UVEITIS

PRECEPTOR:
dr. RAHMAD SYUHADA, Sp.M

Wulandari, S.Ked
17360077
ANATOMY UVEA

The uvea is the second layer in the eye,

inside the sclera and outside the retina.
The uvea is a layer that has many blood
vessels that bleed the entire eyeball.
UVEA, consists of:

1. The iris is an extension of the ciliary corpus anteriorly. Iris is a flat surface with
a round aperture that is located in the middle, namely the pupil.

2. Ciliare corpus which is triangular in shape on the cross section, extending

forward from the anterior end of the choroid to the base of the iris
3. Choroid is the posterior part of the uvea located between the retina and sclera
Uvea function;
 Iris & pupil : as a diaphragm for control the amount of light
which goes in and decreases dilate the pupil

 ciliary corpus : - production of aqueous humor

- to regulate lens curvature (accommodation)

 choroid : Nutrient supply in part of the retina

UVEITIS
• Uveitis is an inflammation of the uvealis tract
• Uveitis usually occurs at the age of 20-50 years
• Uveitis is more common in developing countries
than in developed countries
 Uveitis
etiology

Infection Non Infection

Cause; autoimmune
diseases of the ocular or
Cause; viruses, bacteria,
systemic
fungi, parasites
T cells are considered to be
Directly through the wound,
a major role in the
or spread from the focus of
development of non-
infection elsewhere
infectious uveitis

Most encountered
 Dilatation of small blood
vessels pericorneal hyperemia
(pericorneal vascular
injection)
A B
Vascular permeability ↑
Exudation: iris edema, pale,
pupil reflex ↓ up to lost, pupil
miosis
Migration of inflammatory
cells and fibrin to BMD /
BMD cloudy, cells and flares
(+), effects tyndal (+)
PATHOPHYSIOLOGY
Disruption of ocular fluid
Inflammatory cells, fibrin,
outflow and increased intra
fibroblasts close the pupil lus
ocular pressure secondary
seklusio pupil / oklusio pupil
glaucoma
Inflammatory cells, fibrin,
causing fibroblasts iris is
attached to the anterior lens Lens metabolic disorders uh
capsule (posterior synechiae) cloudy lenses, complicated
and on the corneal cataracts
endothelium (anterior
synechiae)
Inflammatory cells are
Widespread inflammation:
attached to the corneal
endophthalmitis,
endothelium (keratic
panophthalmitis
precipitate)
Inflammatory cells
Regarding the healthy eye
accumulate in BMD
next to it: symphatetic
(hypopyon) Erythrocyte
ophthalmia
migration to BMD (hifema)
CLASSIFICATION

ANATOMY KLINIS ETIOLOGIS

• UVEITIS ANTERIOR UVEITIS ACUTE UVEITIS EXOGENOUS
• UVEITIS UVEITIS CHRONIC UVEITIS ENDOGEN
INTERMEDIATE
• UVEITIS POSTERIOR
• PANUVEITIS
PATHOLOGICAL NON GRANULOMATOSA

GRANULOMATOSA
CLASSIFICATION
Onset Acute Hidden

Pain Real Not real or mild

Photophobia Real Mild

blurred vision Medium Real

Red circumcision Real Mild

Keratic precipitates Smooth white Big gray (“mutton fat”)

Pupil Small and irregular Small and irregular

NON GRANULOMATOSA
Sinekia posterior Sometimes Sometimes

Nodul iris There is no Sometimes

Location Uvea anterior Uvea anterior,posterior or difus

Pathophysiology Acute chronic

Recurrence Often Sometimes

GRANULOMATOSA
Classification based on anatomical
location
 UVEITIS (Anatomy)

Uveitis Anterior ;
• Regarding iris and pars plicata
• Iritis

Uveitis Intermedia ;
• Regarding pars plana, vitreous and peripheral retina
• Pars planitis, cyclitis, iridocyclitis

Uveitis Posterior ;
•Regarding the choroid and retina
•Choroiditis, Chorioretinitis,
Retinochoroiditis, Neuroretinitis

Panuveitis ;
• Regarding all uveal tracts and ocular segment structure
 UVEITIS ANTERIOR
• Inflammation confined to the anterior
chamber is called iritis, inflammation
of the front chamber and the anterior
vitreus is often referred to as
iridocyclitis
• unilateral with acute onset.
• pain, photophobia, and blurred
vision.
• Circumcorneal redness with minimal
injection of palpebral conjunctivae
and secretions.
• Pupils may be small (miosis) or
irregular because there are posterior
synechiae
• keratic precipitate (KP) (+) Mutton-
fat or granulomatous, small in
non-granulomatous,
• The iris nodule nodules can be seen
on the edge of the iris (Koeppe
nodule), in the iris stroma (Bussaca
nodule) or in the angle of the front
chamber (Berlin nodule).
 UVEITIS INTERMEDIATE
• bilateral
UVEITIS INTERMEDIATE
• floater and blurred vision.
• Pain, photophobia, and red
eyes are usually absent or
few
• The findings of vitritis are
often accompanied by free-
floating vitreous conditions
such as "snowballs" or
wrapping pars plana and
corpus ciliare such as
"snowbanking".
 UVEITIS POSTERIOR

• Posterior uveitis affects the back of

the uvea, which consists mainly of
choroid, so-called choroiditis
(choroidal inflammation).
• Posterior uveitis is usually caused
by an infection in the body, such as
the presence of syphilis or
toxoplasmosis.
Uveitis posterior
SIGNS:
• VITRITIS (cells
and exudates)
• Infiltration and
exudate in the
retina and choroid
• Retinal and
choroidal edema
• Disc Edema
• Retinal bleeding
• Thickening of
blood vessels
ANTERIOR AND POSTERIOR UVEITIS DIFFERENCES
DIAGNOSIS

a) Ophthalmology Examination

 Visus : Visus: is usually normal or

can decrease slightly

 Intraocular pressure (IOP) in

lower inflamed eyes

 Conjunctiva: see ciliary /

peripheral injection

 Cornea: KP (+), corneal stroma

edema
 CELLS:
0: no inflammatory cells
Trace: <5 cells
1 +: 5 - 10 cells
Cells and 2 +: 10-20 cells
flares at KOA 3 +: 20-30 cells
4 +: too much

The intensity of inflammatory cells in COA is grouped according to the number

of inflammatory cells in the slit lamp examination

Flare; caused by an increase in protein in aqueous, (tyndall effect)

DIAGNOSIS
Hypopion; leukocyte collection in
COA
Fibrin formation in COA
Synechia
 The inflammatory process is often accompanied
by the release of inflammatory mediators that
cause fibrin deposits, clotting and proliferation of
fibroblasts = synechia
 Synechia indicates a chronic or recurrent process
 Posterior synechiae; slice adhesion to the lens
 Anterior synechia: iris adhesions to the cornea
Posterior synechiae

Posterior synechiae; slice adhesion to

the lens
THERAPY

1. Midriatikum serves to provide comfort to the patient,

prevent the formation of posterior synechiae, and
destroy synechiae. Provides comfort by reducing
spasm of the ciliary muscles and sphincter pupils using
atropine
Atropine sulfate 1% daily 3 times drops
Homatropin 2% daily 3 times drops
Scopolamine 0.2% daily 3 times drops
THERAPY

2. Corticosteroids
Adult : Topical with dexamethasone 0,1 % or prednisolone 1 %.
If inflammation is very severe, can be geven subconjunctival or periocular:
dexamethasone phosphate 4 mg (1 ml)
prednisolone succinate 25 mg (1 ml)
triamcinolone acetonide 4 mg (1 ml)
methylprednisolone acetate 20 mg
If you have not succeeded you can get oral systemic prednisolone starting at 8 mg
on day until the signs of inflammation are reduced, then5 mg daily.

Child : prednisone 0,5 mg/kgbb for 3 times

THERAPY

2. Corticosteroids
Adults: Topical with dexamethasone 0.1% or prednisolone 1%.
If inflammation is very severe it can be given subconjunctival or periocular:
Dexamethasone phosphate 4 mg (1 ml)
Prednisolone succinate 25 mg (1 ml)
Triamcinolone acetonide 4 mg (1 ml)
Methylprednisolone acetate 20 mg

If it has not been successful it can be given oral systemic prednisone starting at 80
mg per day until the sign of inflammation decreases, then decreases by 5 mg every
day.

Children: prednisone 0.5 mg / kg daily 3 times