Uveitis refers to inflammation of the uveal tract of the eye. It can be caused by infections, autoimmune disorders, or malignancies. Uveitis is classified anatomically by the area of inflammation - anterior, intermediate, posterior, or panuveitis. It is also classified clinically based on duration and course. Anterior uveitis presents with pain, photophobia, redness, and blurred vision. Signs include cells and flare in the anterior chamber, keratic precipitates, and iris lesions. Intermediate uveitis affects the vitreous and peripheral retina. Posterior uveitis causes floaters and fundus lesions. Management involves identifying the etiology, using topical and systemic st

1. Uveitis
DR GOPI KRISHNA
MS OPHTALMOLOGY
PHACO FELLOW
ASSITANT PROFESSOR

2. Uveitis

3. Uveitis
Inflammation of the uveal tract

4. Uveitis is a sight threatening disorder, and may be
associated with life threatening diseases.
Uveitis can be caused by various ocular or systemic
infectious, immunological, and malignant diseases.

5. Classification:
• Anatomical:
- Anterior uveitis 75% : inflammation of
the iris (iritis), and anterior part of the
ciliary body (iridocyclitis).
- Intermediate uveitis: inflammation of
the ciliary body (cyclitis, pars
planatis).
- Posterior uveitis : inflammation
behind ora serrata; inflammation of
the choroid and retina (choroiditis,
retinitis, chorio-retinitis, retinal
vasculitis).
- Pan uveitis: inflammation of the entire
uveal tract.

6. • Clinical:
- Acute: sudden, short duration
- Chronic: insidious, long duration,
sometimes with exacerbation and remission
- Recurrent: repeated episodes of uveitis
separated by periods of inactivity without
treatment.

7. • Pathological classification:
• suppurative / purulent -polymorphonuclear cells
,purulent exudates.
• Staphylococcus strepto,pneumo.gonococci
• Non suppurative
 Non granulomatous - blood aqueous barrier break
down due to physical and toxic insult
- fibrinous exudate,lymphocytes,macrophages,plasma
cells.
-

8. • Small and medium sized fine kps seen in non
granulomatous.

9. Granulomatous uveitis:
• Chronic inflammation,proliferation in nature.
• Nonpyogenic,non virulent,inorganic or
organic,haemorrhage,necrotic tissue.
• Tb,leprosy,syphilis,brucellosis,leptospira,viral,protoz
oal.

10. • Infiltration of lymphocyte,proliferation of large
mononuclear epitheloid and giant cells aggregates to
iris nodules,mutton fat kps.

11. Etiology:
- Infections: Viral; CMV, Herpes virus
Bacteria; T.B., T. pallidum, M. leprae
Fungal; candidia
Parasite; toxoplasmosis. toxocara
-Non-infectious:
Systemic:
Arthrits; Ankylosing spondylitis,
Skin diseases: VKH, Behjet disease, Psoriasis
C.N.S. disorders: Multiple sclerosis
Respiratory diseases; Sarcodosis:
G.I.T. diseases: Ulcerative colitis
Genitourinary diseases : Reiter’s disease
Ocular:
Specific ocular; Fuch’s hetrochromic iridiocyclitis
Non-specific idiopathic

12. • Trauma
• Toxic
 endotoxins,exogenous toxins,endo ocular toxins.

13. A- Infectious origin 92(28.9%)
Toxoplasmosis 52 (16.4%)
Presumed Ocular Tuberculosis 28 (8.8%)
Herpes simplex anterior uveitis 4 (1.3%)
Herpes zoster anterior uveitis 2 (0.6%)
Syphilis 2 (0.6%)
Acute retinal necrosis 2 (0.6%)
Presumed toxocarasis 1 (0.3%)
CMV retinitis 1 (0.3%)
B-Non-infectious 118 (37.1%)
Systemic diseases 74 (23.3%)
VKH 39 (12.3%)
Behçet's disease 26 (8.2%)
Ankylosing sponylitis 3 (0.9%)
Juvenile idiopathic arthritis 2 (0.6%)
Multiple sclerosis 2 (0.6%)
Antiphospholipid Syndrome 1 (0.3%)
Sarcodosis 1 (0.3%)
Primary specific ocular disorders 44 (13.8%)
Pars planitis 18 (5.7%)
Punctate inner choroidopathy 5 (1.6%)
Fuchs heterochromic iridocyclitis 5 (1.6%)
Eales disease 4 (1.3%)
Bird shot retinochoroidopathy 3 (0.9 %)
Primary retinal vasculitis 3 (0.9%)
Serpiginous choroidopathy 2 (0.6%)
APMPPE* 2 (0.6%)
Antiphospholipid syndrome 1 (0.3%)
Sympathetic ophthalmitis 1 (0.3%)
Non-specific idiopathic 108 (34%)
Total 318

14. Anterior uveitis
Symptoms:
- Pain
- Photophobia
- Redness
- Lacrimation
- Blurring of vision

15. Anterior uveitis
Signs
- Reduced visual acuity (V.A.)
- Circum-corneal congestion
- Cornea: Keratic precipitate. KP: (aggregation of inflammatory cells
on the posterior surface of the endothelium)
small , endothelium dusting (non-granulomatous uveitis)
Large (muttan fat) (chronic, granulomatous uveitis)
- Ant. Chamber: cells and flare ( increase protein in the aqueous)
hypopyon (aggregation of inflammatory cells at the
bottom of anterior chamber with fluid level)
- Pupil: Miosed (constricted)
Irregular, posterior synechiae (adhesion between the iris and the lens),
- Iris: Rubeosis ( iris neo-vascularization).
Iris atrophy (chronic)
Iris nodules and granuloma (chronic, granulomatous uveitis)
- Intra-ocular pressure (IOP): may be normal, elevated or
depressed

16. Anterior uveitis
Signs
- Reduced visual acuity (V.A.)

17. Signs
-Circum-corneal congestion

18. Signs
-Cornea:
Keratic precipitate. KP:
aggregation of inflammatory cells on the posterior
surface of the endothelium)
Small , endothelium dusting
(non-granulomatous uveitis)
Large (muttan fat) (chronic,
granulomatous uveitis)
Band keratopathy: deposition of calcium at
Bowmann’s layer

19. Signs
-Ant. Chamber:
- cells
-flare ( increase protein in the aqueous)
-hypopyon (aggregation ofinflammatory
cells at the bottom of anterior
chamber with fluid level)

20. Signs
-Pupil: Miosed (constricted)
Irregular, posterior
synechiae
(adhesion between the
iris and the lens),

21. Signs
-Iris: Rubeosis ( iris neovascularization).
Iris atrophy (chronic)
Iris nodules and granuloma
(granulomatous uveitis)

22. Signs
-Intra-ocular pressure (IOP): may be
normal, elevated or depressed

23. Ankylosing Spondylitits
Young adults
Male are affected more
Arthritis; axial skeleton
-sacroiliac joint and
intervertebral joints
90% positive HLA-B27
Acute, Recurrent,
non-granulomatous Anterior Uveitis

24. Juvenile idiopathic arthritis
Idiopathic,
Chronic arthritis
Age under16 years. Females are affected more commonly
Pauciarticular type (less than 5 joints are involved)
seronegative (for R.F.),
80% positive for ANA
Bilateral, Chronic, non-granulomatous Ant. Uveitis
painless,
Complications:
1- Cataract
2- Band keratopathy
.

25. • Intermediate uveitis: inflammation of the
ciliary body (cyclitis, pars planatis).

26. Intermediate uveitis
Parsplana,peripheral
retina,choroid,vitreous
base
Symptoms
- Floaters (moving shadows in
the field of vision caused by
vitreous opacities)
- Blurring of vision

27. Intermediate Uveitis
Signs:
Ant segment- minimal activity
• Vitreous: cells,
snow-balls
• No fundus lesions

28. Intermediate Uveitis
• Causes of intermediate
uveitis
1- Pars planitis:
Most common
Idiopathic
2- TB
3- Multiple sclerosis

29. • Rx
• 4 step protocol
• periocular triamcinolone and systemic steroids
• Immunosuppressive drugs
• Cryotherapy/ indirect laser photo coagulation
• Parsplana vitrectomy

30. - Posterior uveitis: inflammation behind
ora serrata, inflammation of the
choroid and retina (choroiditis,
retinitis, chorio-retinitis, retinal
vasculitis).
.

31. Posterior Uveitis
• Symptoms
- Floaters (moving shadows in the field of
vision caused by vitreous opacities)
- Blurring of vision

32. Posterior uveitis
Signs:
• Vitreous: cells, flare and opacities
• fundus lesions may be focal, multi-focal, or geographical lesions
-Choroiditis; yellow, well demarcated patches
-Retinitis; white cloudy patches with indistinct margins
-Old inactive lesion appears as white well defined area of
chorio- retinal atrophy with pigmented borders
-Vasculitis; fluffy haziness surrounding blood columns
vascular sheathening

33. Toxoplasmosis
• Toxoplasma gondii is an obligatory,
intracellular protozoan parasite
Acquired, congenital
- Vitritis.
- Retinitis;
Active lesion: creamy-white lesion with
indistinct margins
Inactive lesion: white well defined area of
chorio- retinal atrophy with pigmented
borders

34. Toxoplasmosis
Treatment:
Antiprotozoal drugs; Clindamycin,
sulphonamides
Steroids

35. - Pan uveitis:
inflammation of the entire uveal tract.

36. Pan uveitis
• Idiopathic, multisystem disease
characterized by recurrent episodes of
orogenital ulceration and vasculitis

37. Behcet syndrome
• Diagnosis:
• 1 Recurrent oral ulceration characterized by painful minor or major aphthous
lesions that have recurred at least three times in a 12-month period.
2 Plus at least two of the following:
• Recurrent genital ulceration
• Ocular inflammation.
• Skin lesions include erythema nodosum, folliculitis, acneiform nodules
• Positive pathergy test, cutaneous hypersensitivity, which is characterized by the
formation of a pustule after 24–48 hours at the site of a sterile needle prick

38. Behcets disease
,
Ocular features;
Bilateral,
chronic with exacerbation and remission,
non- granulomatous
pan-uveitis
iridocyclitis
Vitritis
Retinitis
Vasculitis; venous occlusion,
neovascularization,

39. Behjet’s disease

40. Pan uveitis
Vogt Koyanagi Harada (VKH)
Multi-systemic auto-immune disorder affect pigmented
cells in the body.
Involves CNS, eyes, and skin

41. Vogt Koyanagi Harada (VKH)
- Neurological and auditory manifestations
Headache, Tinnitus
- Integumentary findings, not preceding onset of
central nervous system or ocular disease, such as
alopecia, poliosis and vitiligo

42. Vogt Koyanagi Harada (VKH)
- Bilateral uveitis
Acute stage:
Multifocal serous detachment of
sensory retina
Bilateral exudative retinal detachment
Chronic stage:
Depigmentation of the fundus; Vitilligo
of the fundus
Dalen Fuchs atrophic spots

43. Presumed Tuberculous Uveitis
According to WHO:
About one third of the world's population, are infected by tuberculosis
10% of infected people are symptomatic
90% have latent TB
TB is endemic in Iraq
TB uveitis develops following hematogenous spread from a
primary latent focus and usually occurs without evidence of
systemic TB.

44. Presumed TB uveitis
• Clinical signs include ;
-Granulomatous anterior uveitis
- Focal, multifocal choroiditis, choroidal granuloma,
- Retinal vasculitis.

46. Management of Uveitis:
1- Investigations: Aimed for determining the etiology.
Indications: chronic, recurrent, and granulomatous anterior uveitis
Intermidiate, posterior and pan-uveitis
2-Steriods:
Topical, Side effects of corticosteroids eye-drops:
• Flare up of pre-existing eye infection
• Predispose for microbial keratitis, e.g. viral keratitis.
• Inhibit collagen synthesis of the cornea, and predispose for corneal thinning
• Cataract (chronic use)
• Open angle glaucoma (chronic use)
Periocular injections of steroids; used in severe ant. , Intermidiate, posterior uveitis
Systemic steroids; used in; severe anterior, Intermidiate uveitis, posterior uveitis
3- Mydriatics: -decrease pain by relieve ciliary muscles spasm
- prevent synechiae, break down synechiae
4- Anti-microbial drugs: in infectious types; Toxoplasmosis, Presumed TB uveitis.
5- Immunomodulator and/or Immunoppressive agents:
In bilateral, severe , vision threatening , steroid sparing, non-infectious
-Cyclosporin; T-cell immunosuppressive agent
-Methotrexate
- Azathioprine

47. Red Eye
Symptoms Conjunctivitis Keratitis or
corneal foreign
body
Acute iritis Acute
Glaucoma
Vision Not affected depressed depressed depressed
Redness + + + +
Pain Foreign body
sensation,
itching
Pain localized to
the eye
Pain localized
to the eye
Severe pain
radiating
Secretion Watery, mucoid
or purulent
watery watery watery
Photophobia absent mild marked mild
Systemic Sometimes, e.g.
adenovirus
none- 50%
associated with
systemic
disorders
Headache,
nausea and
vomiting

48. Signs Conjunctivitis Keratitis or
corneal foreign
body
Acute iritis Acute
Glaucoma
Congestion Conjunctival Cicumcorneal Cicumcorneal Cicumcorneal
Cornea normal Ulceration or
Suppuration
Keratitic
precipitates
Oedema
Anterior
chamber
normal Cells,
Hypopyon
Cells,
Hypopyon
Shallow
Pupil normal Constricted Constricted,
irregular
Fixed, mid-
dilated
Tension normal Normal High,
Normal, or
Low
High

49. THANK YOU