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Sequelae and complications
         of uveitis



     DR. ANUPAMA KARANTH
   www.ophthalclass.blogspot.com




          ...
Uveitis


 Fourth leading cause of blindness in the developed

 countries

 Complications

     Cataract
 

     Glauco...
Uveitis

 Inflammation in the uveal tract

 Exudation and cellular infiltration

      Iris
  

      Ciliary body
  
...
Sequelae



 Iris

 Ciliary body

 Lens

 Vitreous

 Choroid / Retina



                                www.ophthalc...
Iris


 Organization of exudates

     Adhesions –Synechiae
 


     Fibrous membranes
 




                          ...
Synechiae


 Pupil to lens

     Posterior synechiae
 


 Peripheral iris to cornea

     Peripheral anterior synechiae...
Synechiae

 Pupil to lens
   Posterior synechiae




                                      www.ophthalclass.blogspot.com
Synechiae

 Pupil to lens
   Posterior synechiae

   Festooned pupil

   360 degrees of posterior synechiae – seclusio...
Synechiae

 Peripheral iris to cornea
   Peripheral anterior synechiae (PAS)




                                       ...
Synechiae

 Peripheral iris to cornea
   Peripheral anterior synechiae (PAS)




                                       ...
Synechiae

 Posterior surface iris to lens capsule
   Total posterior synechiae




                                    ...
Posterior synechiae

                             Entire pupil
      Posterior                                            ...
Iris bombé




Iris bombé: ballooning of iris, shallow anterior chamber   www.ophthalclass.blogspot.com
Peripheral anterior synechiae


     Peripheral                              Closure of
      anterior                    ...
Sequelae…


 Extensive exudation in iris and ciliary body

 ‘Plastic’ iridocyclitis

 Organizes into membranes

      P...
Fibrous membranes

 Pupil
   Occlusio pupillae
   Pupil block
   Secondary angle closure glaucoma




                ...
Fibrous membranes


 Retrolental space

     Cyclitic membrane
 

     Posterior lens, vitreous base and pars plicata
 ...
Pupil in iridocylitis


 Miotic

 Posterior synechiae

 Festooned pupil

 Seclusio pupillae

 Occlusio pupillae

 Ec...
Ectropion uveae




                  www.ophthalclass.blogspot.com
Lens


 Iris pigments on lens surface

 Posterior subcapsular cataract

     Inflammation and corticosteroid use
 

   ...
Lens pigments and cataract




                             www.ophthalclass.blogspot.com
Vitreous in uveitis


 Exudates get organized

 Vitreous membranes, contraction

 Traction on retina

     Tractional r...
Choroid and retina

 Destruction of retinal pigment epithelium (RPE) and
  Bruch’s membrane
      Chorioretinal atrophic ...
Complications



    Cataract


    Glaucoma


    Hypotony


    Cystoid macular edema





                         ...
Causes of glaucoma


 Closed angle

     Posterior synechiae
 

     Peripheral anterior synechiae
 


 Open angle

  ...
Causes of hypotony


 Acute inflammation of ciliary body - temporary

 hyposecretion

 Chronic ciliary body damage – per...
Hypotony – phthisis bulbi (LE)




                            www.ophthalclass.blogspot.com
Cystoid macular edema

 Inflammatory mediators reach the macula
 Common cause of visual loss in uveitis




            ...
End stage of inflammatory eye diseases

 Atrophy with shrinkage
      Small globe
  

      Structures still recognizabl...
Phthisis bulbi

 Clinically, any globe which is
      Sightless
  

      Shrunken
  

      Shapeless (‘squared-off’)
...
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Sequelae & Complications of Uveitis

  1. 1. Sequelae and complications of uveitis DR. ANUPAMA KARANTH www.ophthalclass.blogspot.com www.ophthalclass.blogspot.com
  2. 2. Uveitis  Fourth leading cause of blindness in the developed countries  Complications Cataract  Glaucoma  Cystoid macular edema  Hypotony  www.ophthalclass.blogspot.com
  3. 3. Uveitis  Inflammation in the uveal tract  Exudation and cellular infiltration Iris  Ciliary body  Choroid / retina   Consequences Organization of exudates  Fibroblastic activity  www.ophthalclass.blogspot.com
  4. 4. Sequelae  Iris  Ciliary body  Lens  Vitreous  Choroid / Retina www.ophthalclass.blogspot.com
  5. 5. Iris  Organization of exudates Adhesions –Synechiae  Fibrous membranes  www.ophthalclass.blogspot.com
  6. 6. Synechiae  Pupil to lens Posterior synechiae   Peripheral iris to cornea Peripheral anterior synechiae (PAS)   Posterior surface iris to lens capsule Total posterior synechiae  www.ophthalclass.blogspot.com
  7. 7. Synechiae  Pupil to lens  Posterior synechiae www.ophthalclass.blogspot.com
  8. 8. Synechiae  Pupil to lens  Posterior synechiae  Festooned pupil  360 degrees of posterior synechiae – seclusio pupillae /ring or annular synechiae www.ophthalclass.blogspot.com
  9. 9. Synechiae  Peripheral iris to cornea  Peripheral anterior synechiae (PAS) www.ophthalclass.blogspot.com
  10. 10. Synechiae  Peripheral iris to cornea  Peripheral anterior synechiae (PAS) www.ophthalclass.blogspot.com
  11. 11. Synechiae  Posterior surface iris to lens capsule  Total posterior synechiae www.ophthalclass.blogspot.com
  12. 12. Posterior synechiae Entire pupil Posterior Seclusio border to lens synechiae pupillae (360deg) Peripheral iris pushed to Iris bombé Pupil block cornea Secondary angle closure glaucoma Iris bombé: ballooning of iris, shallow anterior chamber www.ophthalclass.blogspot.com
  13. 13. Iris bombé Iris bombé: ballooning of iris, shallow anterior chamber www.ophthalclass.blogspot.com
  14. 14. Peripheral anterior synechiae Peripheral Closure of anterior trabecular synechiae meshwork Secondary Block to angle aqueous closure drainage Gonioscopy to visualize angle in every case of uveitis www.ophthalclass.blogspot.com
  15. 15. Sequelae…  Extensive exudation in iris and ciliary body  ‘Plastic’ iridocyclitis  Organizes into membranes Pupil  Retrolental space  www.ophthalclass.blogspot.com
  16. 16. Fibrous membranes  Pupil  Occlusio pupillae  Pupil block  Secondary angle closure glaucoma www.ophthalclass.blogspot.com
  17. 17. Fibrous membranes  Retrolental space Cyclitic membrane  Posterior lens, vitreous base and pars plicata  Hypotony  Retinal detachment  Ciliary body atrophy and shrunken eye  www.ophthalclass.blogspot.com
  18. 18. Pupil in iridocylitis  Miotic  Posterior synechiae  Festooned pupil  Seclusio pupillae  Occlusio pupillae  Ectropion uveae www.ophthalclass.blogspot.com
  19. 19. Ectropion uveae www.ophthalclass.blogspot.com
  20. 20. Lens  Iris pigments on lens surface  Posterior subcapsular cataract Inflammation and corticosteroid use  Complicated cataract  Breadcrumb appearance  Polychromatic lustre  www.ophthalclass.blogspot.com
  21. 21. Lens pigments and cataract www.ophthalclass.blogspot.com
  22. 22. Vitreous in uveitis  Exudates get organized  Vitreous membranes, contraction  Traction on retina Tractional retinal detachment  Retinal tears and rhegmatogenous retinal detachment  www.ophthalclass.blogspot.com
  23. 23. Choroid and retina  Destruction of retinal pigment epithelium (RPE) and Bruch’s membrane Chorioretinal atrophic patch  White of sclera seen through   Fibroblastic activity Chorioretinal adhesion  RPE proliferation at edges – pigmented scars  Choroidal neovascular membranes   Permanent scotomas www.ophthalclass.blogspot.com
  24. 24. Complications Cataract  Glaucoma  Hypotony  Cystoid macular edema  www.ophthalclass.blogspot.com
  25. 25. Causes of glaucoma  Closed angle Posterior synechiae  Peripheral anterior synechiae   Open angle Cells and protein blockage of trabecular meshwork  Trabeculitis  Corticosteroid induced  www.ophthalclass.blogspot.com
  26. 26. Causes of hypotony  Acute inflammation of ciliary body - temporary hyposecretion  Chronic ciliary body damage – permanent hypotony  Ciliary body traction from a cyclitic membrane Hypotony more dangerous in chronic uveitis than glaucoma www.ophthalclass.blogspot.com
  27. 27. Hypotony – phthisis bulbi (LE) www.ophthalclass.blogspot.com
  28. 28. Cystoid macular edema  Inflammatory mediators reach the macula  Common cause of visual loss in uveitis www.ophthalclass.blogspot.com
  29. 29. End stage of inflammatory eye diseases  Atrophy with shrinkage Small globe  Structures still recognizable  ATROPHIC BULBI  Eg. Chronic long standing uveitis   Atrophy with shrinkage and disorganization Small globe  Structures unrecognizable  PHTHISIS BULBI  Eg. Purulent endophthalmitis  Irreversible blindness www.ophthalclass.blogspot.com
  30. 30. Phthisis bulbi  Clinically, any globe which is Sightless  Shrunken  Shapeless (‘squared-off’)  Soft   Associations Dystrophic calcification eg. band keratopathy  Intraocular ossification  Risk of intraocular malignancy  www.ophthalclass.blogspot.com

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www.ophthalclass.blogspot.com has the complete class on uveitis for undergraduate medical students. This presentation is the third in the series and deals with the sequelae and complications of uveitis.

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