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Diseases of the uvea

Last updated: March 24, 2021

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The uvea is the middle layer of the eye and consists of three parts: iris, ciliary body, and choroid (see also eye and orbit). There are four types of uveitis: anterior, posterior, complete (panuveitis), and intermediate, the latter being the least common. Uveitis is significant because of its association with systemic inflammatory conditions such as sarcoidosis, seronegative spondyloarthropathies, and vasculitides. However, infectious causes such as brucellosis, leptospirosis, and Lyme disease are also possible. Anterior uveitis manifests with periocular pain, ocular hyperemia (“red eye”), and photophobia. Posterior uveitis manifests with painless visual disturbances such as floaters and decreased visual acuity. Initial treatment for uveitis includes topical glucocorticoids and cycloplegics. If infection is suspected, an antibiotic or antiviral is used prior to topical glucocorticoids. Complications of uveitis include secondary glaucoma, cataract, posterior synechiae, and vision loss.

Other disorders of the uvea covered in this article are neovascularization of the iris, benign and malignant uveal tumors, iridodialysis, iridodonesis, and heterochromia.

Common types of uveitis
Anterior uveitis (most common) Posterior uveitis
Affected part of eye
Common etiologies
Clinical features
Diagnostics
Complications

Uveitis is often associated with HLA-B27 syndromes, such as Crohn disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and reactive arthritis.

Posterior uveitis does not manifest with pain (unlike painful anterior uveitis), because the choroid is not innervated by sensory nerves.

References:[1][2][3]

References:[4][5]

Benign tumors

  • Choroidal nevus: benign melanocytic lesion (nevus) of the posterior uvea
    • Epidemiology: common [6]
    • Fundoscopic appearance
      • Flat or slightly elevated
      • Gray-yellow in color
      • Clearly defined margins
      • Remains stable in size over time
    • Treatment
      • No treatment necessary
      • Regular monitoring is important as malignant transformation is possible, though rare.

Malignant tumors

Iridodialysis

Iridodonesis [10]

Heterochromia iridum

  • Definition: irises of different color
  • Types
    • Congenital heterochromia
    • Acquired heterochromia
      • Injury or infection
      • Horner syndrome
      • Glaucoma
      • Fuchs heterochromic iridocyclitis: a chronic low-grade inflammatory disease of the eye characterized by heterochromia and ciliary fibrosis.
      • Sympathetic heterochromia
      • Ocular melanosis

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  2. Shaarawy T, Sherwood M, Hitchings R, Crowston J. Glaucoma. Elsevier ; 2015
  3. Distinguishing a Choroidal Nevus From a Choroidal Melanoma. https://www.aao.org/eyenet/article/distinguishing-choroidal-nevus-from-choroidal-mela. Updated: February 1, 2012. Accessed: November 7, 2018.
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  8. Traumatic iridodialysis from an airsoft pellet in an aviator.
  9. Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. 2002; 47 (4): p.297-334.
  10. Desai D, Tajik AJ. Iridodonesis. N Engl J Med. 2017; 377 (11): p.e14. doi: 10.1056/nejmicm1615424 . | Open in Read by QxMD
  11. Herold G. Internal Medicine. Herold G ; 2014