Uveitis

Outline
The term uveitis denotes inflammation of the uvea, retina,
retinal vasculature and vitreous.
Uveitis is a common cause of blindness, usually affects
young people and associated with systemic autoimmune
diseases.

Etiologi dan Mekanisme

Inflammation
Autoimmune factor
Oxidize damage
The metabolites of arachidonic acid
Immunogenetics

Klasifikasi
Berdasarkan penyebab: infective dan noninfective uveitis
Berdasarkan
granulomatous

clinical
dan

pathology

non-granulomatous

uveitis
Berdasarkan

anatomi

anterior,

intermediate, posterior uveitis dan panuveitis.

Uveitis Anterior
Uveitis anterior adalah peradangan yang terjadi pada traktus
uvea anterior yang terdiri atas iritis iridocyclitis dan
anterior cyclitis.

Gambaran Klinis Uveitis Anterior

Gambaran Klinis Uveitis Intermediate

Gejala :
penglihatan mengambang
kadang-kadang terdapat gangguan visus karena edema
makular kronik
Tanda klinis
vitritis dengan sedikit sel di COA
lesi inflamasi pada fundus

Uveitis Posterior
Inflammation of retina or choroid posterior to vitreous
base. Choroiditis.

Chorioretinitis
Retinochoroiditis
Retinal vasculitis
Neuroretinitis

Gambaran Klinis Uveitis Posterior

Gejala :
penglihatan mengambang
penglihatan ganda
Tanda klinis :
perubahan vitreous
choroiditis
retinitis
vasculitis

Granulomatous
Uveitis

Non Granulomatous
Uveitis

Onset

Tersembunyi

Akut

Nyeri

minimal

Fotofobia

slight

Injeksi
Siliar

minimal

Keratic
mutton fat besar
Precipitate

halus

Clinical Findings
Symptoms:
pain photophobia tearing blurred vision.
Signs:
1 Ciliary congestion or mixed congestion
2 Keratic Precipitates (KP):
corneal endothelium injury
inflammatory cells and pigments existence.

Classification of KP
Stellate KP neutrophil lymphocyte and plasma cells,
nongranulomatous uveitis.
Medium sized KP neutrophil lymphocyte and plasma cells.
Fuchs heterochromic uveitis and uveitis secondary by
herpes simplex virus keratitis.
Mutton fat KP macrophage and epithelioid.
granulomatous uveitis.

Location of KP
Arlts triangle the most common seen in many types of
anterior uveitis
Pupillary cornea seen in Fuchs heterochromic uveitis
uveitis due to herpes simplex virus and glaucomatocyclitic
crisis.
Diffuse

distribution seen

in

Fuchs

heterochromic

uveitis uveitis due to herpes simplex virus .

 3 Flare in the aqueous It is because of the damage

of blood-aqueous barrier and protein enter into aqueous,
presents when anterior uveitis ACG blunt trauma.
4 Cell in the aqueous inflammatory cells display
uniform gray particles under slit lamp. Particularly severe
anterior chamber inflammation may result in layering of
inflammatory cells in the inferior angle hypopyon .

 5 Change in iris: may be edema texture unclear, et

al.
The synechia between iris and the anterior surface of lens
is called iris posterior synechiae.
When posterior synechiae is exensive aqueous cannot
outflow usually produce pupillary seclusion and forward
bulging of the iris is called iris bombe.
Synechia between iris and the posterior surface of cornea is
called iris anterior synechiae.

Iris nodules:
Koeppe nodules: gray semitransparent nodules presenting
at the iris marginnongranulomatous uveitis
Busacca nodules: white or gray semitransparent nodules
presenting in the iris parenchymagranulomatous uveitis
Iris granuloma single pink opaque nodules presenting in
the iris parenchymasarcoidosis

 6 Change of pupil miosis or irregular due to spasm of

ciliary muscle and contraction of sphincter pupillae muscle.
The pupil may be small or irregular due to the formation of the
iris

posterior

synechiae.

If

iris

synechiae

reach

360

degree is called Seclusio pupillae.

If fibrous membrane cover the whole pupil is called
occlusion of pupil.

 7 Change of lens: some pigment may be deposit on the

surface of lens in uveitis; circular shape pigment deposition
often occur after release of iris posterior synechiae.
8 Change of posterior segment Cells in the anterior
vitreous, cystoid macular edema, optic edema.

Complications
Complicated cataract due to the change of aqueous content or
application of corticosteroid.
Secondary glaucoma inflammatory cells fibrous exudation and
tissue fragments block trabecular meshwork the seclusion and
occlusion of pupil impede aqueous outflow.
Ocular hypotension and atrophy of eyeball ciliary body atrophy
aqueous IOP

Differential Diagnosis
1 Acute conjunctivitis
2 Acute angle closure glaucoma
3 intraocular tumor
4 diffuse uveitis

Treatment
Principle
Mydriasis immediately : prevent iris posterior synechiae.
Anti-inflammation in time: prevent tissue injury and
complications.

1.Cycloplegics 1% 2% 4% Atropine
prevent and cure iris posterior synechia, prevent complications
release the spasm of ciliary muscle and Sphincter pupillae muscle,
then reduce congestion, edema, inflammation and pain.
2.Corticosteroids: local and systemic application
3.NSAID

4.Treat primary diseases

5.Treatment of complications
Secondary glaucoma:
take diamox orally and timolol eyedrop.
If pupillary block exist, perform laser iridotomy or iridotomy in
time.
If Anterior chamber angle extensively adhere, perform
trabeculectomy.

Complicated

cataract:

when

inflammation

under

control perform cataract extraction and IOL implantation.

good