Uvea Basics

What does the uvea consist of?

iris, ciliary body, choroid

What is uveitis?

inflammation of the uveal tract

Who gets uveitis?

females for adults, males for kids

What is peak incidence of uveitis?

20-59 years old

What are the causes of uveitis?

idiopathic

immunologic

infectious

traumatic

masquerade

How do we classify uveitis by location? (+define)

anterior uveitis: anterior chamber

intermediate uveitis: vitreous

posterior uveitis: retina +/or choroid

panuveitis: all of uvea

How do we classify uveitis by onset? (+define)

sudden (red, painful)

insidious (white, painless)

How do we classify uveitis by duration? (+define)

limited: ≤ 3 months

persistent: ≥ 3 months

How do we classify uveitis by clinical course? (+define)

acute: sudden onset + limited duration

chronic: persistent with relapse < 3 months after stopping treatment

recurrent: repeated episodes separated by 3 or more months

remission: no cells for ≥3 months

How do we classify uveitis by histopathology? (+ define)

non-granulomatous: fine KP

granulomatous: mutton fat KP

How do we classify uveitis by laterality?

unilateral

bilateral

What are the shared symptoms of anterior uveitis?

seen with acute onset:

pain that is worse when looking near or at light

photophobia

What are the shared signs of anterior uveitis?

circumlimbal injection

KPs

aqueous cells

flare

iris nodules

anterior synechiae

posterior synechiae

IOP changes

pupil miosis

What are KPs?

inflammatory deposits on corneal endothelium

Where are KPs usually found?

inferior cornea in base down triangle configuration (Arlt triangle)

What are fine dusting KPs?

small white dots (pigmented if old)

What are granulomatous KPs?

large greasy dots (mutton fat KP)

What are aqueous cells?

lymphocytes in anterior chamber

What is flare?

protein in the anterior chamber

What causes flare?

breakdown in the blood aqueous barrier

What are iris nodules?

accumulation of epithelioid cells and lymphocytes on anterior iris

What are types of iris nodules?

Koeppe

Busacca

Berlin

Where are koeppe nodules found? What are the associated with?

found at the pupillary margin

seen in granulomatous or non granulomatous

Where are busacca nodules found? What are the associated with?

found in iris stroma

seen in granulomatous uveitis and Fuchs heterochromia iridocyclitis

Where are Berlin nodules found? What are the associated with?

found at limbus

seen in granulomatous uveitis

What is an anterior synechiae? What type of uveitis is it most commonly seen with?

adhesion at iridocorneal angle

seen with chronic + recurrent uveitis

What is a posterior synechiae? What type of uveitis is it most commonly seen with?

adhesion between iris and anterior capsule of lens

seen with chronic + recurrent uveitis

What is seclusio pupilla? What type of uveitis is it most commonly seen with?

posterior synechiae 360º

seen with severe acute uveitis

What are the IOP changes associated with anterior uveitis + what cause them?

increased IOP: due to blockage of TM or closure of angle

decreased IOP: due to decreased AH production from CB

What is an increased IOP due to uveitis common in?

chronic uveitis

What is a decreased IOP due to uveitis common in?

acute uveitis

What is pupil miosis due to?

iris sphincter spasm

What does pupil miosis with anterior uveitis put a patient at risk for? What should you do?

at risk for posterior synechiae

dilate patient

What are the shared complications seen with anterior uveitis?

band keratopathy

glaucoma

cataract

cystoid macular edema

What is the shared treatment for anterior uveitis?

topical steroids

topical cycloplegic