THE UVEAL TRACT . . . CONT.

Symptoms and Signs (see Colour Atlas OP4)

ocular pain,tenderness of the globe, PHOTOPHOBIA, decreased visual acuity, brow ache (ciliary muscle spasm)

ciliary flush (perilimbal conjunctival injection), miosis

anterior chamber cells (WBC in anterior chamber due to anterior segment inflammation) and flare (protein precipitates in anterior chamber secondary to inflammation)

occasionally keratitic precipitates (clumps of cells on corneal endothelium)

iritis typically reduces intraocular pressure though severe iritis may cause an inflammatory glaucoma

Complications

inflammatory glaucoma

posterior synechiae

•iritis leading to iris bombe (posterior iris adheres to anterior lens capsule entrapping aqueous in posterior chamber) – angle closure glaucoma

•indicated by an irregularly shaped pupil

anterior synechiae (rare): adhesions of iris to cornea ––> glaucoma

cataracts

band keratopathy (with chronic iritis)

•superficial corneal calcification keratopathy

macular edema with chronic iritis

Management

dilate pupil to prevent formation of posterior synechiae and to decrease pain from ciliary spasm

topical, subconjunctival, or systemic steroids

systemic analgesia

medical workup may be indicated to determine etiology

POSTERIOR UVEITIS

inflammation of the choroid

Etiology

bacterial: syphilis, tuberculosis

viral: herpes simplex virus, cytomegalovirus in AIDS

fungal: histoplasmosis, candidiasis

parasitic: toxoplasma, toxocara

immunosuppression may predispose to any of the above infections

autoimmune: Behcet's disease

malignancies: metastatic lesions, malignant melanoma

Symptoms and Signs

decreased visual acuity

floaters

frequently there is no conjunctival or scleral injection

vitreous cells and opacities

hypopion formation

Management

retrobulbar, or systemic steroids if indicated (e.g. threat of vision loss)

GLOBE

ENDOPHTHALMITIS

most commonly a postoperative complication of cataract surgery, or due to post-penetrating injury to eye, but also bloodstream dissemination from elsewhere

Symptoms and Signs (see Colour Atlas OP6)

very painful, red eye with circumlimbal flush

anterior chamber cells, hypopyon

reduced vision, extreme photophobia

Management

OCULAR EMERGENCY: immediate admission to prevent loss of eye

vitreous tap and/or vitrectomy

intravitreal, topical, IV antibiotics