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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)
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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
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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
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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
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Anatomic location:
• Anterior
• Intermediate
• Posterior
Pathologic:
• Granulomatous
• Non-granulomatous
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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
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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
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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
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Schematic TherapySchematic Therapy
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HIV and Kaposi SarcomaHIV and Kaposi Sarcoma
FuchsFuchs HeterochromicHeterochromic IridocyclitisIridocyclitis
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FineFine KeraticKeratic Precipitates (Precipitates (KPsKPs) and) and
Large Mutton FatLarge Mutton Fat
AnkylosingAnkylosing SpondylitisSpondylitis
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Juvenile Rheumatoid ArthritisJuvenile Rheumatoid Arthritis
HypopyonHypopyon andand KoeppeKoeppe Nodules Nodules
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MasquaradeMasquarade SyndromeSyndrome
SyphilisSyphilis
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ToxoplasmaToxoplasma and Acute Retinal Necrosisand Acute Retinal Necrosis
HIVHIV
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VasculitisVasculitis and Oral Ulcer/and Oral Ulcer/BehcetBehcet
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