Transcript Anatomy and diseases of the uvea

Anatomy and diseases of the
uvea
Anatomy:
Uvea is the vascular coat of eye ball and
lies between the sclera and retina. Uvea is
composed of three parts i.e. iris, ciliary
body and choroid. These three portions
are intimately connected and a disease of
one part also affects the other portions
though not necessarily to the same
degree.
Uvea
1) Iris:
Iris is a delicate membrane placed in the
anterior part of the eye ball and perforated
in the center i.e. pupil.
It arises from the middle of anterior
surface of ciliary body.
It is slightly pushed forward by the lens
which gives it the appearance of a
truncated cone, the apex of which has
been cut off.
IRIS
Anterior surface has two zones:
1) Papillary zone: is flat and has a dark
border at the papillary margin , known as
papillary ruff. Junction of papillary and
ciliary zone is marked by a smooth ridge
known as collaret.
2) Ciliary zone: towards the ciliary
border has ciliary crypts. Histologically
iris has got 5 layers (from before
backward).
1- Endothelium: flat nucleated cells
absent over the crypts probably to allow
free movement of the aqueous in and out
of the iris.
2- Vessel layer: consist of blood
vessels lying in collagen fibers,
chromotophores etc.,
3- Muscular layer: two muscles:
a) Sphincter pupillae- plain muscle
developed from neuroectoderm- supplied
by parasympathetic fibers coming through
the 3rd nerve (relayed in ciliary ganglion).
b) Dilator pupillae- also arise from
neuroectoderm and supplied by cervical
sympathetic fibers reaching the eye through
long ciliary nerves (not relayed in ciliary
ganglion).
4- Pigmented epithelium- two layers.
The two layers are loosely attached to
each other and there is a potential space
between the 2 layers. In iridocyclitis
there is adhesion of the iris to the lens.
When a mydriatic is applied the posterior
layer of pigment epithelium gets partly
detached. This produces pigment
deposition and pigmented patches on the
anterior lens capsule (broken posterior
synechiae).
5- Internal limiting membrane- fine and
homogenous structure, not consistently
present.
Function of the iris:
1- Regulates the entry of light into the eye
by changing the size of papillary aperture.
2- Cuts away the peripheral aberrations.
3-Absorption of aqueous also takes place
from its surface.
2) Ciliary body:
Ciliary body is a ring shaped structure
placed more or less sagitally and extends
from the ora-serrata to the scleral spur. It
consists of ciliary processes and ciliary
muscle. On longitudinal section it is
triangular. It’s anterior surface or base is
shortest. Iris is attached to the base.
The outer side of triangle is adjacent to
sclera and is formed by ciliary muscle.
Ciliary body
Ciliary body
The inner surface is directed towards
the cavity of the eye ball and is divided
into two portions anterior (pars plicata )
and posterior (pars plana).
Ciliary muscle consists of:
1. Meridional fibers.
2. Circular fibers.
3. Radiating fibers.
Meridional fibers on contraction pull the
suprachoroidea forwards and release the
suspensory ligament allowing the lens to
become more convex as in
accommodation. The pars plicata has
about 70 ciliary processes. They secrete
aqueous.
Functions of ciliary body:
1. Brings about accommodation.
2. Formation of aqueous.
3. Helps in drainage of aqueous at the
angle of anterior chamber.
3) Choroid:
Choroid is the analogue of pia-arachnoid
of the brain and serves the same purpose
of supplying nutrition to the neural
portion of eye i.e. retina. Choroid is
composed of five portions.
1. The outer most is
SUPRACHOROIDEA a potential space
between the choroid and sclera. This is
lined by endothelium and traversed by
fibrous trabeculae.
This space is utilized for the treatment of
aphakic glaucoma in the operation of
cyclodialysis.
Deeper to it are three vascular layers.
2. Layer of LARGE BLOOD VESSELS is
outer most.
3. Next comes MEDIUM SIZED BLOOD
VESSELES.
4. and SMALL BLOOD VESSELES or
CHOROIDO-CAPILLARIES.
Layer of choriocapillaries is the most
important. It serves to provide nutrition to the
outer layers of retina. The choriocapillaries
are much wider than the capillaries
elsewhere. Their diameter varies from 10 to
30 microns.
5. The innermost layer is avascular known as
MEMBRANE of BRUCHS. This is
composed of elastic and cuticular lamina and
pigment epithelium of retina is intimately
attached to it.
Classification:
A) Depending upon the site of
inflammation:
1) Anterior uveities
- iritis.
- cyclitis.
- iridocyclitis.
As iris and ciliary body are continuous,
iritis seldom occurs without some
inflammation of the ciliary body and vice
versa.
Iritis
cyclitis
iridocyclitis
The terms iritis and cyclitis are used
depending on which structure is clinically
more affected.
2) Posterior uveities- choroidities.
3) Pan uveities: Iris, ciliary body and
choroid are inflamed.
B) Uveities may be:
-acute.
-sub acute.
-chronic.
choroiditis
choroiditis
C) Clinico –pathological classification:
Granulomatous
1) Onset: insidious,
Non Granulomatous
(1
Acute onset of severe
eye relatively white.
inflammation (red eye).
2) Course: chronic.
Short.
3) KPs: medium and large Small KPs.
and often mutton fat.
4) Slight aqueous flare.
5) Nodules on iris present Intense aqueous flare.
Koeppe's nodules are
Absent.
seen on the pupillary
margin. Busacca's
nodules are seen near
coflarette.
6) Dense broad based
posterior synechiae.
Fine synechiae.
7) Tends to affect entire
uvea.
Tends to affect anterior
uvea.
8) Heavy
vitreous exudate
or veils common.
Fine punctate opacities in
the vitreous.
9) Etiology: direct
organismal infection.
Allergy.
10)Complications: more
Complications: few.
Etiology:
In most cases it remains obscure.
1) Infection:
a. Exogenous- the organisms reach the eye
from outside.
i) Perforating injury.
ii) Perforating corneal ulcer.
iii)Intraocular operation.
This usually leads to suppurative iridocyclitis,
endophthalmitis and even panophthalmitis.
b. Secondary- due to spread from one or other
of the ocular tissue- corneal ulcer, scleritis.
c. Endogenous: Organisms primarily lodged
in some other organ of the body reach the
eye through the blood stream.
i) Viral- herpes simplex, herpes zoster,
measles, mumps, rubella.
ii)Bacterial: tuberculosis- syphilis, leprosy,
gonorrhea, brucellosis.
iii) Fungal: histoplamosis, asperigillosis,
candida albicans, actionomycosis.
iv) Protozoa: Toxoplasmosis.
v) Nematodes: ankylostomiasis, filariasis.
2) Allergy:
a. Bacteria:
i) T.B. usually of the lungs, lymph nodes.
ii) Streptococci- teeth, tonsils, sinuses,
urogenital tract.
Primarily source of infection exists at these
sites. At one time the infection was
generalized by the escape of organisms into
the blood stream when the ocular tissue- uvea
had become sensitized to them. At a later
date further dissemination of the organisms
or their proteins meeting the sensitized uveal
tissue excites an allergic response.
b. Lens proteins- phako- anaphylactic
reaction. They have also a toxic action on
iris.
c. Uveal pigment- sympathetic ophthalmitis.
3) Constitutional disorders:
Diabetes mellitus, gout, rheumatoid arthritis
(adult and juvenile), ankylosing spondylitis.
4) Trauma:
a. Blunt.
b. Sympathetic ophthalmitis.
5) Idiopathic:
a. Sarcoidosis.
b. Vogt- Koyanagi- Harada's disease.
c. Behcet's disease.
6) Miscellaneous:
Intraocular haemorrhage, intraocular tumour.
Pathology:
Inflammation of the iris and ciliary body has
the same characteristic as other vascular
connective tissue.
Sarcoidosis
1. dilatation of the blood vessels.
2. exudation of protein rich fluid into the
tissue space with leucocytes or
lymphocytes.
1) Pupil: small and reacts sluggishly to
light owing to
a. hyperemia of the radially disposed
vessels of the iris.
b. exudate contains toxic substances which
irritate the sphincter pupillae (this muscle in
more powerful than dilator pupillae).
2) Delicate patterns of iris: crypts-
become blurred and indistinct (muddy iris).
3) Colour of iris: undergoes change-
brown iris becomes grayish.
4) Exudate in AC:
a. Aqueous flare.
b. Sometimes hypopyon.
5) Exudate in posterior chamber:
induces adhesion between posterior surface
of iris and the lens (posterior synechiae).
6) Exudate in vitreous: vitreous haze.
Symptoms:
1) Pain the eye ball:
It is dull aching, worse at night, it may be
referred to the forehead along the 1st
division (ophthalmic) of the trigeminal. It is
due to:
a. The iris has a rich nerve supply; the nerve
endings are stimulated by a high
concentration of toxic substances.
b. Spasm of ciliary muscle.
c. Secondary glaucoma.
2) Diminition of vision due to:
a. Spasm of ciliary muscle- pseudo myopia.
b. turbidity of aqueous, vitreous.
c. exudate in papillary area.
d. choroidities when associated in
panuveitis.
e. Secondary glaucoma.
f. complicated cataract.
g. cyclitic membrane.
h. retinal detachment.
3) Photophobia, redness, watering.
Signs:
1) Oedema lids in severe cases with watery
discharge.
2) Ciliary and conjunctival congestion.
3) Cornea:
May show oedema, KPs- These are small
accumulations of cells derived from the
uveal tract upon the back of the cornea.
They are found in iridocyclitis, and
choroidities. In iridocyclitis the nutrition of
the corneal endothelium becomes affected
so that the cells become sticky and may
desquamate in places.
There the cells derived from the uvea tend to
stick, forming KPs. The KPs are scattered
over a triangular area of the lower part of the
cornea (triangle of Arlt) an arrangement due
to convection currents in the aqueous and
gravitation of the cells towards the bottom of
the AC.
Morphological types:
KPs may be fine, coarse, snowball type or
mutton fat (these are large greasy plaques
with regular outline). KPs may either be fresh
(grayish white with regular outline) or old
(pigmented brown and serrated margins).
HISTOLOGY:
1)In exudative type of inflammation the KPs
are composed mainly of lymphocytes and
plasma cells.
2)Granulomatous type of uveities- mutton
fat KPs are composed of epithelioid and
histiocytic mononuclear phagocytes.
IMPORTANCE:
KPs may be seen with naked eye- mutton fat
KPs.
Frequently the KPs cannot be seen even
with corneal loupe.
The detection of these KPs with slit lamp is
of great value:
1) In diagnosing a quiet uveitis, sympathetic
ophthalmitis.
2)KPs are also useful in prophylactic
treatment of sympathetic ophthalmitis.
3)KPs indicate whether the uveitis is active
or healed.
4)AC:
a- Deep (due to iris being plastered on the
lens)
b-cells in AC
c- aqueous flare
The aqueous humour is almost optically
empty. If a spot light of slit lamp be used
the presence of colloidal particles such as
proteins produces sufficient dispersion of
light (Tyndall phenomenon) to make it
visible.
This is known as aqueous flare and it is
present in iridocyclitis due to increased
permeability of the vessels to proteins.
5) pupil:
Is small, irregular (due to posterior
synechiae) and reacts sluggishly to light.
This irregularity is exaggerated when pupil
is dilated with mydriatic- festooned pupil
(resembles a wreath such as is placed on a
war memorial). Posterior synechiae may be:
a) filiform seen in non granulomatous
uveitis.
b) broad based posterior synechiae seen in
granulomatous uveitis.
c) annular or ring synechiae or seclusion
pupillae.
In severe cases of plastic iridocyclitis or after
recurrent attacks the whole circle of the
papillary margin may become tied down to the
anterior lens capsule.
It is of great danger to the eye since if
unrelieved it inevitably leads to secondary
glaucoma- the aqueous unable to pass forwards
into the anterior chamber, collects behind the
iris which becomes bowed forward like a sail, a
condition which is called iris bombe. Regarded
from in front, the anterior chamber is seen to be
funnel shaped, deepest in the centre and
shallowest at the periphery.
The filteration angle is then obliterated by
the apposition of the iris to the cornea of
the periphery where eventually adhesion
may from (peripheral anterior synechiae).
The drainage of aqueous is obstructed and
the tension rises.
d) Total posterior synechiae: whole of the
posterior surface of the iris is plastered to
the lens. The AC is deep uniformly.
OCCLUSIO PUPILLAE (blocked
pupil):
In severe cases of irido cyclitis the exudates
may cover or may organize across the entire
papillary area which becomes ultimately
filled by a film of opaque fibrous tissue- the
condition is called occlusio pupillae
occlusion pupillae and seclusion pupillae
often occur together.
Occlusion pupillae may occur with total
posterior synechiae.
6) IRIS:
a- "Muddy iris" – delicate pattern or iris –
crypts become blurred and indistinct.
b- nodules- these may be of 2 types:
i) pseudo nodules: These consists of
accumulations of lymphocytes and epitheloid
cells which are deposited on the iris koeppe’s
nodules near the papillary border and
Busacca's nodules near the collarette.They
disappear without fibrosis.
ii)True nodules: These arise in the stroma of
the iris and on healing leave behind a scar or
an atrophic patch.
nodules
1.Colour
Tuberculous
nodule
Syphilitic
nodule
Leprosy
nodule
Sarcoid
nodule
Ophthalmia
nodosa
Grey or yellow
avascular
capillaries pass
over nodule.
Yellowish-red
avascular
Pale
avascular
Reddish
Pink
vascular
vascular
capillaries
pass over and
in the nodule
2.Location
3.Progress
Pupillary or
Pupillary or
Pupillary
ciliary region
ciliary region
region
Grow slowly
Grow
relatively
Grow
quickly
slowly
Any part
Grow slowly
Any part
Grow
slowly
Syphilitic nodule
C- Colour of iris: undergoes change brown
iris becomes grayish. White patches of
atrophy are seen in late stages.
d- Rubeosis iridis: new vessels on iris in
chronic iridocyclitis.
7) Lens:
Anterior surface of lens may show patches
of pigment where posterior synechiae have
been broken by mydriatic.
8) INTRAOCULAR PRESSURE: may be
raised, normal or lowered.
9) CILIARY TENDERNESS: particularly when cyclitis
is predominant.
Healed iridocyclitis
Active iridocyclitis
Diminished vision may be
present.
1) symptoms:
Pain, redness,
photophobia, diminished
vision
Eye is white
Pigmented KPs with
crenated or serrated
margin.
Absent
Absent
2)signs:
a- ciliary and conjunctival
congestion
b-KPs grayish white,
circular with regular
margin.
c- Aqueous flare present.
d- Ciliary tenderness
present.
COMPLICATIONS:
1) Secondary glaucoma: hypertensive
iridocyclitis. This may be due to:
i) clogging of trabecular meshwork by
inflammatory exudates- plasmoid aqueous.
ii) seclusio pupillae.
iii) seclusio pupillae produces iris bombe
which gives rise to peripheral anterior
synechiae.
iv) occlusion pupillae.
v) increased capillary hydrostatic pressure
leading to increased aqueous formation.
2) Complicated
cataract: Refer lens
chapter.
3) Cornea:
a) a corneal opacity may result from
persistent oedema.
b) band shaped keratopathy particularly in
cases of Stills disease.
c) Retrocorneal membrane due to
organization to exudates behind the cornea.
4) Cyclitic membrane:
It is a membrane formed in the anterior
vitreous behind the lens due to organization
of inflammatory exudates.
Significance:
1-causes diminision of vision
2- causes traction retinal detachment.
3- one of the causes of pseudoglioma in
children.
5) Retinal detachment:
a) due to contraction of cyclitic membrane.
b) It may be exudative retinal detachment
when iridocyclitis is associated with
choroiditis.
Retinal detachment
6) Phthisis bulbi:
a) damage to ciliary body occurs due to
organization of exudates on the surface.
b) contraction of cyclitic membrane may
detach the ciliary body. These result in
decreased production of aqueous leading
to ocular hypotony and phthisis bulbi.
Phthisis bulbi
Differential diagnosis:
1-Pain
Acute conjunctivitis
Acute
Iridocyclitis
Acute congestive
glaucoma
Foreign body or gritty
sensation
Pain radiating
along 1ST division
(ophthalmic)
Of 5th nerve
Severe neuralgic
pain radiating along
all 3 divisions of 5th
nerve associated
with nausea and
vomiting.
Moderate
Gross diminision
sometimes reduced
No pain
2-Vision
Not affected, may be
slightly blurred.
diminision
to just PL.
3-Discharge
4-Congestion
Mucopurulent
Conjunctival
congestion
Watery (serous)
Watery (serous).
Ciliary and
conjunctival
congestion
Ciliary and
conjunctival
congestion
5-Cornea
Clear sensation
normal
Mild oedema
sensation
Normal KPs on
back of cornea
Cloudy or
steamy
insensitive.
6-AC
normal
deep
Shallow.
7-Pupil
Normal size
reaction
Normal
Small, irregular
sluggish reaction
Large, vertically
oval fixed.
8-Intraocular
pressure
normal
Low, normal or
raised
Markedly raised
eye stony hard.
9-Ciliary
tenderness
absent
present
Absent.
Acute iridocyclitis should also be differentiated
from other causes of red- corneal ulcer, scleritis etc.
INVESTIGATIONS:
1.General examination for evidence of leprosy,
tuberculosis, syphilis, rheumatoid arthritis etc.
2.Urine – albumin, sugar and microscopic
examination for pus cells.
3.Stools- ova and cyst.
4.Tuberculosis – Mantoux test, X-ray chest
5.Syphilis – blood VDRL
6.Rheumatoid arthritis- Rose- waaler test.
7.Toxoplasmosis: HA test, dye test and ELISA
test.
8.Thorough dental, ENT, and gynaecological
check up to rule out septic foci
TREATMENT:I) Local:
i. Cycloplegic mydriatic therapy:
a) 1% atropine drops or ointment t.d.s. This is
the most important drug in the treatment of
iridocyclitis. It acts as follows:
1-puts the iris and ciliary body at rest.
2-diminishes congestion of iris and ciliary
body.
3-prevents the formation of posterior
synechiae or tends to break those already
formed.
4-has mild anaesthetic action.
b) In cases where pupil does not dilate with
atropine, subconjunctival injection of 0.3 cc
mydricaine is given (this contains atropine,
adrenaline and procaine and is a potent
mydriatic).
c) In cases of atropine allergy- 2%
homatropine, 1% cyclopentolate, 0.5%
hyoscine may be used.
ii) Cortisone drops or ointment 3-6 times a
day. This is useful because of the allergic
nature of the disease. In severe cases
subconjunctival injection of Dexamethasone is
given.
NB: Indiscriminate and long term use of
corticosteroid may cause rise in intraocular
pressure.
iii) Hot fomentation t.d.s.
iv) dark glasses.
II) General
1)Treatment of causative factor- T.B., (1
infected teeth etc., should be treated or
eliminated.
2) Analgesics- paracetamol.
3) Systemic corticosteroid in severe cases of
iridocyclitis or when associated with
choroiditis.
III) Treatment of complications:
1) secondary glaucoma:
a) local use of 1% atropine,
corticosteroid, hot fomentation.
b) Tab. Diamox 250 mg t.d.s.
c) surgical- paracentesis. Peripheral
iridectomy can be done to relieve the
papillary block in cases of iris bombe. In
cases with extensive peripheral anterior
synechiae due to iris bombe,
trabeculectomy may be required.
Earlier, Fuchs four dot iridotomy was
done by passing Von Graefes knife across
AC puncturing and counter puncturing
both cornea and iris. This is now of
historical interest only.
2) Complicated cataract: Refer lens
chapter.
Choroiditis
Etiology:
I-Infection
1) Endogenous
a. virus
- Rubella.
b. bacteria
- TB, syphilis.
c. fungi
- histoplasmosis.
d. protozoa
- toxoplasmosis.
e. Nematodes - ankylostomiasis, filariasis.
2) Exogenous : perforating injury; perforated corneal ulcer ect,
these lead to suppurative choroiditis , endophthalmitis and
even panophthalmitis.
3) Secondary : spread of inflammation from posterior scleritis
II) Idiopathic: sarcoidosis ,Vogt – koyanagi - haradas disease
choroiditis
Inflammation of choroids:
Suppurative choroiditis: this is acute type of (1
inflammation and usually spreads over whole of
choroids, ultimately leads to panophthalmitis.
2) Non suppurative choroiditis:
a) Granulomatous choroiditis : it is associated with
presence causative organisms .
b) Exudative choroditis : this is non specific plastic
inflammatory reaction characterized with
excessive exudation and poor cellular response .
this is an allergic response of the sensitive tissue to
the presence of bacterial toxins .
Fundus examination shows :
1) vitreous haze and vitreous opacities.
2) patches of choroiditis. These patches are
yellowish or yellowish white with ill defined
fluffy margin.
3) Later the exudates undergo resolution by
fibrosis and the patches become white with
well defined margin.
Complication :
1) complicated cataract result from defective
nourishment of the lens.
2) Exudative retinal detachment due to exudation of
fluid between pigment epithelium and rods and
cones .
3) optic neuritis : result when the inflammatory
patch is close to optic disc .
4) consecutive optic atrophy : from the destruction
of retinal ganglion cells .
Varieties of posterior uveitis :
It classified according to the situation and character
of the patches:
1.Circumscribed choroidities.
2.Diffuse choroiditis.
3.Disseminated choroiditis.
4.Anterior choroiditis.
5.Central choroiditis.
6.juxta papillary choroiditis of Jensen.
Symptoms :
Visual disturbances are common:
1) visual acuity may become defective more markedly
when:
a- the lesion is in the central area near the posterior
pole.
b- cloudiness of vitreous is present.
2) metamorphpsia –distortion of object may be seen .
3) micropsia and macropsia –objects appear smaaler
or bigger, due to separation or crowding of
retinal elements respectively.
4) photopsia–subjective flashes of light, due to
irritation or retinal elements by exudates.
5) positive scotoma: perception of black spot before the eye.
6) negative scotoma: hiatus in the field of vision ( patient is not
aware of this ).
specific type of posterior uveitis :
Tuberculosis of the choroid occurs in acute milliary and chronic
forms:
1) acute - in milliary tuberculosis there are multiple small spots
scattered all over the fundus varying in size from pin point to
2mm diameter.
2) chronic tuberculosis - may result in:
diffuse choroiditis.- disseminated choroiditis.
- solitary or conglomerate tubercle.
Differences between active and healed choroiditis :
Active choroiditis
1-Vitreous haze is present.
2-Yellow patch with
feathery margin.
3-Borders are not
pigmented.
4-Produces passive scotoma
due to inflammatory
exudates in front of
light sensitive element.
5-Underlying choroidal
vessels obscured.
6- Often requires
treatment.
Healed choroiditis
Vitreous is clear.
White patch with
circumscribed margin.
Borders are pigmented.
Produce negative scotoma
due to destruction of
photoreceptors.
Large choroidal vessels.
No treatment required.
Treatment of choroiditis:
usually unsatisfactory as the retinal damage caused is
permanent.
1) local: - 1% atropine .
- posterior subtenon injection of corticosteroid.
- hot fomintation .
2) systemic: - corticosteroid by mouth .
- specific treatment of cause syphilis Inj . Benzathine penicillin.
- tuberculosis – anti tubercular
treatment.
congenital abnormalities of the uveal tract:
persistent pupillary membrane - in the early foetal
eye pupil is covered over by a delicate
membrane known as pupillary membrane.
conginital aniridia : failure of iris to develop.
There is usually associated nystagmus and
foveal hypoplasia.
heterochromia iridis : part of the same iris
usually a sector may differ in colour from the
remainder .
heterochromia iridum : one iris may have
different colour from the other.
behcets syndrome: it is an acute iridocyclitis seen
in young adult associated with:- hypopyon,
ulcerative lesion in mouth.
Congenital aniridia
Iris coloboma
heerfordts disease: it is a bilateral affection characterized by
involvement of the entire uveal tract, the parotid gland and
cranial nerve.
Vogt koyanagi haradas syndrome
Fuchs heterochromic iridocyclitis
Sympathetic ophthalmitis
Rubeosis iridis: it is characterized by the development of new
and enlarged vessels on iris.and is seen in:
i) diabetes mellitus
ii)After central retinal vein occlusion
iii)After central retinal artery occlusion
In cases of diabetes mellitus with rubeosis and mature cataract
iridectomy may have to be omitted or peripheral iridectomy
done in an area where rubeosis is not present
Complication:secondary glaucoma due to fibro vascular
membrane blocking trabecular meshwork and due to
recurrent hyphaema
Rubeosis iridis
Vogt koyanagi haradas
syndrome
Nodules on the iris are seen in the following disease •
1) Iridocyclitis: due to tuberculosis, syphilis, leprosy •
2)Iris melanoma:usually seen in people between 40 and 50 •
years and presents as a solitary pigmented nodule on the
lower half of iris feature that should arouse suspicion of
malignancy include:
- ectropion uveae •
- pupillary distortion •
- neovascularization •
- raised IOP •
- increase in nodule size •
3) Lisch nodules •
4) Juvenile xanthogranuloma •
Iris melanoma
Lisch nodules
Juvenile xanthogranuloma
PANOPhTHALMITIS •
Definition: •
An intense suppurative inflammation of the entire uveal •
tract which fills the eye ball with pus, extends to all the
structures of the eye and ends in complete destruction of
this organ.
Etiology: •
Infection is by pyogenic organisms: •
1) ps. Pyocyanea •
2) pneumococcus •
3) staph •
4)strept •
5) E. coli •
6) gonococcus •
i) Exogenous infection: •
1) perforated corneal ulcer •
2) penetrating wounds •
3) intraocular operation •
ii) Endogenous infection •
Results from septic embolism of a retinal or a choroid vessels.
Such cases occur in the course of infectious disease
pneumonia, meningitis
symptoms:
1) the disease is usually start with fever,
headache, vomiting
2) severe pain in the eye ball.
3) complete loss of sight.
Sign: it is usually unilateral
1) lids swollen and red.
2)congunctiva- intense ciliary and
congunctiva congestion, chemosis of
conjunctiva.
3) slight proptosis and limitation of
movement of eyeball.
4) perforated corneal ulcer, and cloudy
yellow ring infiltration occur.
5) AC filled with pus.
6) increased I.O.P .
7) in severe cases the pus bursts through the wall
of the globe.
Treatment:
I- At early stage :
1) intensive treatment by antibiotics both local
and systemic.
2) analgesics- tap.paracetamol.
3)hot fomentation.
II- As soon as it becomes evident that the eye
cannot be saved evisceration is done.
Frill excision: if the entire sclera is left. There is
considerable pain, reaction and delayed healing.
It is not considered advisable to enucleate in cases
of panophthalmitis on account of the danger of
causing meningitis.
Prognosis:
is always bad. However the condition does not
cause sympathetic ophthalmitis.
Hetrochromia waardenhurg’s
Iris prolapse
Iris hemangioma
Iris cyst
Iris nevus
Iris tumor
Iris neovascuralization
Herbert’s pits
hypopyon
Keratouveitis
Koeppe's nodule
Synechiae posterior
pseudo exfoliation
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