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Disorders of the Uvea

by Carlo Raj, MD
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    00:01 There once again, revisit our eye structure and this time focusing on the uvea.

    00:07 The uvea is a little bit different.

    00:08 The uvea could technically from the posterior side, so that means over to the left, could include the choroid which is the dark pigment there, could as it moves anteriorly, be the extension into the ciliary body.

    00:24 Picture that. See that? The ciliary body of course then controls the iris.

    00:29 You see that? That all be part of what is known as anterior, so over to the right, and posterior to the left. Anterior and posterior uvea.

    00:39 Our focus here in pathology would be anterior.

    00:41 No what may happen is the fact that, well, what if you came to the bottom of the iris? Take a look at the iris.

    00:49 That iris is communicating with whom? Very importantly, the iris in front of it is then communicating with the sclera, isn't it? Isn't that where you have the canal Schlemm, the trabecular meshwork? Can you picture that? Take a moment.

    01:03 Now what may then happen is if there is uveitis, then let?s say that this is bacterial infection.

    01:08 And if this uveitis or let?s say extra-articular manifestation secondary to HLA B27 seronegative spondyloarthropathies.

    01:15 That is a lot of words but we?ve talked about that earlier.

    01:18 What may then happen is that, with uveitis and inflammation, the sclera might then become so incredibly red.

    01:26 Unbelievable injected conjunctiva.

    01:29 And number two, it might start accumulating pus in what is known as your uveoscleral junction.

    01:35 And we call that hypopyon.

    01:37 So let us begin our discussion of uveitis, shall we? Disorders of the uvea would divide this into what is known as infectious, systemic, and such as you shall see.

    01:47 Uvea vascular coat includes the choroid, where is that? To the left in the picture, that more posterior.

    01:56 As we move anteriorly it extend into the ciliary body.

    02:00 That ciliary body is then controls the size of the pupil via the iris, correct? Are you with me? That is your entire uveal structure.

    02:09 So if you?ve ever been confused on that and many medical students are, hopefully no longer.

    02:14 And what made that happen is that uvea may then undergo pathology.

    02:20 Ad when it does, it may then either be caused by infections as we shall see or our focus will be system.

    02:26 Okay? Take a look at the eyes bilaterally in this patient and the conjunctiva.

    02:34 They seem incredibly red.

    02:35 So does you?re thinking about uveitis? Let us say that this was a young boy and was unable to properly well, upon flexion of the vertebrae, it was a loss of the vertebral curvature.

    02:51 I might be thinking number one differential in this young male approximately 27 years of age, ankylosing spondylitis.

    02:58 And take a look at the eyes in this young male, and you find that to be disinjected.

    03:04 Extra articular manifestation of ankylosing spondylitis and uveitis, right? Amd uveitis.

    03:10 So as I've said we?ll divide this into infectious and systemic.

    03:15 Under infectious we have some organisms here.

    03:18 If you are immunocompetent, an infection that may then cause infectious uveitis, toxoplasm actually. Cat?s scratch disease maybe.

    03:27 Maybe rabbits and tularemia.

    03:30 And maybe even perhaps herpes.

    03:32 Herpes tends to affect the cornea but obviously could have carried to uveal type of pathology.

    03:39 And fungal.

    03:40 Some of these streptococcus, coccidioides and such.

    03:43 And also do not forget about syphilis.

    03:46 Now of the two types of or two categories of uveitis here, more commonly you find it with systemic diseases, not infectious.

    03:58 So infectious uveitis, I gave you the list.

    04:01 Systemic. Idiopathic, sarcoidoses or I gave you the male.

    04:07 You had ankylosing spondilitis, the bamboo spine.

    04:10 That shows you the eyes that were extremely reddened.

    04:14 HLA-B27 extra articular manifestation, were the four that you must know for HLA-B27 0 negative.

    04:22 Yeah! Good.

    04:24 Do you know about psoriatic arthritis, ankylosing spondylitis, enteropathic and reactive? With systematic uveitis and a couple of others.

    04:36 JIA stands for Juvenile Idiopathic Arthritis.

    04:40 Maybe tubulointerstitial disease, nephritis.

    04:44 And a condition called Fuchs heterochromic iridocyclitis.

    04:50 The Fuchs membrane is something that you would perhaps see in the retinal pigment epithelium.


    About the Lecture

    The lecture Disorders of the Uvea by Carlo Raj, MD is from the course Optic Pathology.


    Included Quiz Questions

    1. Juvenile idiopathic arthritis
    2. Enteropathic arthritis
    3. Psoriatic arthritis
    4. Ankylosing spondylitis
    5. Reactive srthritis
    1. Hypopyon
    2. Injection
    3. Endophthalmitis
    4. Hyphema
    5. Trachoma

    Author of lecture Disorders of the Uvea

     Carlo Raj, MD

    Carlo Raj, MD


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