• Clinical science

Diseases of the uvea

Abstract

The uvea is the middle layer of the eye and consists of three parts: iris, ciliary body, and choroid (see also eye and orbit). There are four types of uveitis: anterior, posterior, complete (panuveitis), and intermediate, being the latter the least common. Uveitis is significant because of its association with systemic inflammatory conditions such as sarcoidosis, seronegative spondyloarthropathies, and vasculitides. However, infectious causes such as brucellosis, leptospirosis, and Lyme disease are also possible. Anterior uveitis manifests with periocular pain, ocular hyperemia (“red eye”), and photophobia. Posterior uveitis manifests with painless visual disturbances such as floaters and decreased visual acuity. Initial treatment for uveitis includes topical glucocorticoids and cycloplegics. If infection is suspected, an antibiotic or antiviral is used prior to topical glucocorticoids. Complications of uveitis include secondary glaucoma, cataract, posterior synechiae, and vision loss.

Other disorders of the uvea covered in this learning card are neovascularization of the iris, benign and malignant uveal tumors, iridodialysis, iridodonesis, and heterochromia.

Anatomy of the eye

Uveitis

  • Definition: inflammation of the uvea (anterior, intermediate, posterior, and complete )
Common types of uveitis
Anterior uveitis (most common) Posterior uveitis
Affected part of eye
Common etiologies
Clinical features
  • Dull, progressive periocular pain
  • Ocular hyperemia (red eye)
  • Photophobia
  • Decreased visual acuity (blurry vision)
  • Increased lacrimation (epiphora)
  • Hypopyon
  • Painless visual disturbances
    • Floaters/scotomata
    • Decreased visual acuity (blurry vision)
Diagnostics
  • Slit lamp examination
  • Conjunctival smear and cytology if infectious cause is suspected
  • Tonometry
  • Further workup of any suspected underlying systemic condition
Complications
  • Visual field loss due to scarring
  • Major loss of visual acuity, if macula is affected

Uveitis is often associated with HLA-B27 syndromes, such as Crohn disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and reactive arthritis.

Posterior uveitis does not manifest with pain (unlike painful anterior uveitis), because the choroid is not innervated by sensory nerves!

References:[1][2][3][4][5]

Neovascularization of the iris

References:[6][7]

Tumors

Benign tumors

  • Choroidal nevus: benign melanocytic lesion (nevus) of the posterior uvea
    • Epidemiology: common
    • Fundoscopic appearance
      • Flat or slightly elevated
      • Gray-yellow in color
      • Clearly defined margins
      • Remains stable in size over time
    • Treatment
      • No treatment necessary
      • Regular monitoring is important as malignant transformation is possible, though rare.

Malignant tumors

References:[8][9]

Rare conditions

Iridodialysis

  • Definition: separation of the iris from the ciliary body
  • Etiology: blunt trauma to the eye
  • Clinical features
    • Diplopia
    • Photophobia
    • Glare symptoms
    • Other signs and symptoms of blunt trauma to the eye (e.g., anterior chamber hemorrhage, secondary glaucoma, vision loss)
  • Diagnostics
    • Slit-lamp examination
    • Ophthalmoscopy to exclude further traumatic bulb injuries
  • Treatment
    • Observation, bed rest
    • Topical cycloplegics (e.g., atropine, scopolamine) and glucocorticoids
    • In cases of anterior chamber hemorrhage: anterior chamber washout
    • If diplopia or other visual disturbances persist: surgical repair

Iridodonesis

Heterochromia iridum

References:[10][11][12]

last updated 12/04/2018
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