Uveal Tract

Anatomy
Is a vascular layer that consists of :
Iris
Cilliary body
Choroid

Function :
Nutrition supply

Iris
Is a diaphragm that dividing ocular chamber into
two parts:
Anterior
Posterior

Building a hole at the center called as pupil

Anterior part ---> origins from corneal endothelia
Posterior part --> origins from retinal endothelia

 Muscles :
M. Spchiter pupil ---> circular, N III
(parasympatic), myosis
M. dilator pupil ---> radier, sympatic, midriatics

Root of the Iris are thin ---> tear easily

Vascularization :
From A. ciliaris posterior longus

 Pupil
As a aperture that can found in an ordinary
photographic camera
Normal : round, central, isokor
If > 1 : Polikoria, if not central : korektopia
Pupil reaction :
toward to the direct and indirect light
toward to the close point
toward to the drugs

 Toward to the light :

retina

N II

Chiasma optic

Brachium Coliculus sup.

Optical tract

Nc. Eidinger Westphal

Parasymphatic fiber

Afferent
Efferent

Pupil

N III

 Toward to the close distance :

Trias :
convergence
miosis
accommodation

Toward to the drugs :

Miotic : esserine, pilocarpine
Midriatic : atropine, homatropine, cocaine,
adrenaline

 Pupil reaction anomaly are depend on :

afferent
efferent

Argyle Robertson Pupil :

efferent damage, direct and indirect light
reaction (-)
irregular miosis
anisokor

Horner syndrome :
miosis, ptosis, enofthalmus, anhydrous,
paralysis of M. dilatator pupil

 Cilliary body :
triangle form, the basis is at the front which the iris
attached spreads until the Choroid
consist of :
M. ciliaris for accommodation (longitudinal, circular,
radier)
Ciliar processus :
inside part divided into:
pars plana
pars corona
originating zonula zinii fibers : suspending the lens, for
accommodation process

On severe inflammation --> damage of ciliary body --->

atrophy ---> secretion
---> ptisis bulbi

perforating injuries can occurring SO

Congenital Iris Anomalies

Pupil membrane persistency
Fetus : pupil closed ---> 7 - 8 pregnancy
---> born : open pupil
If absorption
altered

Fine cotton in front of

the lens

 Iris coloboma
Two forms :
Congenital : anomalies of formation
Acquired : after glaucoma operation, optical
iridectomy

Usually followed with Choroid coloboma

 Iris heterochromia
bilateral ; unilateral
differences colors between different area of the iris
Two forms :
Congenital : glaucoma congenital
Acquired : iris atrophy after iridocyclitis/glaucoma

Traumatic Iris Disturbances

Iridoplegi
if affected by blunt injury, because of parese
N. III

temporary (2 - 3 weeks)
permanent

Th/
Using of black eye glasses
Do not read (can not accommodate)
R/ pilocarpine ---> for myotics

 Iridodialisis
E/ : injuries ---> tearing of iris root --> pupil
excentric
Th/
Midriatics
banded
diplopia (+) ---> iris reposition

 Hifema
E/ : injury --> rupture of blood vessels --> blood in the
anterior chamber (hifem)
There is two types :
Primary : straight after injuries
Secondary :
fifth days after injuries
> severe
if immediately reabsorption of the clot & regeneration not occurred

Complication :

IOP elevated
Corneal hemosiderosis
Uveitis
Muddying of vitreous body

 Th/
totally bed rest
IOP observation & condition of hifema
IOP high --> diamox, glycerin
--> 24 hours still high ---> parasintesa
--> if normal & hifema still >>> --> parasintesa

Iris Neoplasm
Iris Tumor
Nevus Pigmentosus Iridis --> benign melanoma

clear border
brown spotted
not progressive
no disturbances

Malignant

deep brown spotted

rough surface
not clear border
Metastasis to preaulicular glands

 Therapy :
Metastasis (-) : Iridectomy
Metastasis (+) : Enucleation

Inflammation of The Iris

Inflammation of the Iris : Iritis
Usually followed by inflammation of the ciliary body :
Iridocyclitis
E/ :
Systemic disease :
lues, TBC, gout, GO, focal infection, tooth, ENT, urinary tract,
infection (virus, fungal, worm), DM

Secondary iridocyclitis around eye region

Perforating trauma
SO
Idiopathic ----> Immune reaction

 Clinical Finding
Subjective :
Spontaneous pain of the eye ball, headache reference to
temporal regions
Photophobia
Decreasing visual acuity

Objective :

Palpebra
CB
C
COA

: edema
: ciliar injection
: muddying, KP in endothel
: Flare (+), Hipopion +/-, mild
---> narrow if iris bombe is present
: Irregular --> sinechia post.
Pupil : seclusion & oclusion

 Complication :
muddiness of vitreous
cataract
IOP low or high

Sequels :

pupil seclusion
pupil occlusion
posterior synechia
Iris bombe
glaucoma

 Uveitis anterior clinically divided into :

Granulomatous
Non-granulomatous
Mixed

 Uveitis Granulomatous

Non acute
Cellular reaction >>> vascular
Blurred iris surface
KP in thick endothel
deep COA
muddying vitreous

Uveitis Non Granulomatous

E/ allergy ?
Acute reaction >>> cellular
Fine KP
Vitreous not so muddy
COA : Hipopion +/-

Mixed : all of signs above

 Iridocylitis caused by virus :

Bechet syndrome, uveitis, stomatitis, genital ulcer

Vogt. Kyanagi syndrome : uveitis, tinnitus, alopecia, vitiligo

 Th/ :
Midriatics :
SA 0,5 % ed/eo
for lowering blood vessel congestion/inflammation
resting the eye (relaxation of M. spinchter pupil & M ciliaris)

If IOP high ----> diamox 3 x I tablets

Contra Indications :
kidney disturbances
diamox allergy
signs :
stomach uncomfort
lips dryness

Analgesic ---> to relieve the pain

 Causative & symptomatic therapy

Local & systemic corticosteroid
Local : e.d. sub conjungtival 2 X 1/week
Systemic high dose, short terms 1 X 12 tablets ---> tapering off

Contra Indication :
Pulmonary TBC, Hypertension, DM, Coronary disturbances, Physiological disease,
peptic ulcer

Continuing observation (important):

Blood glucose
Blood pressure
Weight body
Water retention

The eye should be bandaged

Choroid
Consists of several layer :

Epithelium
Bruch membrane
Chorio capillaries
Blood vessels (medium and large size)
Suprachoroid

Artery : origins from A. ciliaris breves

Vein : 4 V. Vortikalis from 4 posterior quadrant --->
V. ophthalmic --> cavernous sinus

Non-inflammation
Choroid Anomalies
Coloboma
Degenerative :
Choroid Bodies Drusen
Myoris Degenerative

 Blunt trauma
Macular tearing ---> white sclera
Th/ : SA --> relaxation of the eye

Tumor
Benign : melanoma, white spotted below retinal blood vessel
---> visual disturbances
malignant :
secondary glands melano sarcoma
Th/ :
Metastasis (-) : Enucleation
Metastasis (+): Excenteration

Inflammation of The Choroid

Choroiditis : Posterior Uveitis
Disturbances near the Retina ---> usually
followed by retinal infection : Chorioretinitis
Dividing into two forms :
Exudative Choroiditis : Non purulent
Purulent Choroiditis : Supurative

Exudative Choroiditis
Clinical manifestation depend on location of the
lesion --> macula ---> visual acuity decreased, even
the inflammation is not severe
Divided into :
Disseminate
Diffuse
Sircumscripted :

Centralized/Macular
Paracentralized/paramacular
Juxta Papillary
Periphery

 Sircumsripted Choroiditis :
limited exudat area, solitaire :
PD : TBC, Lues, toxoplasma, focal infection

Disseminated Choroiditis
small exudat in just one area or all around the fundus
PD : miliary TBC

Diffuse Choroiditis
Exudat are spreading to healthy area

Supurative Choroiditis
E/ :
Pyogenic bacteria, which exogenous acquired
----> ocular bulb perforating
Endogenous --> hematogen metastasis
percontinuitatum

Main clinical sign :

Pus in the Vitreous

Supurative Endophthalmitis
Supurative Endophthalmitis
Looks like without clinical sign manifestation if
observed outside the eye
Signs :
subjective : fast loss of visual acuity
objective : yellow vitreous, fundus is not clearly
seen

Inflammation is not reach the ciliary body

 Gambar endof

 Septic Endophthalmitis
The inflammation reaching the ciliary body
Clinical sign :
Cilar injection (+), hipopion, choroid abscess & ciliary
body
Loosing fast of visual acuity, not reversible

Th/ :

Antibiotics
Corticosteroid
Analgesic
Roborantia

If severe pain present ---> evisceration, not

enuclation

 Panophthalmitis
All of eye tissue are infected including the adnexa
Clinical signs :
bulb protorsio, difficulty to move the eye, palpebral edema, conjugtival
chemosis, muddying of cornea, perforating, visus 0, headache

Th/ :
bulbar evisceration
Local & systemic antibiotics

Periphery --> even severe inflammation occurred, visual acuity

good --> scotoma occur
(+) : blind spot
(-) : blind spot with perimeter examination

 Clinical signs :
Objective with ophthalmoscopy :
yellow spotted, clear border with retinal blood vessel above
Blood vessels (-) : if the inflammation reach the retina
Vitreous are muddy if inflammation cells are present

Subjective :

Visual acuity disturbances : metamorphosis --> macropsi & micropsi

If exudat + infiltrate pressing the retina --> visual cell stacking
Hemeralopia/nyctalopia --> if chronic
Scotoma
Fotopsi
Photophobia

Symphatic Ophthalmia
Unique granulomatous iridocyclitis
bilateral
leading from wound of one eye --->
iridocyclitis (exiting eye)
followed by other eye ( sympathizing eye)

 Etiology :
Wound :
Injury ---> wounding of ciliary body
Operation --> ciliary body ; iris ; capsule lentis are
trauma

Corpus Alineum in Intra Ocular space

Perforating of Corneal ulcer
Corneal ulcer

Incubation
3 - 8 weeks after the eye wounding
can also happen after 20 years

 Beware :
Wounding eye --> recurrent iridocyclitis for more than 3 weeks
Observe the other eye if iritasio simpatica occur :

photophobia
lacrimation
blurred vision
pain
flare (+)

Enucleating wounding eye as soon Stadium

as possibleI (Iritation)
(within 2 weeks)
If neglected/doubtfully ---> iritatio oftalmia --> symphatic ophthalmia

 Signs of Symphatic ophthalmic :

Muddying of cornea
small pupil
greeny muddy vitreous body

Therapy :
Same as iridocyclitis

Stadium II
(stadium
simpatica)