Uveitis causes. Uveitis - what is it, how to treat acute eye disease, causes. Uveitis due to connective tissue disease

One of the most common eye diseases is inflammation of the choroid. This is a set of eye diseases in which different parts of the choroid become inflamed. The disease develops due to infection, eye injuries and needs qualified help, as it causes serious complications.

The structure of the choroid of the eye consists of three sections: the iris, the ciliary body and the vascular part itself (the choroid).

This part of the eyeball is well supplied with blood due to the developed vascular system. At the same time, the vessels of the eye are very small, and the blood flow in them is slow. This creates conditions for the retention of microorganisms, which can cause an inflammatory process.

In addition to slow blood flow, the development of the disease is also facilitated by the features of the innervation of the eye. That is why inflammation usually affects one of the areas of the choroid: anterior or posterior.

The anterior section consists of the iris and the ciliary body. It is supplied with blood by the posterior long artery and the anterior ciliary branches. Innervation is provided by a separate branch of the trigeminal nerve.

The blood supply to the posterior part is provided by the posterior short ciliary arteries, and the nerve sensitivity of this area is absent.

Types of uveitis

According to the anatomical location, four types of the disease are diagnosed:

Anterior area.
Back department.
Intermediate.
Total.

With the development of the inflammatory process in the anterior section, the iris, the vitreous body, or both areas become inflamed. The patient is diagnosed with anterior cyclitis or iridocyclitis. This type of inflammation is the most common.

Posterior uveitis causes inflammation of the retina and damage to the optic nerve. The process in the middle section affects the vitreous and ciliary body, the retina and directly the choroid itself.

With simultaneous inflammation of all departments, total, or generalized, uveitis is diagnosed.

By the nature of the process, the presence of suppuration and fluid, uveitis is:

serous;
purulent;
fibrous-plastic;
mixed;
hemorrhagic.

In the first type, the release of a liquid of a transparent type predominates. More severely, the disease manifests itself with suppuration of the eye. In fibrous uveitis, fibrin, a protein involved in blood clotting, is shed. With the hemorrhagic type, the walls of the capillaries are damaged, and blood is released.

The causes of inflammation of the choroid of the eye are endogenous (internal) and exogenous (external) factors. The endogenous form develops as a result of the introduction of microorganisms by blood flow from other sites of infection in the body.

The cause of exogenous inflammation is the introduction of microbes from the outside during eye injuries, burns, surgical interventions and other medical procedures.

According to the mechanism of occurrence, two types of the disease are distinguished:

primary;
secondary.

Primary uveitis is an independent pathology that develops without previous eye diseases.

Secondary uveitis occurs as a complication of various eye diseases during or after them. Examples are corneal ulcer, scleritis, bacterial conjunctivitis.

According to the phase of the course, uveitis is:

sharp;
chronic.

The acute course of the disease is diagnosed when it lasts up to three months. If recovery does not occur, the disease enters the chronic phase. Inflammation of the choroid of the eye is also congenital and acquired.

The reasons

The causes of the inflammatory process in the choroid are eye injuries, infections, allergic reactions. The disease develops as a result of metabolic disorders, hypothermia, immunodeficiency, and general diseases of the body.

The overwhelming cause of uveitis is infectious infection, which accounts for up to 50% of cases.

The causative agents are:

treponema;
Koch's wand;
streptococci;
toxoplasma;
herpes infection;
fungi.

The penetration of microbes occurs both directly and when bacteria and viruses are introduced from other places of inflammation: caries, foci of suppuration, tonsillitis.

With complicated drug and food allergies, allergic uveitis occurs.

The defeat of the choroid occurs in various diseases:

tuberculosis;
syphilis;
arthritis;
intestinal infections;
rheumatism;
skin diseases;
kidney pathology.

Traumatic inflammation of the choroid occurs due to direct trauma to the eye, the presence of foreign bodies and burns. The causes are also endocrine pathologies (diabetes mellitus, menopause).

Symptoms

The clinic of different uveitis is somewhat different. Symptoms of anterior inflammation:

redness of the eyes;
lacrimation;
increased sensitivity to light;
loss of vision;
painful sensations;
narrowing of the pupil;
rise in intraocular pressure.

The acute course of the disease causes severe symptoms, forcing the patient to see a doctor as soon as possible.

In chronic inflammation, the severity of manifestations is weak or barely noticeable: some redness of the eye, a feeling of red dots in front of the eyes.

Peripheral uveitis manifests itself:

a feeling of flies flickering before the eyes;
bilateral eye damage;
decrease in visual acuity.

Inflammation in the posterior region disturbs the distorted perception of objects. The patient complains that he sees "through the fog", he has dots before his eyes, visual acuity decreases.

Diagnostics

The appearance of symptoms of uveitis is a reason for immediate medical attention. Delaying the visit is fraught with serious consequences up to blindness.

The doctor conducts an external examination, determines the visual acuity and fields, measures eye pressure.

The reaction of pupils to light is studied in the light of a slit lamp, retinitis is visible in the study of the fundus. Additionally, ultrasound, angiography and MRI are used.

Treatment

Uveitis therapy should be carried out only by a qualified specialist, and self-medication is unacceptable.

To relieve spasm of the ciliary muscle, mydriatics are prescribed: atropine, cyclopentol. Inflammation is stopped with the help of steroid drugs for local and general use (ointment injections): betamethasone, dexamethasone, prednisone.

Taking into account the pathogen, antimicrobial or antiviral drugs are used.

Be sure to prescribe drops that reduce intraocular pressure. With the help of antihistamines, allergic symptoms are removed.

With a mild course of the disease, the symptoms disappear after 3-5 weeks. In severe forms resort to surgical treatment.

Conclusion

Uveitis is a serious pathology of the eye that needs qualified treatment. It is unacceptable to self-medicate and delay a visit to the doctor. Timely treatment is the key to a favorable prognosis.

2965 09/18/2019 5 min.

The eyes are an important part of the whole body. Sometimes, during diagnostics, the source of the problem is found not at all where it was previously searched for. The treatment of any health problem must be approached comprehensively. This is especially true of such an eye disease as uveitis. It is important to treat not only the symptoms, but to identify the cause of the disease.

What is uveitis?

Uveitis is a general concept that refers to inflammation of various parts of the choroid (iris, ciliary body, choroid). This disease is quite common and dangerous. Often (in 25% of cases) uveitis leads to and even to blindness.

The appearance of this disease contributes to the high prevalence of the vascular network of the eye. At the same time, the blood flow in the uveal tract is slowed down, which can lead to the retention of microorganisms in the choroid. Under certain conditions, these microorganisms are activated and lead to inflammation.

Lacrimation as one of the signs of uveitis

The development of inflammation is also influenced by other features of the choroid, including different blood supply and innervation of its various structures:

the anterior section (iris and ciliary body) is supplied with blood by the anterior ciliary and posterior long arteries, and is innervated by the ciliary fibers of the first branch of the trigeminal nerve;
the posterior section (choroid) is supplied with blood through the posterior short ciliary arteries and is characterized by the absence of sensitive innervation.

These features determine the location of the uveal tract lesion. The anterior or posterior section may suffer.

Classification

The anatomy of the eye predisposes to the fact that the disease can be localized in different places of the uveal tract. Depending on this factor, there are:

Anterior uveitis: iritis, anterior cyclitis. Inflammation develops in the iris and. This variety is the most common.
Median (intermediate) uveitis: posterior cyclitis, pars-planitis. The ciliary or vitreous body, retina, choroid are affected.
Posterior uveitis: choroiditis, retinitis, neurouveitis. The choroid, retina and are affected.
Generalized uveitis - panuveitis. This type of disease develops if all parts of the choroid are affected.

Forms

The nature of inflammation in uveitis can be different, and therefore the following forms of the disease are distinguished:

serous;
hemorrhagic;
fibrinous-plastic;
mixed.

Depending on the duration of inflammation, acute and chronic (more than 6 weeks) form of uveitis is distinguished.

Causes of inflammation

Uveitis can develop due to a variety of reasons, the main of which are:

infections;
trauma;
systemic and syndromic diseases;
metabolic disorders and hormonal regulation.

The most common infectious uveitis: they occur in 43.5% of cases. Infectious agents in this case are mycobacterium tuberculosis, streptococci, toxoplasma, pale treponema, cytomegalovirus, herpesvirus, fungi. As a rule, such uveitis is associated with infection entering the vascular bed from any focus of infection and develops with sinusitis, tuberculosis, syphilis, viral diseases, tonsillitis, sepsis, dental caries, etc.

Increased specific sensitivity to environmental factors plays a role in the development of allergic uveitis - drug and food allergies, hay fever, etc. Often, with the introduction of various sera and vaccines, serum uveitis develops.

Uveitis can occur against the background of systemic and syndromic diseases, such as:

rheumatism;
rheumatoid arthritis;
psoriasis;
spondyloarthritis;
sarcoidosis;
glomerulonephritis;
autoimmune thyroiditis;
multiple sclerosis;
ulcerative colitis;
syndromes of Reiter, Vogt-Koyanagi-Harada, etc.

Post-traumatic uveitis occurs due to penetrating or contusion damage to the eyeball, foreign bodies entering the eyes.

The following diseases also contribute to the development of uveitis:

metabolic disorders and hormonal dysfunction (diabetes mellitus, menopause, etc.);
diseases of the circulatory system;
diseases of the organs of vision (, conjunctivitis, keratitis, blepharitis, scleritis, perforation of a corneal ulcer).

And this is not the whole list of diseases that can cause and develop uveitis.

Symptoms and Diagnosis

At the initial stage of the disease, the color of the iris changes and adhesions appear. The lens of the eye becomes cloudy. Further, uveitis can manifest itself in different ways, depending on the type and form of inflammation. The general symptoms are:

photophobia;
chronic lacrimation;
aching or sharp pains;
pain and discomfort;
deformation, ;
the appearance of a light "fog" before the eyes;
deterioration of visual acuity, up to blindness;
fuzzy perception;
increased intraocular pressure (with a feeling of heaviness in the eye);
transition of inflammation to the second eye.

Uveitis(wrong uevit) - an inflammatory pathology of various parts of the uveal tract (choroid), manifested by pain in the eyes, hypersensitivity to light, blurred vision, chronic lacrimation. The term "uvea" in translation from the ancient Greek language means "grape". The choroid has a complex structure and is located between the sclera and the retina, resembling a bunch of grapes in appearance.

In the structure of the uveal membrane there are three sections: the iris, the ciliary body and the choroid, located under the retina and lining it from the outside.

The vascular membrane performs a number of important functions in the human body:

The most basic and vital function of the uveal membrane for the body is to supply blood to the eyes. The anterior and posterior short and long ciliary arteries provide blood flow to various structures of the visual analyzer. All three parts of the eye are supplied with blood from different sources and are affected separately.

The sections of the choroid are also innervated in different ways. Branching of the vascular network of the eye and slow blood flow are factors that contribute to the retention of microbes and the development of pathology. These anatomical and physiological features influence the occurrence of uveitis and ensure their high prevalence.

With dysfunction of the choroid, the work of the visual analyzer is disrupted. Inflammatory diseases of the uveal tract account for about 50% of all ocular pathology. Approximately 30% of uveitis lead to a sharp drop in visual acuity or to its complete loss. Men get uveitis more often than women.

variety of forms and manifestations of eye lesions

The main morphological forms of pathology:

Anterior uveitis is the most common. They are represented by the following nosologies - iritis, cyclitis,.
Posterior uveitis - choroiditis.
Median uveitis.
peripheral uveitis.
Diffuse uveitis is the defeat of all parts of the uveal tract. The generalized form of the pathology is called iridocyclochoroiditis or panuveitis.

Treatment of uveitis is etiological, consisting in the use of local dosage forms in the form of eye ointments, drops, injections and systemic drug therapy. If patients with uveitis do not turn to an ophthalmologist in a timely manner and do not undergo adequate therapy, they develop severe complications: cataracts, secondary glaucoma, retinal edema and detachment, lens accretion to the pupil.

Uveitis is a disease, the outcome of which directly depends on the time of detection and treatment. In order not to bring the pathology to loss of vision, treatment should be started as early as possible. If the redness of the eye does not go away for several days in a row, it is necessary to visit an ophthalmologist.

Etiology

The causes of uveitis are very diverse. Taking into account the etiological factors, the following types of the disease are distinguished:

In children and the elderly, ocular uveitis is usually infectious. In this case, provoking factors are often allergies and psychological stress.

Foci of inflammation in the uveal membrane are cotton-like infiltrates with indistinct contours of yellow, gray or red.. After treatment and the disappearance of signs of inflammation, the foci disappear without a trace or a scar is formed, translucent through the sclera and having the appearance of a white area with clear contours and vessels along the periphery.

Symptoms

The severity and variety of clinical symptoms in uveitis is determined by the localization of the pathological focus, the overall resistance of the organism and the virulence of the microbe.

Anterior uveitis

anterior uveitis has the most prominent manifestations

Anterior uveitis is a unilateral disease that begins acutely and is accompanied by a change in the color of the iris. The main symptoms of the disease are: eye pain, photophobia, blurred vision, "fog" or "veil" before the eyes, hyperemia, profuse lacrimation, heaviness, pain and discomfort in the eyes, decreased sensitivity of the cornea. The pupil with this form of pathology is narrow, practically unresponsive to light and having an irregular shape. Precipitates are formed on the cornea, which are an accumulation of lymphocytes, plasmocytes, pigments floating in the chamber moisture. The acute process lasts an average of 1.5-2 months. In autumn and winter, the disease often recurs.

Anterior rheumatoid serous uveitis has a chronic course and blurred clinical picture. The disease is rare and is manifested by the formation of corneal precipitates, posterior adhesions of the iris, destruction of the ciliary body, clouding of the lens. Rheumatoid uveitis is characterized by a long course, is difficult to treat and is often complicated by the development of secondary ocular pathology.

peripheral uveitis

In peripheral uveitis, both eyes are often affected symmetrically, appear “flies” before the eyes, visual acuity worsens. This is the most difficult form of pathology in terms of diagnostics, since the focus of inflammation is located in a zone that is difficult to study by standard ophthalmological methods. In children and young people, peripheral uveitis is especially severe.

Posterior uveitis

Posterior uveitis has mild symptoms that appear late and do not worsen the general condition of patients. At the same time, pain and hyperemia are absent, vision decreases gradually, flashing dots appear before the eyes. The disease begins imperceptibly: patients have flashes and flickers before their eyes, the shape of objects is distorted, vision is blurred. They experience difficulties in reading, twilight vision worsens, color perception is disturbed. Cells are found in the vitreous body, and white and yellow deposits are found on the retina. Posterior uveitis is complicated by macular ischemia, macular edema, retinal detachment, and retinal vasculitis.

The chronic course of any form of uveitis is characterized by a rare occurrence of mild symptoms. In patients, the eyes slightly redden and floating dots appear before the eyes. In severe cases, complete blindness, glaucoma, cataracts, and inflammation of the eyeball membrane develop.

Iridocyclochoroiditis

Iridocyclochoroiditis is the most severe form of pathology caused by inflammation of the entire vascular tract of the eye. The disease is manifested by any combination of the symptoms described above. This is a rare and formidable disease, which is the result of hematogenous infection of the uveal tract, toxic damage or severe allergization of the body.

Diagnostics

Uveitis is diagnosed and treated by ophthalmologists. They examine the eyes, check visual acuity, determine the field of view, conduct tonometry.

The main diagnostic methods to detect uveitis in patients:

biomicroscopy,
gonioscopy,
Ophthalmoscopy,
eye ultrasound,
Fluorescein angiography of the retina,
ultrasonography,
Rheoophthalmography,
electroretinography,
Anterior chamber paracentesis
Vitreous and chorioretinal biopsy.

Treatment

Treatment of uveitis is complex, consisting in the use of systemic and local antimicrobial, vasodilating, immunostimulating, desensitizing drugs, enzymes, physiotherapy methods, hirudotherapy, traditional medicine. Usually, patients are prescribed drugs in the following dosage forms: eye drops, ointments, injections.

Traditional treatment

Treatment of uveitis is aimed at the speedy resorption of inflammatory infiltrates, especially in sluggish processes. If you miss the first symptoms of the disease, not only the color of the iris will change, its dystrophy will develop, but everything will end with decay.

For medical treatment of anterior and posterior uveitis use:

Antibacterial agents a wide spectrum of action from the group of macrolides, cephalosporins, fluoroquinolones. The drugs are administered subconjunctivally, intravenously, intramuscularly, intravitreally. The choice of drug depends on the type of pathogen. To do this, conduct a microbiological study of the detachable eyes on the microflora and determine the sensitivity of the isolated microbe to antibiotics.
Viral uveitis is treated with antiviral drugs- "Acyclovir", "Zovirax" in combination with "Cycloferon", "Viferon". They are prescribed for topical use in the form of intravitreal injections, as well as for oral administration.
Anti-inflammatory drugs from the group of NSAIDs, glucocorticoids, cytostatics. Patients are prescribed eye drops with prednisolone or dexamethasone, 2 drops in a sore eye every 4 hours - Prenacid, Dexoftan, Dexapos. Inside take "Indomethacin", "Ibuprofen", "Movalis", "Butadion".
Immunosuppressants prescribed for the ineffectiveness of anti-inflammatory therapy. The drugs of this group inhibit immune reactions - Cyclosporine, Methotrexate.
To prevent the formation of adhesions, eye drops "Tropicamide", "Cyclopentolate", "Irifrin", "Atropine" are used. Mydriatics relieve spasm of the ciliary muscle.
fibrinolytic drugs have a resolving effect - Lidaza, Gemaza, Wobenzym.
Antihistamines funds - "Clemastin", "Claritin", "Suprastin".
vitamin therapy.

Surgical treatment of uveitis is indicated in severe cases or in the presence of complications. The adhesions between the iris and the lens are dissected in an operative way, the vitreous body, glaucoma, cataract, eyeball are removed, the retina is soldered with a laser. The outcomes of such operations are not always favorable. Possible exacerbation of the inflammatory process.

Physiotherapy is carried out after the subsidence of acute inflammatory phenomena. The most effective physiotherapeutic methods are: electrophoresis, phonophoresis, vacuum pulsed eye massage, infit therapy, ultraviolet radiation or laser blood irradiation, laser coagulation, phototherapy, cryotherapy.

ethnoscience

The most effective and popular methods of traditional medicine that can complement the main treatment (in agreement with the doctor!):

Prevention of uveitis consists in maintaining eye hygiene, preventing general hypothermia, injuries, overwork, treating allergies and various pathologies of the body. Any eye disease should be treated as early as possible so as not to provoke the development of more serious processes.

Video: mini lecture on uveitis

Anatomy of the choroid

vascular tract (uvea) consists of three sections: the iris ( iris), ciliary or ciliary body ( corpus ciliare) and the choroid proper ( chorioidea).

iris- anterior, visible part of the choroid, has an extensive network of sensitive innervation from n. ophthalmicus(first branch of the trigeminal nerve). The vascular network of the iris is formed by the anterior ciliary and posterior long ciliary arteries. The iris is divided into anterior (mesodermal) and posterior (ectodermal) sections. The mesodermal layer consists of the outer boundary layer, which is covered with endothelium, and the stroma of the iris. The ectodermal layer consists of muscular, inner boundary and pigment layers. There are two muscles in the iris - the dilator and the sphincter of the pupil. The first is innervated by the sympathetic nerve, the second by the oculomotor. The color of the iris depends on its pigment layer and the presence of pigment cells in the stroma.

The function of the iris is to regulate the amount of light entering the retina by changing the size of the pupil, that is, the function of the diaphragm. It also, together with the lens, separates the anterior and posterior sections of the eye, and together with the ciliary body produces intraocular fluid. Through the pupil there is an outflow of aqueous humor from the posterior chamber to the anterior.

Ciliary (ciliary) body not available for inspection. Palpation examines its pain, with gonioscopy - a small area of its surface is partially visible, passing into the root of the iris. The ciliary body is a ring about 6-7 mm wide. Its front part has about 70 processes, it is called the ciliary crown ( corona ciliaris). The back is flat, called the ciliary circle, the flat part ( orbiculus ciliaris or pars plana). Zinn ligaments are attached to the lateral surfaces of the ciliary processes, which hold the lens.

As in the iris, in the ciliary body, the mesodermal part is distinguished, which consists of 4 layers (suprachoroid, muscle layer, vascular layer, basal plate) and the ectodermal part, which is represented by two layers of the epithelium: outer pigmented and inner non-pigmented.

In the thickness of the ciliary body there is an accommodative muscle, which has a double innervation: parasympathetic ( n. oculomotorius) and cute. Sensory innervation is carried out n. ophthalmicus.

The accommodative muscle consists of three parts: meridial (Brücke muscle), circular (Müller muscle) and radial (Ivanov muscle).

There are many vessels in the ciliary body - branched anterior ciliary and posterior long ciliary arteries and veins of the same name.

The function of the ciliary body: accommodation and production of intraocular fluid.

choroid- the back of the vascular tract, lines the fundus of the eye, shines through the transparent retina. It consists of 5 layers: suprachoroidal, layer of large vessels, layer of medium vessels, choriocapillary layer, basal plate (Bruch's vitreous membrane). The choriocapillary layer is closely associated with the retinal pigment epithelium, therefore, in diseases of the choroid, the retina is involved in the process.

The blood supply to the choroid is carried out by the posterior short ciliary arteries, the outflow of blood occurs through the vorticose veins, which pass through the sclera at the equator. Has no sensory innervation. Function - retinal trophism.

Thus, the iris and the ciliary body have a common blood supply, innervation, therefore, they are usually affected simultaneously. Features of the blood supply to the choroid determine the isolation of its lesions. However, all three sections of the choroid are anatomically closely related, there are anastomoses between the systems of the anterior and posterior ciliary vessels, so the pathological process can capture the entire uveal tract.

Diseases of the choroid

There are the following types of pathological conditions of the choroid:

1) developmental anomalies;

2) inflammatory diseases (uveitis);

3) dystrophic diseases (uveopathy);

4) neoplasms.

Anomalies of development

Albinism complete absence of pigment in the skin, hair, eyebrows, eyelashes. The iris is very light, translucent with red light, sometimes the sclera is translucent. The fundus of the eye is light, the vessels of the choroid are visible. There is low vision, photophobia, nystagmus.

Treatment: correction of refractive errors, pleoptics.

Aniridia no rainbow. Complaints about low vision, photophobia.

Treatment: contact lenses, surgery - iridoprosthetics.

Polycoria the presence of multiple pupils. Complaints of low vision, monocular diplopia.

corectopia pupil repositioning .

Treatment: contact lenses, surgery - closed iridoplasty.

Iris coloboma defect of the iris, always located below, the pupillary border and the sphincter of the pupil are preserved.

Treatment: operation - closed iridoplasty, contact lenses.

Choroidal coloboma localized in the lower part of the fundus, in this area the retina is underdeveloped or absent.

Treatments no.

Residual pupillary membrane in the pupil area there are white opaque threads that do not start from the edge of the pupil, but from the projection of the small arterial circle of the iris.

Treatment: removed only when vision is reduced.

Inflammatory diseases of the vascular tract (uveitis)

There are anterior uveitis (iritis, cyclitis, iridocyclitis), posterior uveitis (choroiditis) and panuveitis, depending on which part of the vascular tract is affected.

Iridocyclitis. The inflammatory process in the anterior vascular tract can begin from the iris (iritis) or from the ciliary body (cyclitis). But due to the common blood supply and innervation of these departments, the disease quickly passes from the iris to the ciliary body or vice versa, and iridocyclitis develops. Allocate acute and chronic forms of the disease. The patient complains of photophobia, lacrimation, eye pain and decreased vision.

Clinical signs:

- pericorneal or mixed injection;

- pain on palpation of the eye (ciliary pain) and decreased accommodation;

- edema and hyperemia of the iris, heterochromia;

 the pupil is narrowed, weakly reacts to light;

 posterior synechia - fusion of the iris with the anterior surface of the lens;

- clouding of the vitreous body;

 Presence of precipitates on the corneal endothelium.

In severe cases, purulent exudate may appear in the anterior chamber of the eye (hypopion) or blood (hyphema). After the use of mydriatics, the pupillary edge may acquire jagged contours, as a result of the presence of posterior synechiae. If mydriatics are not used, a circular synechia may form, and then a film that can completely close the pupil lumen.

Complications. If the posterior synechiae form along the entire pupillary edge of the iris, the aqueous humor secreted by the ciliary body cannot get into the anterior chamber from the posterior chamber, bombardment (protrusion into the anterior chamber) of the iris occurs. The root of the iris also shifts forward, adhesions appear between the anterior surface of the iris and the posterior surface of the cornea (anterior synechia), which block the angle of the anterior chamber, where the drainage zone of the eye is located. All this leads to an increase in intraocular pressure and the development of secondary glaucoma). In addition to secondary glaucoma, complications of anterior uveitis can be: ribbon-like corneal degeneration, complicated uveal cataract, hypotension, subatrophy of the eye).

Differential Diagnosis carried out with an acute attack of angle-closure glaucoma, acute conjunctivitis (Table 3).

Table 3 Differential diagnosis of acute iridocyclitis with acute attack of glaucoma and acute conjunctivitis

signs	Acute attack of glaucoma	Acute iridocyclitis	Acute conjunctivitis
Clinical course, complaints	Sudden onset, severe pain in the eye with irradiation to the temporal region, jaw; headache, nausea, vomiting	Gradual onset, constant aching pain in the eye, photophobia	Gradual onset, sensation of a foreign body under the eyelids
Visual acuity	Reduced significantly		Normal
intraocular pressure		Normal or slightly reduced	Normal
Vascular Injection	stagnant	Pericorneal or mixed	Conjunctival
Cornea		Precipitates	Not changed
Anterior chamber of the eye		normal depth	normal depth
Reaction to light, pupil size	Absent, pupil wide	Reduced, pupil narrow	saved, normal
	Sometimes edematous	The drawing is smoothed, edema	Not changed

Choroiditis (posterior uveitis) - inflammation of the choroid itself, which is usually combined with inflammation of the retina and is called chorioretinitis.

Due to the absence of sensitive innervation typical for anterior uveitis, there are no complaints of pain in the eye, photophobia, lacrimation in choroiditis. On examination, the eyes are calm. Depending on the localization of the process, the complaints of patients differ. With central localization, closer to the posterior pole, patients complain of a significant decrease in visual acuity, flashes and blinking before the eye (photopsia), as well as metamorphopsia (curvature of objects and lines). These complaints indicate that the retina is involved in the process. Diagnosis is carried out using the method of ophthalmoscopy. In the case of peripheral forms of inflammation, depending on the size of the foci, patients may complain of photopsy and impaired twilight vision (hemeralopia), and in the presence of small and single foci, there are no functional subjective sensations. Inflammation can be focal (isolated) or disseminated. Fresh choroidal foci are a yellowish-gray cellular infiltrate with indistinct borders. The retina above the infiltrate is edematous, so the course of the vessels in places is not ophthalmoscoped.

Opacity develops in the posterior parts of the vitreous body, sometimes precipitates are visible on the posterior border membrane of the vitreous body.

As the inflammatory process subsides, the focus acquires a whitish-gray color with clear boundaries. In the zone of the focus, the stroma of the choroid atrophies, a dark brown pigment appears at the site of the infiltrate. In the chronic course of the process, gray-green granulomas with prominence can sometimes form, which can be the cause of exudative retinal detachment. In this case, it is necessary to carry out a differential diagnosis with a neoplasm of the choroid.

Etiology and pathogenesis of uveitis. The mechanisms of development of uveitis are predetermined by the action of infectious, toxic, allergic and autoimmune factors. Most often these are endogenous factors: infection from other foci of inflammation in the body, as well as in systemic diseases: collagenosis, especially in juvenile rheumatoid arthritis, ankylosing spondylitis, Reiter's disease; tuberculosis, secondary syphilis, sarcoidosis, Behcet's disease (hypopion-iridocyclitis, aphthous stomatitis, damage to the mucous membrane of the external genital organs), brucellosis, toxoplasmosis, herpes, etc. In the etiology of iridocyclitis, exogenous factors also play a significant role: the consequences of penetrating eye injuries, chemical burns, perforation of a corneal ulcer, etc.

Treatment. In order to identify and sanitize possible foci of infection, other etiological factors, it is necessary to conduct a complete examination of the body. Cycloplegics and mydriatics are used in anterior uveitis to reduce pain and prevent the formation of posterior synechiae. Prescribe antibiotics, sulfanilamide drugs, corticosteroids locally, parabulbarno, intramuscularly, non-steroidal anti-inflammatory drugs, desensitizing drugs, immunomodulators. If an etiological factor is established, appropriate specific therapy is prescribed. Be sure to use physiotherapeutic methods of treatment (magnetotherapy, laser irradiation, electrophoresis).

19.09.2014 | Viewed: 5 061 people

Uveitis is a group of diseases that occur with inflammation of the vascular network of the eye in its different areas - in the iris, choroid, ciliary body. Uveitis is accompanied by symptoms such as redness, pain and discomfort, increased photosensitivity, profuse lacrimation, spots and floating circles in the field of vision.

Diagnosis of diseases includes perimetry, visometry, retinography, ophthalmoscopy, biomicroscopy, ultrasound, CT or MRI of the eye, electroretinography, etc.

Treatment is based on identifying and eliminating the cause of uveitis. The patient is prescribed local and general therapy, complications of the pathology often require surgical intervention.

What is uveitis?

Uveitis is inflammation of the uveal tract. This pathology is quite common and is observed in about half of all cases of inflammatory eye diseases.

The choroid of the organs of vision consists of the ciliary (ciliary) body, the iris and the vascular network itself - the choroid, which lies directly under the retina.

In connection with this anatomical structure, the main forms of uveitis are cyclitis, iritis, iridocyclitis, chorioretinitis, choroiditis, and others.

Up to a third of cases of uveitis lead to complete or partial blindness.

The high frequency of pathologies is due to the fact that the vessels of the eye are branched and spread to many structures of the eye, while in the area of the uveal tract the blood flow is greatly slowed down.

This specificity affects some stagnation of microbes in the choroid, which easily leads to the development of an inflammatory process. Another characteristic feature inherent in the uveal tract is the separate blood supply to its anterior part (the iris with the ciliary body) and the posterior part, the choroid.

The anterior part of the uveal tract is supplied by the posterior long arteries and the anterior ciliary arteries. Blood enters the posterior part of the uveal tract from the posterior short ciliary arteries.

In connection with this feature, the pathology of these two parts of the uveal tract, as a rule, is not connected with one another, that is, the diseases often occur separately.

The supply of nerve roots to the choroid of the organs of vision is also not the same. The ciliary body and the iris are innervated by the ciliary fibers of one of the branches of the facial nerve, while the choroid is not penetrated by nerve fibers at all.

Types of uveitis

According to the location of the inflammatory phenomena, uveitis is:

Anterior (among them - iritis, anterior cyclitis, iridocyclitis).
Posterior (this group includes choroiditis, retinitis, neurouveitis, chorioretinitis).
Median (including pars planitis, posterior cyclitis, peripheral uveitis).
Generalized.

If a patient develops anterior uveitis, then the ciliary body and iris are involved in the pathological process. This type of disease is the most common.

Median uveitis affects the choroid and ciliary body, as well as the retina and vitreous body. If posterior uveitis is diagnosed, then in addition to the retina and choroid, the optic nerve is affected.

If inflammatory processes cover all parts of the uveal tract, then panuveitis develops, or generalized uveitis.

According to the type of inflammation, uveitis can be purulent, serous, fibrinous, hemorrhagic, mixed. Due to the occurrence, pathology can be primary (associated with systemic diseases), secondary (develops against the background of other eye diseases), as well as endogenous, exogenous.

According to the nature of the course, uveitis is differentiated into acute, chronic, recurrent. According to the type of changes in the choroid, diseases are classified into non-granulomatous, or toxic-allergic widespread, and granulomatous, or local metastatic.

Causes of uveitis

There are many etiological factors that can lead to the development of uveitis. Among them are infections, systemic diseases, allergies, toxic lesions, metabolic diseases, hormonal disruptions, eye damage.

The most common uveitis that develops with the penetration of infectious particles (more than 40% of cases). The causative agents of the disease are most often: staphylococci, streptococci, mycobacterium tuberculosis, herpesvirus agents, pathogenic fungi.

This type of uveitis is caused by the penetration of infection from a chronic focus, located in any part of the body, by the hematogenous route. Often, infection occurs against the background of tuberculosis and syphilis, caries, sinusitis, sepsis, etc.

Allergic uveitis occurs with high sensitivity to various stimuli (external, internal) - when taking medications, food allergens. In some cases, uveitis can be a side effect of immunizations or sera.

The appearance of uveitis is often associated with common pathologies and syndromes. These include rheumatoid arthritis, systemic lupus erythematosus, vasculitis, psoriasis, multiple sclerosis, Reiter's disease, uveomeningoencephalitis and others.

Uveitis often develops after trauma to the eye - wounds, burns, penetration of a foreign body, contusion. In addition, uveitis can be accompanied by metabolic disorders - gout, diabetes, blood diseases, hormonal disorders.

Secondary uveitis develops in parallel with other eye diseases - conjunctivitis, retinal detachment, keratitis, scleritis, corneal ulcers, etc.

Clinical picture of uveitis

The symptoms of uveitis vary depending on the location of the inflammation, the type of infection that has entered the eye, and the state of the body's immune system.

Acute anterior uveitis is expressed by the following symptoms: pain syndrome, irritation and redness of the eye, increased photosensitivity, lacrimation, visual acuity loss, pupil constriction. Often the pressure inside the eye increases.

If anterior uveitis acquires a chronic course, then often there are no subjective signs at all, or they are weakly manifested in the form of a slight reddening of the eyes, a rare appearance of floating “flies” in the field of view.

With frequent exacerbations of anterior uveitis, precipitates form on the endothelium of the cornea of the eye. In addition, the activity of the pathological process is evidenced by the presence of microorganisms in the fluid released from the anterior chamber of the eye (this is detected as a result of bakanalysis).

Often, anterior uveitis is complicated by the formation of synechia - adhesions between the iris and the lens. Also, the disease can lead to the development of cataracts, glaucoma, swelling of the central part of the retina, inflammation of the eye membrane.

Uveitis, covering the peripheral sections of the choroid, cause damage to two eyes at the same time. The patient notes a decrease in the sharpness and brightness of central vision, the appearance of floating circles, "flies".

Posterior type uveitis is subjectively expressed by a decrease in visual clarity, image distortion, and a decrease in visual acuity.

Posterior uveitis is characterized by the appearance of macular edema, its ischemia, blockage of retinal vessels, and the development of optic neuropathy.

The most complex form of uveitis is generalized iridocyclochoroiditis. Usually this type of disease is inherent in the defeat of the whole organism, which, for example, happens with sepsis. Often the disease accompanies panophthalmitis.

If uveitis occurs against the background of the Vogt-Koyanagi-Harada syndrome, then the patient has severe headaches, hearing loss, hair loss, psychosis, and the appearance of vitiligo. Uveitis associated with sarcoidosis has the following clinic: eye manifestations, cough and shortness of breath, inflammation of the lymph nodes, lacrimal glands, salivary glands.

Diagnosis of uveitis

Diagnosis of the disease by an ophthalmologist necessarily includes the following procedures: visual examination, including assessment of the condition of the eyelids, the mucous membrane of the eye, checking the reaction of the pupils, perimetry, visometry. The doctor measures intraocular pressure, since many types of uveitis lead to an increase or decrease in pressure.

During biomicroscopy, zones of ribbon-like dystrophy, posterior adhesions, cellular reaction, precipitates, and sometimes cataracts are determined. Gonioscopy helps to detect the presence of pathological exudate, the presence of anterior adhesions, the formation of new vessels in the iris and anterior chamber of the eye.

Ophthalmoscopy is required to determine focal changes in the fundus of the eye, as well as edema of the retina and optic nerve head. If such an examination is impossible, which often happens when the vitreous body, lens and cornea lose transparency, then an ultrasound of the eye is prescribed.

For the differentiation of uveitis by type and for accurate diagnosis of neovascularization of eye structures, angiography of vessels, optical tomography, and laser scanning tomography are recommended.

In addition, rheoophthalmography, electroretinography can effectively reflect the ongoing processes.

According to indications, chorioretinal biopsy, paracentesis of the anterior chamber of the eye can be prescribed. Some patients (depending on the cause of uveitis) may need to consult a phthisiatrician or venereologist, as well as x-rays of the lungs, tuberculin tests, consultations of a neurologist, rheumatologist, allergist, immunologist and a number of relevant studies.

In addition to instrumental examinations, laboratory methods for diagnosing uveitis are necessary - tests and analyzes to identify pathogens (herpes virus, chlamydia, cytomegalovirus, etc.), as well as determining indicators of rheumatoid factor, C-reactive protein, conducting allergy tests and other studies.

Treatment of uveitis

Therapy is prescribed by an ophthalmologist together with other narrow specialists. If the diagnosis of the disease was early and correct, and the treatment was timely and aimed at eliminating the etiological factor, then a complete recovery is possible. Also, uveitis therapy should include measures to prevent complications that can cause a decrease in visual acuity.

The main therapeutic course consists of drugs for dilating the pupil (mydriatics), glucocorticosteroids to eliminate inflammation, and immunosuppressants.

If the cause of uveitis is infection with pathogenic bacteria, then antiviral drugs and antibiotics are prescribed.

For other prerequisites for uveitis, antihistamines, cytostatics, non-steroidal anti-inflammatory drugs, etc. will be needed.

Locally performed instillations of mydriatics - atropine, cyclopentol. Such treatment eliminates spasm of the ciliary muscle, and is also a prevention of the formation of posterior adhesions and a measure of therapy for existing adhesions.

Of great importance in the treatment of uveitis are local remedies with glucocorticosteroids - laying ointments, instillations into the conjunctival sac, etc. Some patients require systemic administration of glucocorticosteroids - dexamethasone, prednisolone, hydrocortisone.

If there is no positive dynamics, immunosuppressants are introduced into the course of therapy - cytostatics, etc. If the patient has increased intraocular pressure, special preparations in the form of drops, hirudotherapy are recommended.

When the acute phase of uveitis subsides, physiotherapeutic methods, phonophoresis with enzymes are included in the treatment.

If therapy was ineffective, or was started out of time, complications of uveitis may develop. Their treatment is often surgical - dissection of adhesions of the iris, operations on the vitreous body, surgery for glaucoma and cataracts, detached retina.

The generalized form of the disease may require removal of the vitreous body, and sometimes evisceration of the eye.

Forecast

Adequate and timely started treatment usually leads to a complete recovery in 3-6 weeks. With chronic uveitis, it often worsens, which often occurs against the background of another relapse of the underlying disease.

If complications of the pathology develop, posterior adhesions, glaucoma, cataracts, edema and retinal detachment, retinal infarction can form. Central chorioretinitis can cause a drop in visual acuity.

Prevention of uveitis

Prevention of the disease is reduced to the treatment of all ophthalmic pathologies, the correction of systemic diseases, the prevention of eye injuries, and the prevention of contact with allergens.