1. UVEA
Dr. T.Sarada

2. Iris (4)- metabolism of Ant.seg
Middle coat (Iris,Ciliary body,Choroid)
Vascular
Provides nutrition
Iris (4)- metabolism of Ant.seg
Ciliary body (Pars plicata ; Pars plana)
- secrete aqueous – nutrition to avascular structures
Choroid – nutrition to outer retina

3. Inflammations (Uveitis) Vascular & circulatory distyrbances
( CSR ; NVI ; UES )
Degenerative changes
( Atrophy / Iridoschisis /PDS /Myopic / ARMD )
Cong. Abnormalities
( Persistent pupillary membrane / Coloboma )
Cysts / Tumors
( Malignant melanoma )

4. UVEITIS - Classification
Based on Anatomical site
1.Anterior ( Iritis / Ant.cyclitis / Iridocyclitis )
2.Intermidiate ( Post.cyclitis / Pars planitis )
3.Posterior ( Choroiditis / Chorioretinitis )
Pan Uveitis ( all uveal tissue )
Based on Etiology
infective / allergic/ toxic/ traumatic/ asso with sys diseases/ idiopathic.
Based On Duration ( Acute / Chronic )
Based on Pathology(Granulomatous/Non-granulomatous)

5. Etiopathogenesis Etiology – 1. Infective a. Exogenous
b. Secondary infection
c. Endogenous
2. Allergic(hypersensitivity linked)
a. Microbial allergy
b. Anaphylactic
c. Atopic
d. Auto immune
e. HLA - associated

6. 3. Toxic a. Endotoxins b. Endo ocular toxins c. Exogenous toxins 4
3. Toxic a. Endotoxins b. Endo ocular toxins c. Exogenous toxins 4. Traumatic 5. Associated with non- infective systemic diseases 6.Idiopathic

7. PATHOLOGY Supperative uveitis Non granulomatous uveitis

8. Anterior Uveitis / Iridocyclitis
Definition
Etiopathogenesis
Classification
Clinical features
Symptoms:
Pain
Redness
Photophobia
Lacrimation
Diminision of Vision

9. Signs
Lids –oedema Conjunctiva – CCC Cornea – oedema, KPs Anterior chamber – Flare (tyndall / brownian ), Cells / Hypopyon Changes in depth/angle Iris – Loss of pattern/colour Iris nodules (Koppe’s/Busacca’s) Synechia (posterior/anterior) Pupil - irregular , <reaction,Seclusio/Occlusio Pupillae Lens – Pigment.on ALC / Complicated cataracts Anterior Vitreous - cells

10. KPs Keratic precipitates
Proteinaceous cellular deposits on endotheliun of cornea
Arranged in traingle ( Artls)
Severity/duration/type of uveitis
Fine KPs –small/nongranulomatous/lymphocutes/numerous/acute
Mutton fat KPs – large,waxy/granulomatous/chronic/epitheloid&macrophages/fewer
Old KPs - pigmented kPs/Groundglass appearence

12. Tyndalization
Hypopyon . . . . . . . . . . . . . 4

13. Koppe’s
Busacca’s

14. Festooned pupil

15. Complications Complicated cataracts
Secondary Glaucomas ( Early /Late )
Cyclitic memebrane
Choroiditis
Band-shaped keratopathy
Pthisis bulbi

16. DD(Differential Diagnosis) of RED EYE
Acute Conjunctivitis
Acute irido cyclitis
Acute Congestive Glaucoma

17. Differentiating features of red eye
Acute acute acute
conjun irido cong gla
Onset
Pain
Discharge
Coloured halos
Vision
Congestion
Tenderness
Pupil
Media AC
Iris
IOP
Constitutional sym

18. Investigations Heamatological – TLC , DLC & ESR RBS, bl uric acid
Serological tests
Other tests
Urine examination
Stool examination
Radiological
Skin tests

19. Treatment Non specific Rx – Local Rx Corticosteroids
( Topical / Sub-conjunctival/ Sub-tenons )
Cycloplegics (Atropine/Cyclopentolate/Homide)
Systemic Rx
Cortico steroids
NSAIDs
Immuno-suppressives
Hot applications
Specific Rx for underlying Cause
Rx of complications

20. ENDOPHTHALMITIS
Definition : Inflammation of endo cavities of eyeball (Anterior chamber & Vitreous ) With uveal tissue
Etiopathogenesis: Infective : Exogenous/Endogenous/sec
Non-infective(sterile):
. Post operative
.post traumatic
.intra ocular tumor
.phacoanaphylactic
Clinical features:
Symptoms : Cardinal features
Pain / Swelling of lid / < vision

21. Signs: Lid-oedema Conjunctiva – congestion/chemosis
Cornea – Odema/Infiltrates
Anterior chamber – Exudates/Hypopyon
Iris – oedematous/muddy
Pupil – yellow reflex(amaurotic cat’s eye) due to exudates in vitreous
IOP-

22. Endoph.- Organisms Gram +ve Gram -ve
Pseudomonas- 8% Proteus- 5% Haemophilus influenza-0-1% Klebsiella
Staph. Epidermidis-43% Streptococcus-20% Staph. Aureus- 15% Propionibacterium Bacillus cereus 1%

23. Treatment Intra Vitreal AB & diagnostic tap Topical /Systemic AB
Steroid therapy
Supportive therapy
Vitrectomy
Enucleation ( End Stage)

24. Clinical management - suspected endophthalmitis
Aq. And vitreous biopsy
Inject intravitreal AB
Obtain C/S report
Consider vitrectomy
No improvement
Repeat intravit. Inj.( Abs indicated by C & S reports)
Clinically worsening

25. Intravitreal antibiotics
Combination of 2 drugs to cover G+ and G- organisms
Gentamicin (G-) + Cefazoline (G+)
Vancomycin (G+) + Amikacin (G-)
Vancomycin (G+) + Ceftazidime (G-)

26. Vitrectomy in Endophthalmitis
“Core” vitrectomy
Periphery not attacked
“½ vit. Volume” removed
No attempt at vit. Separation
Low suction
Endo. Phc - if needed for ret. Tears
Fluid - gas exchange

27. Endophthalmitis Patient Personnel Environment Endophthalmitis
Instruments
Personnel

28. Panophthalmitis
Definition: Inflammation of cavities of eyeball with all coats of eyeball Endopthalmitis + outer coat involvement Etiopathogenesis- Clinicalfeatures – All C/F of endoph + Proptosis , Painful limitation of movements,Near total loss of vision Compl’ : (Orbital cellulitis / Cavernous sinus thrombosis/meningitis) Management – Systemic ABs & Eviseration

29. MALIGNANT MELANOMA OF CHOROID
Most common / adults / 40 to 70yrs / unilateral.
Neural crest derived pigment cells.
Pathology : pre-existing nevus cells / denovo
gross – two forms – circumscribed
diffuse
Histo pathology : 4 types (modified CALLENDERS)
1. spindle cell type
2. epitheloid cell type
3. mixed cell type
4. necrotic type

31. 3. stage of extra ocular extention 4. stage of distant metastasis
C/ P : 4 stages
1. Quiescent stage – small / large
2. Glaucomatous stage
3. stage of extra ocular extention
4. stage of distant metastasis

34. naevus,melanocytoma,hyperplasia of pigment epithelium.
D/D :
Quiescent stage – without RD
naevus,melanocytoma,hyperplasia of pigment epithelium.
- with RD – simple RD, choroidal hemangioma & secondary deposits.
Glaucomatous stage -

35. Transillumination test USG FFA Radio active tracer MRI
INVESTIGATIONS :
Indirect ophthalmoscopy
Transillumination test
USG
FFA
Radio active tracer
MRI

37. Treatment : 1.conservative - Brachytherapy <10mm in elevation
<20mm diameter
- External beam radiotherapy
- Trans pupillary thermotherapy(TTT)
- Trans scleral local resection
- Steriostatic radio surgery
2. enucleation
3. exenteration or debulking
4. palliative

38. Than’Q