UVEITIS-CLASSIFICATION
DR R PATEL
DEFINITION
Uveitis ,by strict definition implies an
inflammation of the uveal tract .However ,the
contiguous structures e.g. vitreous, optic nerve,
cornea & sclera can also be involved .
It is one of the vision threatening ocular
disorders.
It is responsible for 10% of legal blindness.
CLASSIFICATATION
A. Anatomical
B. Aetiological
C. Based on type of inflammatory
reaction
Anatomical classification
ANTERIOR UVEITIS
Iritis
Anterior cyclitis
Iridocyclitis
INTERMEDIATE UVEITIS syn pars planitis & peripheral uveitis
POSTERIOR UVEITIS
Focal choroiditis
Multifocal or diffuse choroiditis
Chorioretinitis
Retinochoroiditis
Neuroretinitis
PANUVEITIS
ANTERIOR UVEITIS
TYPES
IRITIS :inflammation primarily involves iris
IRIDOCYCLITIS :Inflammation of
iris+ciliary body
INTERMEDIATE UVEITIS:Inflammation
predominantly involving vitreous
Acute anterior uveitis in young adults
• Majority are men
• 45% are positive for HLA-B27
• Initially no systemic disease
• Minority subsequently develop ankylosing spondylitis
Fibrinous exudate Residual pigment on lens
Intermediate uveitis
• Typically affects children and young adults
• Insidious and chronic
• Frequently bilateral but asymmetrical
• Usually presents with floaters
Vitritis Vitreous snowballs
Mild peripheral Snowbanking in pars
periphlebitis planitis
Intermediate uveitis
Cystoid macular oedema
Treatment
Posterior sub-Tenon steroids if poor VA
POSTERIOR UVEITIS
Involves the fundus posterior to the
vitreous base
Retinitis with the primary focus in the
retina
Choroiditis with the primary focus in the
choroid
Vasculitis : involves veins ,arteries or both
OTHER TERMS
PANUVEITIS :(diffuse) involvement of the entire
uveal tract with out predominant site of
inflammation
ENDOPHTHALMITIS : IMPLIES
INFLAMMATION OFTEN PURULENT involving
all intraocular tissues except the sclera
PANOPHTHALMITIS involves the entire globe
often with orbital extension
FREQUENCY :Anterior uveitis > posterior
>intermediate >panuveitis
AETIOLOGICAL CLASSIFICATION
[Link] uveitis- 30% of all cases
[Link] to systemic diseases .
[Link] causes .
[Link] induced .
[Link] syndrome.
[Link] .
SECONDARY to systemic diseases
[Link] ARTHRITIS
Ankylosing spondylitis.
Reiter` s syndrome
Psoriatic arthritis
Bechect`s disease
Juvenile rheumatoid arthritis(JRA)
B. GASTROINTESTINAL
Ulcerative colitis
Crohn`s disease
Whipple`s disease
[Link]
Sarcoidosis .
Tubercuculosis
[Link]
Syphilis
Gonorrhea
Spondylarthropathies
Gender HLA-B27 Acute iritis
70% males 95% 30%
Ankylosing
spondylitis
Reiter syndrome90% males 60% 20%
Psoriatic arthritis equal 30% 10%
Juvenile chronic iridocyclitis
• Majority are girls
• Initially no systemic disease
• Minority subsequently develop arthritis
Progression of complications
Posterior synechiae Band keratopathy Cataract
[Link] CAUSES
[Link]
Herpes zoster
Herpes simplex
Cytomegalovirus
Measles
Influenza
[Link]
Presumed ocular histoplasmosis
Candidiasis
Coccidoidomycosis
[Link]
Toxoplasmosis
Toxocariasis
Pneumocystis carinii
Onchocerciasis
Herpes zoster ophthalmicus
• Iritis in 40% of cases
• Within 3 weeks of onset of rash
Small-medium KP
Particularly if external nasal Iris atrophy - 20%
branch involved - Hutchinson sign
Candidiasis
Infection with yeast-like fungus - Candida albicans
Risk groups
• Drug addicts or compromised host
• Patients with long-term indwelling catheters
Progression
Unifocal choroiditisMultifocal retinitis and vitreous
‘cotton-ball’ colonies
Endophthalmitis Vitreoretinal traction
Presumed ocular histoplasmosis syndrome
• Fungal infection - Histoplasma capsulatum
• Vitreous is never involved
Atrophic ‘histo’ spots Peripapillary atrophy
Peripheral streaks Choroidal
of chorioretinal atrophy neovascularization
Toxoplasma retinitis
• Recurrence of healed congenital lesion
• Usually between ages 10-35 years.
Unifocal retinitis adjacent to old scar Vitritis may be severe
- heals within 1 to 4 months - ‘headlight in fog’
Ocular toxocariasis
Always unilateral
Chronic endophthalmitis Posterior pole granuloma
Presents between 2 to 9 years. Presents between 6 to 14 years.
with leukocoria or strabismus with visual loss
Optic nerve granuloma Peripheral granuloma
Presents between 6 to14 years. Presents during adolescence or
with visual loss adult life with visual loss
Indolent CMV retinitis
• Frequently starts in periphery • Slow progression
• Granular opacification • No vasculitis
• Mild vitritis
[Link] INDUCED
Phacoanaphylactic
endophthalmitis
Phacotoxic uveitis
[Link] SYNDROME
[Link] SEGMENT
Retinoblastoma
Leukaemia
Intraocular foreign body
Malignant melanoma
Juvenile xanthogranuloma
[Link] SEGMENT
Reticulum cell sarcoma
Retinal detachment
Lymphoma
Retinoblastoma
Malignant melanoma
Multiple sclerosis
Retinitis pigmentosa
[Link]
[Link] with anaphylactic & allergic reactions
[Link] with septic conditions
Meningitis
Sinusitiis
Otitis media
Dental caries
Tonsillitis
Choclecystitis
Pyaemic states
Pneumonia
Urinary tract infection etc.
CLASSIFICATATION according to
type of inflammation
[Link]
[Link]
Nongranulomatous/Granulomatous
Onset acute insiduous
Photophobia marked slight
Vision decrease ++ +++
Pain marked minimal
Site anterior posterior
Ciliary injection +++ +
KPS fine,small large mutton fat
Flare +++ (flare) + (cells)
Iris nodule - +++
Posterior synechiae: thin+weak Thick +heavy
Vitreous haze : slight moderate+marked
Causes of granulomatous uveitis
Sarcoidosis
Syphilis
Vogt-Koyanagi-Harada disease
Sympathetic ophthalmia
Multiple sclerosis
Lyme disease
Tuberculosis
Herpes zoster
Coccidioidomycosis
Leprosy Toxoplasmosis
Brucellosis
Idiopathic
Causes of non-granulomatous
uveitis
Idiopathic causes
Diseases associated with HLA-B27
Ankylosing spondylitis
Reactive arthritis
Inflammatory bowel disease
Psoriasis
Sarcoidosis
Trauma
Infections
Herpes zoster and/or herpes simplex
Syphilis
Lyme disease
Juvenile idiopathic arthritis
Tubulointerstitial nephritis and uveitis syndrome (TINU)
Fuchs heterochromic iridocyclitis
Basic mechanism of ocular
inflammation & Sign of Uveitis
BASIC MECHANISM OCULAR SIGNS
[Link] dilatation Ciliary injection
[Link] permeability Aquous flare
[Link] of cells
A .Inflammatory cells
.=keractic precipitates
=Hypopyon
=Retrolental cells
=Vitreous cells
B :Erythrocytes
=Hyphema