Uveitis

Uveitis is an inflammation of the middle eye (the uvea), which consists of the choroid, the ciliary body and the iris. The vitreous may also be involved.

CLASSIFICATION

ragoeiditidaThere are a plethora of different diseases that can cause uveitis. One way to differentiate is the division according to the anatomical site of inflammation, i.e., the three parts of the uvea:

The anterior uveitis is an inflammation of the front portion of the uvea, particularly the iris and the ciliary muscle. Exist cells only in the anterior chamber, it is called iritis, if there are also a few cells behind the lens, especially in the anterior vitreous, and we speak of iridocyclitis. Uveitis anterior could be accompanied by macular edema and edema of the optic nerve.

Uveitis intermedia affect the central part of the uvea. The highest densities of free cells are found in the vitreous (vitreous inflammation or vitritis). There can also be a few cells in the anterior chamber present. A special form of intermediate uveitis is pars Planitis, where one inflammatory debris (snow drifts, English: snow bank) is particularly at the lower region between the retina and ciliary body. If the inflammatory cells join together in the vitreous cavity, they are called snow balls. Accompanying this one can be retinal periphlebitis (vascular inflammation of the retinal veins, vasculitis), macular edema and papilledema.

Posterior uveitis includes now also changes (infiltration of inflammatory cells) in the retina and choroid. This is called depending on the infestation of the inflammation retinitis, choroiditis and chorioretinitis.
Panuveitis includes all three parts of the uvea.

UVEITIS DIAGNOSTICS

Basic diagnostik for all uveitis

Routine labor: ESR, CRP, serum electrophoresis, differential-BB,
Liver and kidney function, serum ACE.
Chest x-ray
HLA-B 27, B-17 in anterior uveitis
Toxoplasmosis serology, Lyme disease, syphilis (Treponema pallidum)

Anterior uveitis

With arthritis, arthralgias, serology (chlamydia, yersinia, shigella, salmonella, Campylobacter), Antistreptokinase test, anti-streptococcal DNAse test,
When back pain at night x-ray of the lumbar spine and sacroiliac joints, (Bone scan),
Urogenital tract, diarrhea serology (chlamydia, yersinia, salmonella),
Swab (urethral, urine, stool), possibly colonoscopy.

Supplementation program in anterior uveitis

Virus serology HSV, VZV, EBV, HIV
RF, ANA, ANCA
Aqueous humor for diagnostic puncture, serology, microbiology, PCR,
HSV at Heterochromiezyklitis Fuchs

Uveitis intermedia

RF, ANA, ANCA, complement, exclusion rheumatological
HLA-A 29 base disorders, collagen diseases, vasculitis
Toxocara serology, leptospires
FAG (Fluoreszenzangiographie) leaks
Neurology (spinal tap, MRI) exclusion MS

Posterior uveitis

Inflammatory parameters ANA, RF, ANCA, circulating immune complexes
HSV serology, CO, CMV, EBV, HIV, Brucella, Toxocara, Candida,
Histoplasmosis
HLA-B 51 Mb Bechet
HLA-A 29 birdshot chorioretinopathy
HLA-DR 4, 53-DW Vogt-Koyanagi-Harada syndrome
FAG leaks

Supplementation program in posterior uveitis

Anterior chamber, vitreous aspiration microbiology (Candida)
Serology (antibodies)
Cytology (e.g. at Maskeradesyndrom by Lymphoma)
Neurology (spinal tap, MRI) exclusion MS

A synopsis of intraocular non-infectious inflammation

(Subdivided by anatomical focus of inflammatory activity)

Anterior Uveitis

Idiopathic
HLA-B 27 – Association (Bechterew’s disease, Reiter’s syndrome, psoriatic arthritis)
Heterochromiecyklitis Fuchs
Juvenile rheumatoid arthritis
Behçet disease
Sarcoidosis
Ulcerative colitis, Crohn’s disease

Intermediate Uveitis

Idiopathic
Sarcoidosis
Multiple Sclerosis

Posterior Uveitis

Idiopathic (retinitis, Retinovaskulitis, choroiditis, chorioretinitis, Retinochoroiditis)
Bechet vasculitis
Sarcoidosis
Ulcerative colitis, Morbus Crohn
Birdshot retinopathy
Serpiginous choroiditis
White-Dot Syndrome
Masquerade uveitis in lymphomas and leukemias

Panuveitis

Idiopathic
Behçet disease
Sarcoidosis
Vogt-Koyanagi-Harada syndrome
Sympathetic opthalmia