This document discusses various types of uveitis including classification, signs, symptoms, complications, investigations, and treatments. It covers infective causes like toxoplasmosis, tuberculosis, syphilis, and fungal infections. It also discusses immune-mediated uveitis associated with conditions like VKH syndrome, Behcet's disease, and sarcoidosis. Intermediate uveitis is characterized by inflammation of the pars plana, peripheral retina, and choroid. Posterior uveitis involves the retina and choroid and can be caused by infections, autoimmune diseases, or unknown etiologies.

1. BY
DR. VIJAY PRATAP SINGH
MLB MC , JHANSI

2. Uveitis
Term uveitis strictly means inflammation of uveal
tissue only. However, clinically there is always some
associated inflammation of the adjacent structure
such as
 Retina
 Vitreous
 Sclera
 Cornea

3. CLASSIFICATION OF UVEITIS

4.  Infective uveitis
 Immune related uveitis
 Toxic uveitis
 Traumatic uveitis
 Uveitis a/w non-infective systemic diseases.
 Idiopathic uveitis

5. Intermediate uveitis
 Inflamation of pars plana ,peripheral retina, choroid
and vitreous base.
-Account for 10% of all uveitis
-Bimodal distribution
 Etiology –
-Idiopathic (HLA-DR2) 85%
-Known cause(15%) TB, Syphilis, Sarcoidosis and Lyme
disease.

6. Sign
 Ant. Segment sign- looks normal but may be show
- Low grade flare and cell
- Few KP’s d/t spill over ant. Uveitis
- Late stage- lens show complicated cataract.
 Post. Segment sign.-
- Vitreouse cell
- Snow ball or cotton ball opacities near ora serrate
- Sever vitreouse opacification – may be leucocoria

7. Complication
 Complicated cataract
 CME
 Secondary glaucoma
 Vitreouse haemorrhage.
 Tractional RD
 Band keratopathy
Tx-
 Periocular or systemic steroid
 Immunosuppressive drugs
 Cryotherapy or indirect laser photocoagulation
 Pars plana vitrectomy

8. POSTERIOR UVEITIS is Inflammation of retina or choroid
posterior to vitreous base.
Choroiditis
Chorioretinitis
Retinochoroiditis
Retinal vasculitis
Neuroretinitis

9. Infective causes

10. Non infective causes

11. Symptoms
 CHOROIDITIS is a painless condition but visual
symptoms d/t vitreouse haze and retinal involvement
 Visual symptoms
Defective vision
Photopsia
Floaters
Metamorphosia
Micropsia
Macropsia
Positive scotoma

12. Sign
 Ant. Segment sign-
Usually there is no external sign, however fine KP’s
may be seen
 Vitreouse opacities-
It is mainly d/t choroiditis
Choroiditis may be
Focal
Diffuse and
Multifocal

13. Choroidal patches
 Active patches
Pale yellow or dirty white
raised area with ill-defined
edge.
 Healed patches-
Sharply defined from the
rest of normal area d/t
atrophy of choroidal tissue

14. Approch to uveitis

16. SLE
 Diagnostic criteria-
Malar rash
Serositis
Arthritis etc.
Choroidopathy: Fundus examination may reveal multiple serous
retinal detachments, retinal pigment epithelium detachments
and a central serous chorioretinopathy
Retinopathy: It typically occurs bilaterally but may be unilateral
or asymmetric. The most common findings include cotton-wool
spots and hemorrhages. Less common findings include hard
exudates, retinal edema, visual acuity loss or metamorphopsia,
and vascular tortuosity.
Specific tests- Anti nuclear Ab Assay.

17. SARCOIDOSIS
 Ant seg- sarcoid granulomas, iris nodules
 Post seg- vitritis, periphlebitis, snow balls
 Diagnosis-
X-ray chest
Hypercalcemia
Serum ACE
Ga scan
Biopsy

18. Ocular sarcoidosis
 (A) Large iris nodules;
 (B) nodular involvement of the trabecular meshwork
 (C) snowballs Periphlebitis in sarcoidosis.
 (D) Periphlebitis with involvement of the optic nerve
head
 (E) occlusive periphlebitis and disc oedema;
 (F) ‘candlewax’ drippings

19. Choroidal and retinal involvement in sarcoidosis.
 (A) Small peripheral choroidal granulomas;
 (B) confluent choroidal infiltrates;
 (C) multifocal choroiditis;
 (D) multiple small retinal granulomas.
Dx- CXR, Serum ACE, Biopsy.
Tx- Depend on severity, topical/periocular/systemic
steroid can be used.

20. HSV, VZV
 Immunosuppressed patients
 Hutchinson’s sign.
 Reduced corneal sensations
 Sectoral atrophy of iris.
 Peripheral retinal periarteritis.
 ARN- retinal necrosis in periphery which rapidly
spreads.
 PORN- rapidly progressive visual loss.
 Full thickness necrosis and early macular involvement.
 PCR based assay.

21. CMV Retinitis
 Usually a/w Pt. suffuering
from AIDS, on cytotoxic
chemotherapy or long term
immunosuppression.
 Ant. Segment sign- KP’s may
be seen.
 Post. Segment sign-
Haemorragic retinitis
Granular retinitis
Tx-
-HAART.
-Ganciclovir, valaganciclovir,
foscarnet and cidofovir

22. TOXOPLASMOSIS
 Congenital toxoplasmosis.
 Acquired toxoplasmosis.
 Toxoplasmosis in the immunocompromised host.
 Ocular toxoplasmosis.

23. Congenital toxoplasmosis.
The classic clinical triad
 Retinochoroiditis.

 Cerebral calcifications.
 Convulsions.

24. OCULAR TOXOPLASMOSIS
 Ocular Toxoplasmosis is the most common cause of
Posterior uveitis,
The lesions develop in deep retina, few to no vitreous
cells may be present (Headlight in fog)
 It frequently presents as a focal necrotizing retinitis,
adjacent to a larger, atrophic chorioretinal scar,often
located in macula in congenital cases.

25. The hallmark of the disease is a necrotizing
Retinochoroiditis, which may be
Primary or
Recurrent
- In primary ocular toxoplasmosis, a unilateral
focus of necrotizing retinitis is present at the posterior
pole in more than 50% of cases
-The area of necrosis usually involves the inner layers of
the retina and is described as a whitish fluffy lesion
surrounded by retinal edema

26. Recurrent ocular toxoplasmosis
 TOXOPLASMOSIS With reactivation of live tissue
cysts ,the areas of newly active necrotizing retinitis are
usually adjacent to old scars (so-called satellite
lesions).
 In some patients, multiple grayish white dots at the
level of the retinal pigment epithelium (RPE) appear.
No associated vitreous reaction occurs with this
manifestation.
 Macular edema may be seen.

27. Complication of ocular Toxoplsmosis
 Optic neuritis or papallitis a/w edema k/a Jensen
disease.
 PVD & Tractional RD.
 Retinal vasculitis.
 Granulomatous or Nongranulomatous anterior uveitis.
 Retinal ischemia
 Neovascularization of the retina & Optic disc.
 Secondary glaucoma.
 Optic atrophy.
 BRVO & BRAO
 CME or CNVM (rare & late sequel).

28. Investigation
LABORATORY STUDIES- Serology
 Serum antitoxoplasma antibody titers
 Enzyme-linked immunosorbent assay (ELISA)
 Indirect fluorescent antibody test
 Indirect hemagglutination test
 Complement fixation
 Sabin-Feldman dye test
IMAGING STUDIES-
Fluorescein angiography (FFA)
Indocyanine green (ICG)
B-SCAN

29. Treatment-
 TRIMETHOPRIM AND SULFAMETHOXAZOLE with Para-
aminobenzoic acid (PABA).
 Pyrimethamine (Daraprim) with oral folinic acid.
 Clindamycin, spiramycin, tetracyclines, atovaquone,
azithromycin and clarithromycin.
 Topical steroids
 Photocoagulation or cryotherapy & Pars plana vitrectomy
are surgical option

30. OCULAR TOXOCARIASIS
 Intestinal roundworm.
 Young children
 Almost U/L
 Clinically p/w-
- Chronic toxocara endophthalmitis (leucocoria)
- Post pole / peripheral granuloma
 Dx-ELISA, USG, CT scan.
 Tx- Sub-Tenon steroid, pars plana vitrectomy

31. Syphilitic uveitis
 It may occur disseminated, peripheral or diffuse
choroiditis.
 Dx- Confirmed by
FTA-ABS blood test
TPI test
VDRL tes
 Tx- usual uveitic Tx + Systemic penicillin or other
antisyhilitic drugs

32. Tubecular uveitis
 Common cause in developing countries.
 Clinical presentations-
A) Ant. Uveitis
B) Post. Uveitis -Multiple miliary
tubercal in choroid
-Douse or multifocal choroiditis.
-Choroidal garanuloma.
C) Vasculitis (Eales’ disease).
 Dx- Clinical based + skin test +
Isoniazid response test
 Tx- Chemotherapy with (R+Z)+ Usual
Tx of uveitis

33. Fungal uveitis
PRESUMED OCULAR
HISTOPLASMOSIS SYNDROME
More common in endemic area
Clinical features-
Histospot-
Atrophic scar scattered in mid-retinal
periphery
Macular histospot-
Atrophic macular scar f/b a hole in
Bruch’s membrane
Tx-
a) Systemic steroids in active macular
lesions
b) Laser photocoagulation in
subretinal neovacular membrane
c) Anti-VEGF

34. Ocular candidiasis
Opportunistic infection in pt.
suffering from AIDS
Cause multifocal chorioretinits.
 Multiple small, round, whitish
area a/w area of haemorrages
with pale center(Roth’s spot).
 Tx-
Topical cycloplegics &
antifungal
Systemic antifungal.
Pars plana vitrectomy

35. HLA associated uveitis
Behcet’s Disease-
A/w HLA-B51
 B/L ,acute recurrent iridocyclitis a/w hypopyon
 Also a/w post. Uveitis, vitritis, periphlebitis retinae and
retinitis .
Tx-
 Corticosteroid
 Immunosuppressive drugs

36. Vogt–Koyanagi–Harada syndrome
 VKH syndrome is an idiopathic multisystem autoimmune
disease featuring inflammation of melanocyte-containing
tissues such as the uvea, ear and meninges. a/w HLA-
DR4/DW15
 Post. Uveitis lesion includes
- Multifocal choroidits
- Exudative RD
- Choroidal depigmentation(sun glow fundus)
- Dalen-fuch’s nodules
- Peripheral choroidal granuloma
Tx-Corticosteroid and immunosuppressive drugs