Presentation about uveitis

1. UVEA
Dr GOPI KRISHNA
ASSISTANT PROFESSOR
MS OPHTHAL
PHACO FELLOW.

2. UVEA
• Middle vascular coat of eye ball
• 3 parts
• Iris ,ciliary body and choroid

3. IRIS
• Anterior most part of uvea
• 3-4 mm aperture called pupil which regulates amount of light
reaching retina
• It divides space between cornea and lens into AC and PC

6. Macroscopic structure of Iris
Anterior surface divided into ciliary zone and pupillary zone by
collarette
1.Ciliary zone:
series of radial streaks d/t underlying blood vessels,crypts –
superficial layer of Iris is missing .
Peripheral and central crypts
2.Pupillary zone :
 part between collarette and pigmentation frill
 Smooth and flat

7. Microscopic structure of iris
• Anterior to posterior
• Anterior limiting layer
• Iris stroma
• Anterior epithelial layer
• Posterior pigment epithelial layer

8. Anterior limiting layer
• Anterior most condensed part of stroma
• Melanocyte’s and fibroblasts
• Deficient in crypts areas
• Colour of IRIS depends on this layer
• Blue iris –thin pigmentation
• Brown iris- thick

9. Iris stroma
• Loose collagen network.
• Sphincter pupillae,dilator
pupillae,vessels,nerves,pigments,lymphocytes,macrophages,mast
cells,fibroblasts.
• Sphincter pupillae-pupillary zone of iris,Parasympathetic nerve supply,
1mm circular band ,constricts pupil.
• Dilator pupillae – posterior part of stroma in ciliary zone ,cervical
sympathetic supply -dilates pupil.

10. Anterior epithelial layer
• Gives rise to dilator pupillae muscle
• Anterior continuation of pigment epithelium of retina and ciliary body

11. Posterior pigmented epithelial layer
• Anterior continuation of NPE of ciliary body
• At pupillary border it continues anterior pigment epithelial layer

12. Ciliary body
• Forward continuation of choroid at Ora serrata
• Cs – triangular in shape
• Anterior – part of AC and PC
• Middle – Iris is attached
• Outer side – lies against sclera with suprachoroidaal space in between
• Inner side – 2 parts , anterior part has ciliary process 2mm ( pars
plicata),posterior part smooth pars plana 4 mm
• Function: aqueous humour production,ciliary muscle help in
accommodation

13. 1. Supra ciliary lamina:
• outermost condensed stroma.
• Pigmented collagen fibres.
• Anteriorly continues with anterior limiting membrane of
iris,Posteriorly continues as suprachoroidal lamina.

14. 2. Stroma:
• Collagen and fibroblast’s ,
Ciliary muscle,vessels,nerves,pigments.
• Ciliary muscle: Non striated muscle ,
Cut section triangular in shape
Longitudinal/ meridonial fibres – helps in aqueous flow
Circular fibres – accommodation.
Radial / oblique fibres – aqueousflow.
• Nerve supply - parasympathetic fibres through short ciliary nerve.

15. CILIARY BODY

16. 3. Pigment epithelium:
• anteriorly continued with pigment epithelium layer of iris
• Posterior continued from retinal pigment epithelium’s
4.Non pigment epithelium :
Anteriorly continued as posterior pigment layer of iris,posteriorly
extended from neurosensory retina
5. Internal limiting membrane:
• Extended from internal limiting membrane of retina,lines non
pigmented epithelial layer.

17. Ciliary process
• Finger like projection’s from pars plicata
• 70-80 in number, 2 mm long 0.5 mm diameter
• White in colour
• Lined by two epithelial layers ,core contains blood vessels and
connective tissue
• Site of aqueous production

18. Choroid

19. Choroid
• Posterior most part of vascular coat of eye ball
• Extends from optic disc to Ora serrata
• Inner surface lies in contact with RPE of retina
• Outer lies in contact with sclera

20. Microscopic structure of choroid
1. Suprachoroidal lamina
2. Stroma
3. Basal lamina

21. 1. Suprachoroidal lamina:
 Thin membrane of condensed collagen ,melanocytes,fibroblasts
Anterior extension as supra ciliary lamina
Space between sclera and membrane is suprachoroidal space(long
and short posterior ciliary nerves)

22. 2. Stroma:
Loose collagenous tissue,elastic and reticular fibres,pigment
cells,plasma cells.
 Out to in
Layer of large vessels(hailers layer)
Layer of medium vessel’s (sattles layer)
Layer of choriocapillaries (nourish outer retina).

23. 3.Basal lamina
 Bruchs membrane
Lines layers of choriocapillaries
Approximate with RPE of retina

24. Blood supply of choroid

25. POSTERIOR RETINAL
ARTERY
OPHTHALMIC ARTERY
INTERNAL CAROTID ARTERY
CENTRAL
RETINAL ARTERY
MUSCULAR ARTERY
SHORT POSTERIOR
CILIARY ARTERY
LONG POSTERIOR
CILIARY ARTERY

27. Blood supply to uvea
• 3 sets of arteries supply blood to UVEA
1.SHORT POSTERIOR CILIARY ARTERY :
 Two trunks from ophthalmic artery .
10 -20 branches from each trunk,pierces sclera around Optic nerve and supply
choroid in a segmental manner.
2.LONG POSTERIOR CILIARY ARTERY:
 Two in number,nasal and temporal
Pierce sclera obliquely on medial and lateral side of optic nerve and run in
suprachoroidal space to reach ciliary muscle.

28. At the end of ciliarymuscle these 2 branches anastomose with each other and also with
anterior ciliary arteries and gives supply to ciliary body.
3. Anterior ciliary artery:
Derived from muscular artery which are 7 in number.
MR -2,SR -2 ,IR -2 ,LR -1 .
These muscular arteries pass anteriorly in to episclera ,give branches to sclera
,limbus,conjuctiva,and pierce the sclera near limbus to enter ciliary muscle.
At ciliary muscle they anastomose with two long posterior ciliary arteries to form
CIRCULUS ARTERIOSUS MAJOR near root of iris.
Branches from circular arteriosus major supply ciliary process
Many branches from circular arteriosus major run radially through Iris towards pupil
where they anastomose with each other and form CIRCULUS ARTERIOSUS MINOR.

30. Venous drainage
• Drain blood from iris,choroid ,ciliary body to form Vortex veins
• Vortex veins are 4 superotemporal,inferotemporal,superonasal,inferonasal
• Pierce sclera behind equator and drain into superior and inferior ophthalmic
veins which inturn drain into cavernous sinus.

31. EMBRYOLOGY

32. IRIS
• Both layers of epithelium are derived from marginal region of optic
cup (neuroectoderm).
• Sphincter and dilator pupillae –anterior epithelium (neuroectoderm)
• Stroma and vessels –mesoderm.

33. Ciliary body
• Both epithelium from neuroectoderm.
• Ciliaryprocess from ciliary epithelium.
• Stroma and blood vessels-mesoderm.

34. Choroid
• Inner vascular layer of mesenchyme that surrounds the optic cup.

35. Milestones
• 9th week gestation –ciliary body appears
• 12th week gestation-sphincter pupillae
• 5th month-all layers of choroid are seen,iris fully developed
• 6th month-dilator muscle begins to develop,sphincter muscle fully
developed
• Post natal period- dilator muscle fully developed by 5 yrs,Iris stromal
pigment develops after birth.

36. Congenital anamolies of uveal tract
• Heterochromia iris
 Heterochromia iridium- colour of one iris differs from other iris.
Heterochromia iridis- one sector different from other sector.
Congenital vs acquired ??

38. THANK YOU