Disorders of uveal tract
Uvea: Part of the eye, consisting collectively of the iris, the choroid of the eye, and the ciliary body
Uveitis is an inflammation of the intraocular structures.
- Infections - toxoplasmosis, herpes zoster virus, ocular candidiasis, histoplasmosis, herpes simplex virus, tuberculosis, and syphilis.
- Immune-mediated disorders: such as ankylosing spondylitis, Crohn's disease, Reiter's syndrome, SLE, sarcoidosis, psoriasis
Based on involved structures
(1)Anterior uveitis: inflammation of iris (iritis) or iris and ciliary body (iridocyclitis)
- Most common type 75%
- Only one eye is usually affected
- Symptoms- eye pain ranging from mild aching to intense discomfort, redness, blurred or cloudy vision, small pupil, photophobia, headache.
(2) Intermediate uveitis: structures posterior to the lens (pars plantis or peripheral uveitis )
- Second most common type
- Both eyes tend to be affected and usually painless.
- Symptoms- mild redness, blurred vision
(3)Posterior uveitis: choroid (choroiditis), retina (retinitis), or vitreous near the optic nerve and macula.
- Symptoms- decreased vision, and sometimes retinal detachment. Can be more dangerous leading to visual loss
- Symptoms are slower to develop and often lasts longer.
Nongranulomatous and granulomatous
- Non granulomatous-
- Most common type, which manifests as an acute condition with pain, photophobia, and a pattern of conjunctival injection, especially around the cornea. The pupil is small or irregular, and vision is blurred.
- There may be small, fine precipitates on the posterior corneal surface and cells in the aqueous humor (ie, cell and flare).
- Granulomatous uveitis can have a more insidious onset and can involve any portion of the uveal tract. It tends to be chronic.
- Symptoms such as photophobia and pain may be minimal.
- The keratic precipitate may be large and grayish. Vision is markedly and adversely affected.
- Physical examination
- Complete systems review
- Complete blood cell count
- Erythrocyte Sedimentation Rate
- Antinuclear antibodies (ANA)
- Wear dark glasses outdoors for photophobia
- Mydriasis - to avoid Ciliary spasm and synechia
- E.g., cylopentolate (Cyclogyl) and atropine
- Local corticosteroid drops, such as Pred Forte 1% and Flarex 0.1%, instilled four to six times a day are used to decrease inflammation.
- In very severe cases, systemic corticosteroids, as well as intravitreal corticosteroids, may be used
- Teach patient how to instill medications and adhere to dosing schedule to prevent permanent eye damage.
- Encourage follow-up for intraocular pressure (IOP) masurements because corticosteroids can increase IOP.