chp12 uveitis_2.ppt
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Uveal Tract
Diseases
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OutlineUveal tract is inclined to be affected by autoimmunity 、infection 、 metabolism 、 hematogenousfactor 、 tumor, et al.
• melanin correlated Ag• Choroidal blood flow is slow
• Ag of retina and lens cause uveitis
•Inflammation is the most common reason, tumor is thesecond.
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Outline
• The term uveitis! denotes inflammation of the
uvea 、 retina 、 retinal vasculature and
vitreous.
•Uveitis is a common cause ofblindness, usually affects young
people and associated with systemicautoimmune diseases.
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Etiology and mechanism
• inflammation
• Autoimmune factor
• O"idi#e damage
• The metabolites of arachidonic acid• Immunogenetics
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Classification
• According to causes : infective and non$infective
uveitis
• According to clinical %athology : granulomatous
and nongranulomatous uveitis
• According to anatomy :anterior 、 intermediate 、 %osterior uveitis and
%anuveitis.
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Anterior uveitis
Anterior uveitis consists ofiritis 、 iridocyclitis 、 anterior cyclitis.
classify by %rocess :
( & ) acute anterior uveitis : '(A)*+ %ositive.
( + ) chronic anterior uveitis : such as -uchs
heterochromic uveitis 、 glaucomatocyclitic crisis, et
al.
( 3 ) either acute or chronic: such as
tuberculosis 、 sy%hilis 、 chronic arthritis.
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Clinical findings
• ym%toms/
%ain 、 %hoto%hobia 、 tearing 、 blurred
vision.
• igns/
( & ) ciliary congestion or mi"ed congestion
( + ) 01/
corneal endothelium in2ury
inflammatory cells and %igments e"istence.
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Classification of 01 :
• tellate 01 : neutro%hil 、 lym%hocyte and
%lasma cells, ))nongranulomatous uveitis.
• 3edium si#ed 01 : neutro%hil 、 lym%hocyte
and %lasma cells.))-uchs heterochromic
uveitis and uveitis secondary by her%es sim%le"
virus 4eratitis.
•Mutton fat K : mac!ophage andepithelioid. ))granulomatous uveitis.
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(ocation of 01
• Arlt5s triangle : the most common " seen in
many ty%es of anterior uveitis
• 1u%illary cornea : seen in -uchs heterochromicuveitis 、 uveitis due to her%es sim%le" virus
and glaucomatocyclitic crisis.
• diffuse distribution : seen in -uchsheterochromic uveitis 、 uveitis due to her%es
sim%le" virus .
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( 6 ) -lare in the a7ueous : It is because of the
damage of blood$a7ueous barrier and %rotein enterinto a7ueous, %resents when anterior
uveitis 、 AC8 、 blunt trauma.
( 9 ) Cell in the a7ueous : inflammatory cells
dis%lay uniform gray %articles under slit lam%.
1articularly severe anterior chamber inflammation
may result in layering of inflammatory cells in the
inferior angle ( hy%o%yon ) .
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( : ) Change in iris/ may be edema 、 te"ture
unclear, et al.• the synechia between iris and the anterior
surface of lens is called iris posterior synechiae.
• ;hen %osterior synechiae is e"ensive"
a7ueouscannot outflow " usually %roduce %u%illary
seclusion and forward bulging of the iris " is
called iris bombe.
• ynechia between iris and the %osterior surfaceof cornea is called iris anterior synechiae.
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Iris nodules:
①0oe%%e nodules/ gray semitrans%arentnodules %resenting at the iris margin)) nongranulomatous uveitis
②*usacca nodules/ white or graysemitrans%arent nodules %resenting in theiris %arenchyma))granulomatous uveitis
③Iris granuloma : single %in4 o%a7uenodules %resenting in the iris %arenchyma ))sarcoidosis
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( < ) Change of pupil : miosis or
irregular due to s%asm of ciliary muscle andcontraction of s%hincter %u%illae muscle.
• The %u%il may be small or irregular due to
the formation of the iris %osterior synechiae.If iris synechiae reach 6<= degree " is
called Seclusio pupillae.
• If fibrous membrane cover the whole %u%il " is called occlusion of pupil.
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( ) Change of lens/ some %igment may be
de%osit on the surface of lens in uveitis>circular sha%e %igment de%osition often
occur after release of iris %osterior
synechiea.( ? ) Change of %osterior segment : Cells
in the anterior vitreous " cystoid macular
edema 、 o%tic edema.
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Complications
• Com%licated cataract : due to the change of
a7ueous content or a%%lication of corticosteroid.
• econdary glaucoma : inflammatory
cells 、 fibrous e"udation and tissue fragments
bloc4 trabecular meshwor4 # the seclusion and
occlusion of %u%il im%ede a7ueous outflow.• Ocular hy%otension and atro%hy of eyeball :
ciliary body atro%hy))a7ueous ))IO1
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Differential Diagnosis
、 Acute con!unctivitis
" 、 Acute angle closure glaucoma
3 、 intraocular tumor
$
、diffuse u eitis
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#reatment
principle
• $ydri asis immediately : prevent iris
posterior synechiae.
• Anti%inflammation in time: prevent tissue
in!ury and complications.
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.Cycloplegics : & 、 "& 、 '& Atropine
① %revent and cure iris %osterior synechiae " %reventcom%lications #
②release the s%asm of ciliary muscle and %hincter
%u%illae muscle " then reducecongestion 、 edema 、 inflammation and %ain.
".Corticosteroids: local and systemic application
3.(SAID
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'.#reat primary diseases :
).#reatment of complications : Secondary glaucoma/
① ta4e diamo" orally and timolol eyedro%.
② If %u%illary bloc4 e"ist, %erform laser iridotomyor iridotomy in time.
③ If Anterior chamber angle e"tensively adhere " %erform trabeculectomy.
Complicated cataract% when inflammation under
good control " %erform cataract e"traction and
IO( im%lantation.