UVEITIS. Dr. Yılmaz ÖZYAZGAN

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1 UVEITIS Dr. Yılmaz ÖZYAZGAN

2 UVEITIS DEFINITION BY STRICT DEFINITION, UVEITIS IS AN INFLAMMATION OF UVEAL TRACT. BUT IN PRACTICAL, IT IS GENERALLY NOT RESTRICTED TO THE UVEA AND INVOLVES OTHER ADJACENT STRUCTURES, AS WELL.

3 UVEITIS CLASSIFICATION THE MAIN CLASSIFICATIONS ARE; ANATOMICAL ETIOLOGICAL CLINICAL

4 UVEITIS ANATOMICAL CLASSIFICATION I- II- III- ANTERIORLY LOKALIZED POSTERIORLY LOKALIZED BOTH ANTERIORLY AND POSTERIORLY LOKALIZED

5 I- ANTERIORLY LOKALIZED (Anterior Uveitis) Defines the ocular inflammation lokalized to the iris and the anterior portion of ciliary body (pars plicata).

6 I- ANTERIORLY LOKALIZED I- ISOLATED ANTERIOR UVEITIS causative factors of uveitis are restricted to the anterior uvea. FUCHS UVEITIS SYNDROME (FUS) (= Fuchs Heterocromic Iridocyclitis) SOME OF ENDOGENOUS UVEITIS (Idiopathic)

7 I- ANTERIORLY LOKALIZED II- ASSOCIATED WITH SYSTEMIC DISORDERS Etiological factors of these systemic disorders also cause an anteriorly localized uveitis; Ankylosing Spondylitis Reiter Disease Crohn Disease

8 II - POSTERIORLY LOKALIZED UVEAL INFLAMMATION

9 II- POSTERIORLY LOKALIZED UVEAL INFLAMMATION a- Intermediate Uveitis (Pars Planitis) b- Posterior Uveitis Defines the inflammation lokalized to pars plana, peripheral retina and behind the peripheral retina involving posterior pole.

10 II- POSTERIORLY LOKALIZED I- INTERMEDIATE UVEITIS Defines the inflammation localized to the pars plana and peripheral retina; Pars Planitis Peripheral Uveitis Peripheral Retinitis II-POSTERIOR UVEITIS Defines the inflammation, localized to behind the peripheral retina involving posterior pole.it may be DIFFUSE or MULTIFOCAL

11 II- POSTERIORLY LOKALIZED I- ISOLATED INTERMEDIATE POSTERIOR UVEITIS Sympathetic ophthalmia Birdshot retinochoroidopathy Acute Multifocal Placoid Pigment Epitheliopathy (AMPPE) Presumed Ocular Histoplasmosis Syndrome (POHS) Serpiginous Choroiditis

12 II- POSTERIORLY LOKALIZED II- INTERMEDIATE AND POSTERIOR UVEITIS ASSOCIATED WITH SYSTEMIC DISORDERS Causative factors of the associated systemic disease also result an inflammation of uvea at this site; Toxoplasmosis Toxocariasis Some of endogenous uveitis (Idiopathic)

13 III- BOTH ANTERIORLY AND POSTERIORLY LOKALIZED (PANUVEITIS) Inflammation involves both anterior and posterior uvea simultaneosly with periods of remission and exacerbation. Inflammation may be more prominent in either anterior or posterior uvea during reactivation period.

14 III- BOTH ANTERIORLY AND POSTERIORLY LOKALIZED (PANUVEITIS) I- ISOLATED PANUVEITIS Endogenous (Idiopathic) II- ASSOCIATED WITH SYSTEMIC DISORDERS Behçet Disease Sarcoidosis Vogt-Koyanagi-Harada syndrome

15 Uveitis Associated Transient Changes of The Ocular Structures Conjunctival hyperemia Ciliary injection Keratic precipitates Pupillary miosis Cells in the aqueous humor Anterior chamber flare Hypopyon Hyphema Vitreous opacities and haze Retinal and macular edema Papiledema Retinal hemorrhages Exudates Vasculitis and perivasculitis

16 Uveitis Associated Permanent Changes of The Ocular Structures Posterior synechiae and its sequelae Peripheral anterior synechiae Neovascularization of iris Lens opasification Vitreous opacities and degeneration Sequelae of retinal hemorrhages Sequelae of perivascuilitis and vasculitis Retinal Vascular Occlusion (Vein and/or Artery) Neovascularization of retina Optic atrophy Sequelae of macular edema Complete (full-thickness) or incomplete (lamellar) macular hole

17 CLINICAL COURSE OF THE UVEITIS I- Silent and chronic course without periods of remission and exacerbation FUCHS UVEITIS SYNDROME (FUS) (= Fuchs Heterocromic Iridocyclitis) Juvenile Rheumatoid Arthritis

18 CLINICAL COURSE OF THE UVEITIS II- with periods of remission and exacerbation Sympathetic ophthalmia Uveitis associated with ankylosing spondylitis Behçet disease A- with frequent reactivations B- without frequent reactivations

19 TREATMENT PRINCIPLES OF THE UVEITIS 1- SHORT TERM TREATMENT For the patients with a clinical course of exacerbations and remisions; to eliminate the activation symptoms to achieve the pre-activation visual acuity level

20 TREATMENT PRINCIPLES OF THE UVEITIS 2- LONG TERM TREATMENT to decrease the number of reactivations per time to decrease the severity of reactivations to preserve the visual acuity per time after exacerbation and remissions

21 TREATMENT MODALITIES OF THE UVEITIS 1- LOCAL 2- SYSTEMIC

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