This document provides a comprehensive overview of uveal tissue inflammation, detailing the types of uveitis (anterior, intermediate, and posterior) along with their clinical features, complications, and treatments. It covers classifications based on anatomy, pathology, and etiology, including infections, immune-mediated causes, and trauma. The text also discusses diagnostic investigations and offers extensive treatment options for various uveitis-related conditions.

1. Najihah Binti Mohd Yusri (082012100064)

3. Definition - Inflammation of the uveal tissue.

4. Classification
Anatomical Clinical Pathological Etiological
Anterior Acute Suppurative Infective
Intermediate Chronic Non suppurative Immune related
Posterior Recurrent Toxic
Panuveitis Trauma
Idiopathic

5. Anatomical classification
1. Anterior uveitis :
• Inflammation from iris up to
pars plicata of ciliary body.
• Subdivision :
- Iritis
- Cyclitis ( inflammation of
ciliary body)
- Iridocyclitis.
• C/F
- Pain (dull aching throbbing
worse at night).
- Redness
- Photophobia
- Lacrimation
- Defective vision

6. • Signs
(slit lamp biomicroscopic
examination)
- Lid edema
- Circumcorneal
congestion.
- corneal sign.
- Anterior chamber sign.
- Iris sign
Loss of normal pattern,
and muddy in color,
synechiae,

7. • Complication
- Cataract
- Secondary glaucoma
- Cyclitic membrane
(fibrosis behind lens)
- Choroiditis
- Retinal complication
(scar, fibrosis)
• Ddx
- Acute red eye.
- Granulomatous / non
granulomatous uveitis.

8. TREATMENT OF ANTERIOR UVEITIS
LOCAL SYSTEMIC TREATMENT OF
COMPLICATION
• Hot compress
• Dark glassess
• Atropine 1%
eyedrop
• Corticosteroid
• Corticosteroid
(dexamethason
e)
• Analgesics
(NSAID)
• Immunosupress
ant
• Cataract – lens
extraction
• Secondary
glaucoma
(timolol,
acetazolamide
tab)
• Annular
synechiae
laser
iridotomy

9. 2. Intermediate uveitis
- Inflammation involving
pars plana, peripheral
retina, choroid and
vitreous base.
• 80% bilateral
• Age : 2-4 decade
• 85% idiopathic
• 15%- tb, syphilis
• C/F
- Usually asymptomatic
- Later- blurry and
decrease vision.

10. • Signs
- Anterior segment appears
normal or little KPs, flare.
- Posterior segment shows
snowball / cotton ball
opacities (vitreous
condensation)
• Prognosis
- Good
• Complication
- 42% cataract
- Secondary glaucoma
- Vitreous hemorrhage
- Retinal detachment
• Rx
- Tropical steroid
- Immunosupressive drugs.
- Cryotherapy or indirect
laser photocoagulation
for snowbanking.

11. 3. Posterior Uveitis :
- Inflammation of the
choroid and always
involves the adjoining
retina (chorioretinitis)
• Clinical type
- Diffuse choroiditis.
- Disseminated choroiditis.
- Focal choroiditis.
• C/F
- Defective vision
- Photopsia
- Black spots floating in
front of the eyes.
- Metamorphopsia.
- Micropsia / macropsia

12. • Signs
- Fundus examination
shows features of a
patch of choroiditis.
- active patch of
choriditis :
pale yellow / dirty white
raised area.
• Complication
- complicated cataract
- Vitreus degeneration
- retinal detachment
• Rx
- Corticosteroid
- Immunosupressive
- Specific treatment for
tb, syphilis

13. Clinical classification
• Acute uveitis
- Sudden onset
- Lasting for 6w-3m
*recurrent uveitis :
- Repeated episodes with
inactive period of >3m of rx
• Chronic uveitis
- Insidious onset
- Asymptomatic
- Lasting >3m-years
- Diagnosed when already
develop defective vision

14. Pathological classification
o Non suppurative
o Suppurative

15. A) Non-suppurative uveitis

16. B ) Suppurative / Purulent uveitis
- Invasion of pyogenic organism.
- May start as purulent anterior (iridocyclitis ) or
purulent posterior (choroiditis),
- which soon progresses to involve retina and
vitreous,
- which ultimately leading to endopthalmitis
and panopthalmitis.

17. • Endopthalmitis –
inflammation of inner
structure of eyeball
- Etiology :
 GP cocci, streptococci,
pseudomonas,
pneumococci.
 Fungal (rare)-
Aspergilus, Fusarium,
Candida.
• Panopthalmitis –
intense purulent
inflammation of whole
eyeball.
- Etiology :
 Same

18. • Endopthalmitis
- Modes of infection :
 Exogenous following
perforating injury,
perforated corneal ulcer,
post eye surgery.
 Endogenous tru blood
stream from caries teeth,
septicemia.
 Secondary infection
following orbital cellulitis,
thrombophlebitis,
infected corneal ulcer.
• Panopthalmitis
- Modes of infection :
 Same

19. • Endopthalmitis
- c/f :
 Severe ocular pain,
redness
 lacrimation,
 photophobia,
 loss of vision
• Panopthalmitis
- c/f :
 Severe ocular pain,
headache,
 complete loss of vision,
 profuse watering,
 purulent discharge,
 marked swelling and
redness of eye,
 associated fever and
malaise.

20. • Endopthalmitis
- Swollen lid, conjunctiva
chemosis, edematous
cornea, pupil yellow
reflex, increase iop.
• Panopthalmitis
- Lid edema and
hyperemia, eyeball
slightly proptosed, limited
ocular movement,
conjuctival congestion,
claudy cornea, absent
perception of light, raised
iop.

21. • Endopthalmitis
- Rx :
Antibiotic intavitreal
injection, tropical and
systemic.
Steroid
Antiglaucoma
Vitrectomy
• Panopthalmitis
- Rx :
Antiinflammatory,
analgesic
Broad spectrum antibiotic
Evisceration
- Avoid complication of
intracranial dissemination
- Remove content of
eyeball leving behind
sclera.

22. Etiological (Duke Elder’s) classification
1. Infective uveitis
- Bacterial (granulomatous
and non granulomatous)
- Viral (herpes simplex,
herpes zoster,CMV)
- Fungal (aspergillosis,
candidiasis, blastomycosis)
- Parasitic (toxoplasmosis,
toxocariasis, amoebiasis)
- Rickettsial (scrub typhus,
epidemic typhus)
2. Immune mediated uveitis
- Anaphylactic uveitis
- Atopic uveitis (pollen)
- Autoimmune (RA, SLE)
- HLA-associated uveitis
3. Toxic Uveitis
- Endotoxin (microbial
organism)
- Endocular toxin (from
ocular tissue)
- Exogenous toxin (certain
drugs, inorganic chemical
substance)

23. 4. Traumatic uveitis
- Accidental / operative
injury of uveal tissue.
- Direct mechanical
trauma.
- Foreign body
5. Idiopathic

24. Investigations
1. Hematological
- TLC, ESR (for chronic
inflammatory cond).
- Blood sugar
- Uric acid (gout)
- Serological test (for
syphilis, toxo,
histoplasmosis)
2. Urine examination
3. Stool examination
4. Radiological
- Xray
- CT
- MRI

25. Reference
• AK Khurana, Review of Opthalmology, 6th ed.
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