Uveitis

UVEITIS


UVEITIS

  • Uveitis refers to the inflammation of uveal tissue.

ANATOMICAL CLASSIFICATION

1. Anterior uveitis:

  • It is inflammation of the uveal tissue from iris upto pars plicata of ciliary body.

Subdivided into:

  1. Iritis, in which inflammation predominantly affects the iris.
  2. Iridocyctitis in which iris & pars plicata part of ciliary body are equally involved.
  3. Cyclitis, in which pars plicata part of ciliary body is predominantly affected.

2. Intermediate uveitis:

  • includes inflammation of the pars plana & peripheral part of the retina & underlying ‘choroid’.
  • It is also called ‘pars planitis’.

3. Posterior uveitis:

  • It refers to inflammation of the choroid (choroiditis).
  • There is associated infammatory of retina & hence the term ‘chorioretinitis’  is used.

4. Panuveitis:

  • It is inflammation of the whole uvea.

Causes of Anterior Uveitis

AUTOIMMUNE

  • Ankylosing spondylitis (HLA-B27)
  • Reiter’s syndrome (HLA-B27)
  • Psoriasis
  • Sarcoidosis
  • Bechet’s disease (HLA-B5)

INFECTIONS

  • Syphilis
  • TB
  • Leprosy
  • HSV
  • Herpes zoster

MALIGNANCY

  • Retinoblastoma
  • Leukemia
  • Lymphoma
  • Malignant melanoma

OTHER

  • Idiopathic
  • Trauma
  • Fuch’s heterochromatic
  • iridocyclitis

Causes of Posterior Uveitis (Chorioretinitis)

  INFECTIOUS

  1. Virus
  2. Bacteria
  3. Fungi
  4. Parasite
  •  CMV, HSV, Rubella, Rubeola (Measles)
  • TB, Syphillis, Lyme’s disease
  • Candida, Histoplasma, Cryptococcus, Aspergillus
  • Toxoplasma, Onchocerca
  NON INFECTIOUS

  1. Autoimmune
  2. Malignancy
  3. Unknown etiology
  • Bechet’s disease (HLA-B5), SLE
  • Intraocular lymphoma, Leukemia
  • sarcoidosis

CLINICAL CLASSIFICATION OF UVEITIS

 1. Acute uveitis: 

  • Sudden symptomatic onset & the disease lasts for about six weeks to 3 months.

 2. Chronic uveitis:

  • It frequently has an insiduous & asymptomatic onset.
  • Persists longer than 3 months to even years & is usually diagnosed when it causes defective vision.

NON-GRANULOMATOUS UVEITIS

GRANULOMATOUS UVEITIS

  ACUTE

  • Idiopathic
  • Pyogenic : Staphylococcus, Streptococci
  • HLA-B27 associated: Ankylosing  spondylitis
  • Reiter syndrome
  • Bechet disease
  • Psoriatic arthritis, Reiter’s syndrome
  • Rheumatoid arthritis
  • Glaucomatocyclitic crisis (Ponser-Schlossman syndrome)

 

  ACUTE

  • Rare
  CHRONIC

  • JRA (Juvenile rheumatoid arthritis)
  • Chronic iridocyclitis of children
  CHRONIC

  • Sarcoidosis
  • Syphilis
  • Tuberculosis
  • Leprosy
  • Brucellosis
  • Vogt-Koyanagi-Harada’s disease

Exam Important

  • Anterior uveitis involve Iris and ciliary body.
  • Uveitis is caused by T.B., Staphylococcus,Streptococcus.
  • Commonest parasitic cause of uveitis is Toxaplasma.
  • Most common cause of anterior uveitis associated with Ankylosing spondylitis.
  • Most common etiological variety of uveitis is Allergic.
  • Recurrent non-granulomatous uveitis is seen in Posner-Schlossman syndrome.
  • Granulomatous uveitis with involvement of parotid gland is seen in Sarcoidosis.
  • HLA-B5 → Uveitis in Behcet’s disease.
  • Anterior uveitis is most commonly associated with HLA B 27.
  • Anterior uveitis is commonly associated with Psoriasis, Reactive arthritis & Ankylosing spondylitis.
  • The Uveitis associated with vitiligo & auditory defects occurs in Vogt-Koyanagi syndrome.
  • The investigation used in evaluation of anterior uveitis → HLA B 27, X-ray of sacroiliac joint & TORCH agents.
  • The investigation used in evaluation of posterior uveitis  →  Mantoux test.
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