The Uvea
Lu Chen
Choroid

The choroid is the posterior segment of the
uveal tract, between the retina and the sclera.

It is composed of three layers of choroidal
blood vessels: large, medium, and small. The
deeper vessels are placed in the choroid, the
wider in their lumens.
Uveitis
The uveitis is a common ophthalmopathy which is
an inflammation of uvea caused by multiple reasons.
Characters

commonly occurred in youth

both eyes are involved

relapsing disease

a common ophthalmopathy leading to blindness
Iridocyclitis
It is an inflammation mainly caused by
endogenous or related to systemic diseases besides
injury, surgery and injection.
Symptom

Pain, photophobia

Visual decrease
Sign

Ciliary or mixed congestion

Opaque aqueous humor: Tyndall sign is positive.
It is an important sign of anterior uveitis and
active inflammation.

Keratic precipitate(KP)
-- fine dusty KP
-- “Mutton fat” KP
-- pigmentary KP
-- hyaloid KP
1.Ciliary or mixed injection
2.Aqueous flare
3.Keratic precipitates(K.P)
3.Keratic precipitates(K.P)
Sign

Change of the pupil

Change of the iris
blurred markings, peripheral anterior
synechia, iris nodules

Vitreous opacity
Cystoid macular edema or optic nerve head
edema can be seen when posterior segment is
normal.
plum blossom pupil
Seclusion of pupil
Occlusion of pupil
Koeppe’s nodular
Busacca’s nodular
Complications

Secondary glaucoma: Due to aqueous outflow is
impeded or papillary block, and blindness occurs in
severe cases.

Complicated cataract: Normal physiological
metabolism of the lens is effected and cause
complicated cataract.

Low IOP and atrophy: The generation of aqueous
humor decreases which is easy to arouse low IOP in
early stage of illness. If the inflammation continues for
a long time, it may induces globe atrophy.
Diagnosis

Ciliary congestion, opaque aqueous humor, KP,
pupil constricted, posterior synechia of iris, pain of
ciliary and vitreous opacity.

Opaque aqueous humor and KP are more important.
Differential diagnosis

acute conjunctivitis

acute angle-closure glaucoma

intraocular tumor: It can be distinguished by
history examination.
Treatment

Local treatment:
--- mydriasis: to prevent posterior synechia of the
iris and decrease complications.
--- Corticosteroid: local instillation or local
injection.
Treatment

Systemic treatment:
--- corticosteroid: used in severe stage or long history
--- anti-prostaglandin drug: like inducine etc.
--- treatment to etiology

Treatment to complications:
Operation to secondary glaucoma and complicated
cataract will be performed after inflammation is
controlled.
Middle uveitis
It is an inflammation and proliferative disease
which takes place at pars plana, serrate and
peripheral retina primarily, often bilateral, and with
character of latent onset and chronic course.
Symptom
Latent onset, common symptom is fogging vision.
Visual decreases when complications occurs.
Sign
It is an inflammation takes place at middle
uvea by three-mirror and indirect ophthalmoscope
examination.

Change of anterior segment: There has no or slight
change commonly, and sign of iridocyclitis can be
seen in youth.
Sign

Change of vitreous and pars plana: A lot of white or
yellow-white bank exudates can be seen at inferior
pars plana which is the character of the disease.

Change of retina: There may be retinal vasculitis or
perivasculitis which may extend to posterior pole, the
blood vessles become occlusion like white thread.
Choroidal atrophy , pigmental alteration and
papilledema can be seen in some cases.
Complications

Cystoid macular edema: It is the mainly reason of
visual decrease.

Complicated cataract: It is often opacitive at
subcapsule. The onset is slow which related to
inflammation and corticosteroid.
Diagnosis:
topical sign

Snow bank exudate at inferior pars plana

Vitreous opacity

Phlebitis or periphlebitis in the retina
Differential diagnosis

Irvine-Gass syndrome

vitreous opacity

acute retinitis

acute retinal vasculitis

amyloid degeneration

Behcet disease

others
Treatment

The cause is unclear so there has no effective
treatment now.

The necessary treatment would be given when visual
acuity below 0.5 or visual acuity beyond 0.5 but with
lots of floating opacity in vitreous.
Treatment

local treatment: local instillation or local injection

systemic treatment: corticosteroid and
immunotherapy should be given in severe cases.

operation: cold-coagulation, vitrectomy
Posterior uveitis(Choroiditis)
It is an inflammation at choroid, posterior
vitreous and retina. For anatomy basis, inflammation
often invades into retina.
Symptom

There may be not any symptom if only peripheral
focal part is involved in.

when the posterior diffuse inflammation invades into
macular, floating black shadow before eye, flashing,
metamorphopsia and blurred vision occurs.
Sign

It is often normal in anterior segment and KP may
be seen when ciliary involved.

Vitreous opacity: Vitreous opacity situated in
posterior part like dust or cotton and the fundus is
not very clear.
Sign

Acute stage:
--- Focal or diffuse yellow-white exudation at
fundus with blurred border and various size;
--- Retina edema; fluorescence leakage in FFA and
hyperfluorescence in anaphase.
--- Vitreous opacity: situated in posterior part like
dust or cotton and the fundus is not very clear.
Sign

Scar stage: After some weeks to some months,
exudation patchs begin to absorb.
--- Patchs become yellow-white or grey-white with
clear border.
--- Pigmented spots in it and periphery is surrounded
by pigment.
--- Some funduses look like brown-red appearance of
sunset glow, sclerotic choroidal blood vessels or
exposed white scleral tissue after destruction of
vascular layer in large focus.
Complications

serosity retinal detachment

retinal vasculitis, perivasculitis
Etiology: complicated

infection: circle worm, capsule worm, virus etc.

non-infection: sympathetic ophthalmitis etc.
Treatment

Treatment to etiology systemic treatment

Anti-infection: Corticosteroid should be given but
more attention should be paid to other side effects
during administration.
Panuveitis

The iris, the ciliary body, the choroids are closely
connected not only in anatomy, but also belong to the
same blood source in blood supply. Panuveitis is
called as all parts are involved.

About etiology, symptom and treatment of panuveitis
reference to the previous chapters.
Some Specific Type Uveitis
Sympathetic ophthalmia

Concept: It is the eye which got perforating injury or
intraocular operation( called exciting eye) undergoes
a period of non-purulent uveitis then in another eye,
the uveitis with the same character takes place which
is called sympathizing eye.

Etiology: the cause is unknown
Clinical situation

Exciting eye:
--- Relapse of inflammation in anterior segment of
the eye or original inflammation becomes severe.;
--- The fundus: congestion of optic nerve head;
edema in posterior pole and serosity retinal
detachment.

Sympathizing eye:
--- Anterior segment: anterior uveitis
--- Fundus: hyperemia of optic nerve head; edema in
surround retina; yellow-white exudation and serosity
retinal detachment. It looks like sunset glow after
some months of onset.
--- FFA
--- Complications: cataract, glaucoma, retinal
detachment, optic nerve atrophy
Treatment

Management of perforating eye injury must be correct.

If sympathetic ophthalmia takes place, the course of
the sympathizing eye will not be influenced even the
exciting eye was enucleated.
But following points should be considered:

The damage of injuried eye is severe and there has
no hope to restore vision.

Complicated with secondary glaucoma, the IOP can
not be controlled.

There has no effect of conservative treatment,
chronic inflammation relapses again and vision of
injuried eye had been lost.

Corticosteroid and mydriasis
Acute retinal necrosis syndrome
Acute retinal necrosis is a syndrome includes
acute necrosis retinitis, retinal vasculitis, and retinal
detachment which caused by virus.
Clinical situation

Pain of orbit, scleritis, anterior uveitis at first.

Vitreous exudation, necrosis retinitis and visual
decreased soon. Complicated with retinal detachment.

Pigment deposition can be seen at the posterior
border of retinal lesion when inflammation relieves,
even PVR occurs.
Diagnosis

clinical situation and lab findings
Treatment
It has no effective treatment now.

Anti-virus

Anticoagulant
Vogt-Koyanagi-Harada syndrome

General description: VKH is a syndrome which
involves multiple organs and systems, like eyes, ears,
skin and meninges. The diffused serosity uveitis of
both eye can be found, accompanied with headache,
tinnitus,baldness, vitiligo etc.

Etiology: Unknown. It maybe a immunologic reaction
to retinal pigment epithelium.
Clinical situation

headache, tinnitus etc.

visual decreases of both eyes

fundus: edema of posterior pole, serosity retinal
detachment, edema of optic nerve head, vitreous
body opacity and anterior uveitis.
Clinical situation

VK: the symptom of VK just like acute anterior
uveitis.
Harada disease: the symptom just like sympathetic
ophthalmia and visual decreases of both eyes.

FFA

systemic diseases

fundus: looks like sunset glow

complications: complicated cataract, secondary
glaucoma, and serosity retinal detachment.
scrappy leakage spots
Treatment

Anti-inflammation: Corticosteroid as soos as possible.

Treatment according to the disease.
Behcet disease

a chronic relapsing syndrome, consists of uveitis, ulcer
of mouth, ulcer of genital organ, skin lesion, arthrositis
and nervous system lesion.

commonly occurred in male at age of 20-40

both eyes are involved mostly.

Etiology: Unknown. It maybe a multiple systems and
organs disease caused by immunocomplex.
Clinical situation

posterior uveitis

posterior segment: retinal vasculitis

anterior segment: non-granulomatous uveitis
Clinical situation

complications: complicated cataract, secondary
glaucoma and optic nerve atrophy.

extraocular symptom: relapsing ulcer of mouth,
ulcer of genital organ, skin lesion, arthrositis and
optic nerve atrophy.
Clinical findings
1.Lesion of the eyes
Clinical findings
2.Oral ulcer
Clinical findings
3.Lesion of the skins
Diagnosis

relapsing ulcer of mouth, three times in a year at
least

diagnosis by any two followed:
--- relapsing ulcer of genital organ or scar of
genital organ
--- ophthalmologic lesion
--- skin lesion
--- hypersensitivity of skin
Treatment
very hard, immunologic treatments are applied.

Drug

Plasma exchange

Laser treatment

Treatment according to complications
Tumor of the Uvea
Iris nevus

A benign tumor at surface of iris, brown, smooth and
with clear border. commonly occurred in male at age
of 20-40

If the colour becomes deep or the area of nevus
becomes larger, it is the omen of canceration. Excision
by surgery is necessary.

Follow-up strictly.
Iris cyst

Etiology: congenital, inflammation, serosity, parasitic
and trauma

Implantation cyst is common during perforating
injury or intraocular operation. Follow-up strictly.

During its developing course, pupil may be pushed to a
side, even resulted in glaucoma. Excising by surgery is
necessary.
Choroidal osteoma

Benign tumor and grows slowly

commonly occurred in young female

yellow-white or orange and with blurred border
which is near by optic nerve head


FFA, B-scan and CT are helpful to diagnosis
Follow-up strictly or laser treatment