13. dr. gilbert w.s - uvea

7/26/2019 13. Dr. Gilbert W.S - UVEA

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UVEAUVEA

Dr. Gilbert WS Simanjuntak

Bagian IP Mata FK-UKI

SMF IP Mata RS PGI Cikini

UPF Retina RSMata Cicendo/FK-UNPAD

IntroductionIntroduction

The eye is the window of the human body

through which it feels its way and enjoys

the beauty of the worldLeonardo da Vinci (1452-1519)



UvealUveal TractTract Anatomically composed of:

• The iris

• The ciliary body

• The choroid

Middle vascular layer of the eye

Contributes blood supply to the outer retina

The IrisThe Iris

Anterior extention of the ciliary body

Dividing the anterior chamber from the posterior

chamber

Stroma contain sphincter and dilator muscles

Blood supply: major circle of iris

Sensory fibers∞fibers the in the ciliary body

Controls the amount of light entering the eye• Constriction – parasymphatetic

• Dilation – symphathetic



TheThe CiliaryCiliary BodyBody

• Pars plicata: corrugated• Pars plana: flattened posterior pole

Composed mainly of capillaries and veins (drain

through the vortex vein)

Ciliary processes and ciliary epithelium are

responsible for the formation of aqueous

Ciliary muscle: longitudinal, circular and radial

fibers focus for near/distant objects in the visual

field

Blood supply derived from the major circle of the

iris



TheThe ChoroidChoroid

Posterior segment of the uveal tract, between the

retina and the sclera

Composed of choroidal blood vessels

(choriocapiilaries) 4 vortex vein

Nourish the outer portion of the underlying retina

(outer retina)

UVEITISUVEITIS

Symptoms of disorders depend upon the site of the

disease process:

Pain

Blurring of vision

Photophobia

Red eye

Smaller pupil



Anatomic location:

• Anterior

• Intermediate

• Posterior

Pathologic:

• Granulomatous

• Non-granulomatous



Clinical Findings inClinical Findings in UveitisUveitisa. historya. history

Pain, photophobia, blurrred of vision, redness

Acute/insidious

Previous episodes of arthritis

Possible exposure to toxoplasma, tuberculosis,

syphilis and histoplasma

Possibility of a focus of infection elsewhere in the

body

b. symptoms and signs b. symptoms and signs

VA

Circumcorneal flush/ciliary injection

Fine white deposits (keratic precipitates, “KPs”)

or large keratic precipitates (mutton fat) on the

posterior surface of the cornea

Cells and flare



Nodules (Koeppe or Busacca) Small pupil; synechiae ant or post (irregular pupil)

Yellowish-white patches seen hazily in the

retina/choroid (fresh active lesion) or pigment

deposition in the healed stage (scar)

Extensive laboratory usually not indicated in:

• Anterior uveitis, particularly non-granulomatous

• Responsive to non-specific treatment

Non-responsive anterior/posterior uveitis

laboratory investigation (tailored):

• Routine CBC

• IgM-anti Toxo, VDRL, Chest X-ray, Mantous test,ANA, ds-DNA, etc

c. laboratoryc. laboratory



Differential DiagnosisDifferential Diagnosis

Conjunctivitis

Keratitis or keratoconjunctivitis

Acute glaucoma

Scleritis/episcleritis

Endophthalmitis (infectious uveitis)

ComplicationsComplications

Peripheral anterior synechiae – glaucoma

Posterior synechiae – glaucoma

Cataract

Retinal detachment

Cystoid macular edema



Schematic TherapySchematic Therapy



HIV and Kaposi SarcomaHIV and Kaposi Sarcoma

FuchsFuchs HeterochromicHeterochromic IridocyclitisIridocyclitis



FineFine KeraticKeratic Precipitates (Precipitates (KPsKPs) and) and

Large Mutton FatLarge Mutton Fat

AnkylosingAnkylosing SpondylitisSpondylitis



Juvenile Rheumatoid ArthritisJuvenile Rheumatoid Arthritis

HypopyonHypopyon andand KoeppeKoeppe Nodules Nodules



MasquaradeMasquarade SyndromeSyndrome

SyphilisSyphilis



ToxoplasmaToxoplasma and Acute Retinal Necrosisand Acute Retinal Necrosis

HIVHIV



VasculitisVasculitis and Oral Ulcer/and Oral Ulcer/BehcetBehcet

THANK YOUTHANK YOU

13. dr. gilbert w.s - uvea

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