uveitis condition mainly focusing on its basic anatomy, basic general classification and its clinical features including common symptoms and signs along with pathology, common complications, investigations including both systemic and ocular, treatment and a short summary.

1. UVEITIS
OPTO LUCY JOHNSON MOONJELY
Bsc Optometry

2. Choroid
ANATOMY

3. CLASSIFICATION BASED ON ANATOMICAL SITE
• Iritis
• Iridocyclitis
• Anterior Cyclitis
Anterior
Uveitis
• Posterior Cyclitis
• Hyalitis
Intermediate
Uveitis
• Focal/ multifocal/diffuse choroiditis
• Chorioretinitis
• Retinochoroiditis
• Retinitis
• Neuroretinitis
Posterior
Uveitis
Pan Uveitis
Standardization
of Uveitis
Nomenclature
(SUN)

4. CLASSIFICATION ACCORDING TO INFLAMMATORY ACTIVITY
TIMMING
Onset
• Sudden
• Insidious
Duration
• Limited 3 months/ less
• Persistent
Clinical Course
• Acute
• Chronic
• Recurrent
SUN
Acute
• Sudden
• Limited
Recurrent
• Repeated
episodes with
untreated
inactive
periods
Chronic
• Persistent with
relapse <3
months after
discontinuation
of treatment.

5. CLASSIFICATION BASED ON ETIOLOGY
• Bacteria
• Fungal
• Parasitic
• Viral, others etc
Infectious
• With or without non-systemic
associations
Non -
Infectious
• Neoplastic
• Non- neoplastic
Masquerade
INTERNATIONAL
UVEITIS STUDY
GROUP
(IUSG)

6. CLASSIFICATION ACCORDING TO PATHOLOGY
Feature Granulomatous Non- Granulomatous
Onset Insidious/ chronic Acute
Pain Mild Marked
Photophobia Slight Marked
Ciliary congestion Minimal Marked
KP Mutton fat Fine
Aqueous flare Mild Intense flare
Iris Nodules Usually present Absent
Posterior Synechiae Thick and broad Thin
Fundus Nodular lesions Diffused
Area Anterior uvea and
choroid equally involved
Mainly limited to anterior
uvea
• Suppurative uveitis
• Non- suppuravtive
uveitis

7. CLINICAL FEATURES

8. SYMTOMS
• Unilateral Sudden eye pain
• Redness
• Watering
• Blurring of Vn
• Photophobia
• Floaters
SIGNS
• Visual Acuity
Maybe be normal or decreased

9. SIGNS
CORNEA
Keratic Precipitates (KP)
Fine KP: herpetic, CMV retinitis..
Mutton fat KP: sarcoidosis, TB, syphilis..
Fine KP:“Stellate” – typically covers the entire
endothelium
Mutton fat : mostly on inferior cornea
Mutton fat Fine
d/t toxins nutrition of
corneal endothelium is
affected
Endothelium becomes
sticky and oedematous
Cells desquamated at
places inflammatory
cells stick to
endothelium as cellular
deposits

10. Ciliary flush
Due to involvement of deeper blood
vessels circumcorneal conjunctival
hyperemia
CONJUNCTIVA
Corneal dusting
• Endothelial
dusting by
numerous
individual cells
precedes the
formation of true
KP aggregates.
Ciliary flush

11. IRIS
Posterior synechiae
Iris atrophy
Busaccas nodules
Iris nodules
Spots of exudate/ pigment
derived from the posterior layer
of the iris left permanently on
the anterior capsule of the lens
Adhesions of iris to lens
capsule
Later adhesion leads to fibrous
bands between iris and lens
capsule
In the early stage, mydriatics can free up
the adhesion but not in the late.

12. ANTERIOR CHAMBER
Cells
• Indicator of active inflammation
Flare
• When blood aqueous barrier breaks down
 leakage of protein in the aqueous 
haziness
GRADING ACCORDING TO SUN
CLASSIFICATION

13. IOP
 Low
• Decrease in CB production of aqueous when inflamed or increase in uveoscleral
outflow
 High
• Trabiculitis
• Debris and inflammatory cells in TM
• Pupillary block
• Secondary angle closure
Hypopyon

14. Peripheral anterior
synechiae
When the aqueous
drainage gets hampered
collection of aqueous
behind the iris
iris bulges out
contact with cornea at
periphery
PAS formed

15. VITREOUS
Vitritis- inflammatory cells and opacities
Snowbank- white exudates in the ora serata
and pars plana.
Snowballs- cellular aggregates floating in
the vitreous
Snowbanks are typically seen in inferior vitreous

16. CHOROID
Choroiditis
Active lesion- yellow nodule
Focal choroiditis- toxocariasis, TB, cat
scratch disease
Multifocal choroiditis- cat scratch disease
Choroidal folds

17. RETINA
Retinitis
Active lesion- whitish retinal opacities with
indistinct borders due to surrounding
edema.
Focal retinitis- toxoplasmosis
Multifocal retinitis- syphilis, HSV,CMV
Vasculitis- arteries(arteritis), veins
(phlebitis) or both are affected

18. COMPLICATIONS
• CME
• Choroidal neovascularization
• Glaucoma
• Cataract

19. INVESTIGATION

20. SYSTEMIC
• CBC
• ESR
• CRP
• Antitoxoplasma antibody-Toxoplasmosis
• Syphilis serology test
o Tpha
o VDRL
• ACE – sarcoidosis, TB, leprosy
• ANA- RA
• Chest X-ray- sarcoidosis, TB

21. • QuantiFERON TB Gold- TB
• HIV serology

22. OCULAR
Imaging techniques Indication Application in uveitis
OCT Macular and optic disc
pathology
Macular edema, retinitis,
choroiditis, vitreoretinal
disorders
OCT-A Retinal or choroidal vascular
pathology
Retinitis, choroiditis, retinal and
choroidal neovascularizations
Ultrawide field (optos) Vitreoretinal or choroidal
pathology involving the
periphery
Retinal vasculitis
FFA Retinal and retinal pigment
epithelium pathology
Choroiditis
FAF Retinal vascular pathology Retinal vasculitis, macular
edema, retinal and choroidal
neovascularizations
ICGA Choroidal vascular pathology Choroiditis, choroidal
neovascularizations

24. TREATMENT

25. MEDICAL THERAPY
• Specific (etiology dependent)
o ATT- TB
o Parenteral Penincilin- syphilis
o Sulfa and Pyrimethamine- toxoplasmosis
o Ganciclovir- CMV retinitis
• Non- specific
o Cycloplegics( Mydriatics)
o Corticosteroids
o Immunosuppressives
o NSAIDs

26. Cycloplegics
o To relieve pain and ciliary spasm
o To prevent posterior synechiae and break the ones already formed
Corticosteroids
Depending on the site of inflammation and severity
o Topical – prednisolone, fluorometholone
o Periocular – methylprednisolone, betamethasone
o Systemic – prednisone, methylprednisolone
Immunosuppressives
In corticosteroid resistant and intolerant cases
o Antimetabolites – methotrexate, azathioprine
o Alkylating agents – cyclophosphamide, chlorambucil
o T- cell inhibitors – cyclosporin, tacrolimus

27. Anti- VEGF – ranibizumab
NSAID – Bromfenac, nepafenac

28. SUMMARY
ANTERIOR UVEITIS INTERMEDIATE UVEITIS POSTERIOR UVEITIS
Anterior chamber Vitreous Retina or Choroid
Redness, pain, photophobia,
watering and blurred vision
Floaters Reduced vision
Cells and flare Snowbanks and snowballs Headlight in fog
(toxoplasmosis), vitritis,
vasculitis and chorioretinitis
Topical steroids, cycloplegics Triamcinolone (inj) Systemic steroids,
antimicrobials

29. THANK YOU