The uveal tract consists of the choroid, ciliary body, and iris (Figure 7–1). The term “uveitis” denotes inflammation of the iris (iritis, iridocyclitis), ciliary body (intermediate uveitis, cyclitis, peripheral uveitis, or pars planitis), or choroid (choroiditis). Common usage, however, includes inflammation of the retina (retinitis), retinal vasculature (retinal vasculitis), and intraocular optic nerve (papillitis). Uveitis may also occur secondary to inflammation of the cornea (keratitis), sclera (scleritis), or both (sclerokeratitis). Uveitis usually affects people 20–50 years of age and accounts for 10%–20% of cases of legal blindness in developed countries. Uveitis is more common in the developing world than in the developed countries, due in large part to the greater prevalence of infections that can affect the eye, such as toxoplasmosis and tuberculosis.
Symptoms and Signs (Table 7–1)
Inflammation of the uveal tract has many causes and may involve one or more regions of the eye simultaneously. Anatomically, intraocular inflammation can be classified as anterior uveitis, intermediate uveitis, posterior uveitis, or diffuse or panuveitis (Figure 7–2).
++ Table Graphic Jump Location Table 7–1. Differentiation of Granulomatous and Nongranulomatous Uveitis ||Download (.pdf)
Table 7–1. Differentiation of Granulomatous and Nongranulomatous Uveitis
|Pain||Marked||None or minimal|
|Keratic precipitates||Small white||Large gray (“mutton fat”)|
|Pupil||Small and irregular||Small and irregular (variable)|
|Site||Anterior||Anterior, posterior, or diffuse|
Figure 7-2.Graphic Jump Location
Anatomic classification of uveitis, including anterior uveitis, intermediate uveitis, posterior uveitis and diffuse, or panuveitis. [Modified after Cunningham ET Jr. Diagnosis and management of acute anterior uveitis. American Academy of Ophthalmology, Focal Points 2002, Volume XX, Number 1 (Section 1 of 3).]
Anterior uveitis is most common and is usually unilateral and acute in onset. Typical symptoms include pain, photophobia, and blurred vision. Examination usually reveals circumcorneal redness with minimal injection of the palpebral conjunctiva or discharge. The pupil may be small (miosis) or irregular due to the formation of posterior synechiae. Inflammation limited to the anterior chamber is called “iritis,” whereas inflammation involving both the anterior chamber and the anterior vitreous is often referred to as “iridocyclitis.” Corneal sensation and intraocular pressure should be checked in every patient with uveitis. Decreased sensation occurs in patients with herpetic uveitis due to simplex or varicella-zoster virus infection or leprosy (see Chapter 15), whereas increased intraocular pressure can occur with herpes simplex virus, varicella-zoster virus, cytomegalovirus, toxoplasmosis, syphilis, sarcoidosis, or an uncommon form of ...