprachoroidal space to reach ciliary
muscle without giving any branch
They anastomose with each other and with
the ant.ciliary artery to give rise to the
branches which supply the ciliary body
3/27/2018 79

80. 3) Anterior ciliary arteries
Derived from muscular branch of ophthalmic
artery
7 in number: 2 each from arteries of SR, IR & MR,
1 from that of LR
Pass anteriorly in the episclera
Give branches to sclera, limbus & conjunctiva
Ultimately pierce the sclera near the limbus to
enter ciliary muscle
3/27/2018 80

81. Anastomose with two long posterior ciliary
arteries to form major arterial circle
Several Branches arise from major arterial circle
& supply ciliary process (one branch for each
process)
Many branches from major arterial circle run
radially through iris towards pupillary margin
Anastomose with each other to form minor
arterial circle3/27/2018 81

82. Venous drainage
1) Anterior ciliary veins
• Tributaries of muscular veins
• Carry blood only from ciliary muscle
• Smaller than corresponding arteries
2) Smaller veins from sclera
• Corresponds to scleral branches of the short
ciliary arteries
• Carry’s blood only from sclera and not from
choroid
3/27/2018 82

83. 3) Venae vorticosae (vortex veins or
posterior ciliary veins)
 Four in number (superior temporal, inferior
temporal, superior nasal and inferior nasal)
 Pierce sclera obliquely on each side of SR and IR
muscles about 6 mm behind the equator
-Drains blood from:
 Whole of choroid
 Receives small veins from ONH
 Small veins from retina
 From iris, ciliary process, ciliary muscle,
anterior part of choroid
3/27/2018 83

84. 3/27/2018 84

85. 3/27/2018 85
Two superior vortex veins open into superior ophthalmic vein
Two inferior vortex veins open into inferior ophthalmic
vein

86. 3/27/2018 86
 Occasionally highly myopic eyes have a vortex vein
called the Ciliovaginal vein , located in the posterior
pole , drains near or through the optic nerve

87. • Uveitis : Inflammation of the uveal tissue .
• SUN categorizes uveitis anatomically as:
Anterior uveitis: Inflammation of uveal tissue from
iris to ant. Part of ciliary , can further be subdivided as
 Iritis: predominantly iris
 Iridocyclitis : iris and pars plicata of CB
 Ant.cyclitis : predominantly pars plicata
3/27/2018 87

88. Fig . Anatomical classification of uveitis
3/27/2018 88

89. Intermediate uveitis : Pars plana and
peripheral part of retina and
underlying choroid
Posterior uveitis : Choroid
Panuveitis : Whole uveal tissue
3/27/2018 89

90. Symptoms
 Pain
 Photophobia
 Lacrimation
 Redness
 Blepharospasm
 Defective vision3/27/2018 90

91. Signs
3/27/2018 91
Ciliary injection :-

92.  Posterior synechiae and irregular pupil
3/27/2018 92

93.  KP : Deposits of inflammatory cells like
lymphocytes , plasma cells and macrophages
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94.  Hypopyon:-
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95. Miosis:-
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96. 3/27/2018 96
Complications
 Complicated cataract
 Secondary glaucoma
 Papillitis
 Band shaped keratopathy
 Phthisis bulbi

97. • Choroiditis
 Inflammation of choroid.
Choroiditis
Focal choroiditisMultifocal choroiditisDiffuse choroiditis
central juxta papillary
Ant.
peripheral Equatorial
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98. 3/27/2018 98
Aqueous cells
• Cell is the individual inflammatory
cell
• +nce of cell indicates the
inflammatory activity

99. 3/27/2018 99
Grade Cells in field
- Less than one cell
+/- One to five cells
+1 Six to fifteen
+2 Sixteen to twenty five
+3 Twenty six to fifty
+4 Greater than fifty
Tabular grading of aqueous cells

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Aqueous flare
 Haziness of normal clear fluid In the AC
 Represents the +nce of proteins due to
breakdown of the blood aqueous barrier

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 Flare may be clinically graded by using the slit lamp to
assess the visualization of iris and lens
Grade Description
0 No aqueous flare
+1 Faint (just detectable)
+2 Moderate flare with clear iris and lens
+3 Marked flare(iris and flare hazy)
+4 Intense flare(fibrin or plastic aqueous

102. Function of uvea
IRIS
 Equivalent to diaphragm of camera.
 It controls amount of light entering the eye.
 Contributes for the formation of Blood aqueous barrier.
 Helps in synthesis of Prostaglandins and Leukotrienes
which are the inflammatory mediators.
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103. Ciliary body
 Helps in aqueous humor production .
 Helps in maintenance of IOP.
 Muscles of ciliary body helps in accommodation.
 Ciliary body is also the site for synthesis of prostaglandins
and leukotrienes.
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104. 3/27/2018 104
Choroid
Supply the oxygen , metabolites to the outer retina ,
RPE , possibly the prelaminar portion of the optic nerve.
Only the source of metabolic exchange for the avascular
fovea.
High metabolism of the outer retina generates heat and
choroidal blood flow may act as a sink.
Choroid contains melanocytes that improves the optical
func.by absorbing scattered light , may indirectly
protect against the oxidative stress

105. References:-
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106. 3/27/2018 106

107. Best wishes for
MR.GAURI SHANKER SHRESTHA
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