Ò3 parts: Øiris (iris) Øciliary body (corpus cilliare) Øchoroid (choroidea) Ò ÒFunction: Øregulation of the entry of the light into the eye (pupil) Øaccomodation Øproduction of aqueous humor Ò Ò ÒUveitis – inflammation of the uvea Ò ØIntraocular inflammation causes damage of the endothelium of intraocular vessels with the collapse of the blood-barrier. Ò ØThere is a dilation of blood vessels, leakage intravascular content into the intravascular space, migration of leukocytes and other cells. Ò Ò Ò ÒAnatomical: Øanterior (iritis, iridocyclitis) Øintermediate (pars planitis, cyclitis, vitritis) Øposterior (choroiditis, chorioretinitis) Øall parts (panuveitis) Ø ÒClinical: Øacute - symptoms suddenly, lasting no longer than 6 weeks Øchronical - gradual onset of symptoms, duration of more than 6 weeks Ò Ò Ò Ò Ò Ønongranulomatous – acute formation, short duration, significant cilliary injection, small precipitates on the corneal endothelium, cells in the anterior chamber, fibrinous exsudate Ø Ò Ò Ò Ò Ò Ò Ò Obsah obrázku zavřít Popis byl vytvořen automaticky Anterior Uveitis - Pearls and Pitfalls - County EM Ø Øgranulomatous – slow formation, protracted course, significant cillary injection, precipitates on the corneal endothelium, iris nodules, vitritis, often affected choroid Ò Ò Ò Ò Ò Ò Ò Ò Granulomatous Iritis (Anterior Uveitis) Clinical Presentation: History, Physical, Causes ÒAccording to the etiology: ÒExogennous (injury uvea, microorganism invasion from the outside) Ò ÒEndogennous (inner, systemic inflammatory origin) Øuveitis associated with systemic disease Ò (eg. ankylosing spondylitis, sarcoidosis, tuberculosis, Ò multiple sclerosis) Øuveitis associated with parazitic infection (eg. toxokarosis) Øuveitis associated with viral infection (eg. herpes simplex) Øuveitis asscoiated with fungal infection (eg. candida) Øidiopathic uveitis (comprises about 25% of all uveitis) Ø a. Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò ÒSigns and symptoms: Øeye pain, photophobia, epiphora ciliary injection Øsmall precipitates on the corneal endothelium, abundant cells in the anterior chamber, in the course of severe fibrinous exudate in the anterior chamber Øhypopyon Øsynechiae formation (adhesions between the iris and lens) Ødilation of blood vessels in the iris Ø ØChronic complications (formation of synechiae in case of delayed treatment, complicated cataract development) Ø ØTreatment: corticosteroids locally, parabulbar, if necessary, generally, mydriatics, in the case of viral etiology antivirals Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Obsah obrázku zavřít Popis byl vytvořen automaticky Obsah obrázku zavřít Popis byl vytvořen automaticky ÒEtiology: ØHLA B27+ izolation, Ankylozing spondilitis ( M. Bechtěrev), Reiter syndrom, M. Crohn, Colitis ulcerosa, Ò Psoriatic artritis ØPhacoanafylaktic uveitis – imunological reaction on free proteins of the lens Ø ØViral diseases – Herpes simplex, herpes zoster in combination with keratitis Ø Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Obsah obrázku zavřít Popis byl vytvořen automaticky Obsah obrázku text, kobliha Popis byl vytvořen automaticky ÒSigns and symptoms: Øcreeping course, variable symptoms, usually no pain or only mild pain Ømild ciliary injection, mostly pale bulb, a small amount of precipitates on the corneal endothelium, a small number of cells in the anterior chamber Ølower tendency to the formation of the synechiae, chronic complications according to the disease activity (formation of complicated cataract, secondary glaucoma) ØTreatment: corticosteroids and nonsteroidal anti-inflammatory drugs locally, if necessary parabulbar or systemic, mydriatics, and according to etiology Ø Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò ÒEtiology: ØJuvenile rheumatoid arthritis ØSarcoidosis (granulomatous inflammation type) ØSyphilis ( roseolae of iris ) ØLyme disease ØTBC ( granulomatous inflammation type, yellow nodules on iris) Ø Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Obsah obrázku objekt v exteriéru Popis byl vytvořen automaticky ÒManifestations, symptoms, etiology: Ò Øcreeping course, without pain, decrease vision- opacities, fog Ømostly pale bulb Øvitritis - vitreous opacities (snowballs, snow benches) Øwith increased activity of inflammation macular edema Øchronic complications (development of complicated cataract, macular epiretinal membranes, preretinaland subretinal neovascular membranes) ØTreatment: according to the disease activity monitoring, corticosteroids overall or intravitreal corticosteroids, immunosuppressants (cyclosporine), biological therapy, PPV Øpossible link with MS or Lyme disease or unclear Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò ÒManifestations symptoms: Ò Øbeginning acute without pain, decrease vision- vitreous opacities, fog Ømostly pale bulb Øvitritis - vitreous opacities ØWell demarcated lesions affecting retina and choroid (focal or multifocal) Øwith increased activity of inflammation macular edema Øchronic complications (development of chorioretinal scars) ØTreatment: due to etiology, in infectious etiology causally antibiotics, antivirals systemically, in autoimmune etiology systemic corticosteroids or systemic imunosupressants Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò im000003 im000143 F:\White dot sy foto\Kvasnickova_Pavla_24-08-1967__(0000).jpg F:\White dot sy foto\Beker_Stanislav_17-01-1986__(0000).jpg ÒEtiology: ØToxoplasmosis (frequently) ØToxocarosis ØCandidosis (in patient with decreased imunity) ØSarcoidosis,TBC (granulomatous inflammation type) ØHerpes simplex, zoster retinitis ØCMV retinitis ( in immunocompromised patients) ØWhite dot syndroms (isolated autoimmune inflammation against retinal structures) ØSympathetic ophthalmia Ò Ò Ò Ò Ò Ò Ò Ò Ò ÒSevere form of intraocular inflammation affecting intraocular tissue structures, but does not go beyond the sclera. Ò ØExogenous - postoperative (acute 1-14 days after surgery, chronic two weeks up to two years after surgery), post-traumatic ØEndogenous - hematogenous transmission of pyogenic bacteria or mold (candida) for generalized septicemia Frequently agent: Staphylococcus, Streptococcus, Candida, Propionibacterium, Klebsiella, Haemophilus, Escherichia Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò ÒManifestation, Symptoms: ØAcute endophthalmitis – pain, sudden decrease in vision, conjunctivitis, edema of the eyelids, corneal edema, hypopyon, vitritis, necrosis of the retina Ø ØChronic endophthalmitis – without pain, visual acuity decreased only slightly, hypopyon just sometimes, mild vitritis ÒTreatment: ØATB, antimycotics in infusions, eventuel. intravitreal ØPPV Ø Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Ò Obsah obrázku zavřít, oči, brýle, ochranné brýle Popis byl vytvořen automaticky Obsah obrázku text Popis byl vytvořen automaticky