MindMap Gallery Ophthalmology Chapter 12 Uveal Diseases
About Ophthalmology Chapter 12 Uveal Diseases Mind Map, including several common special uveitis, uveal cysts and tumors.
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This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
Chapter 12 Uveal Disease
Section 1 Uveitis
I. Overview Uveitis used to refer to inflammation of the uvea itself, but now internationally, inflammation that occurs in the uvea, retina, retinal blood vessels, and vitreous body is usually referred to as uveitis. Uveitis mostly occurs in young adults and is easy to merge into the whole body. Sexual autoimmune diseases often recur, are difficult to treat, and can cause some serious complications. They are a common and important blinding eye disease.
2. Anterior uveitis
Anterior uveitis includes 3 types: iritis, iridocyclitis and anterior cyclitis. It is the most common type of uveitis, accounting for about 50% of the total number of uveitis in my country.
(1) Clinical manifestations of anterior uveitis
1. Symptoms: People with acute inflammation may experience eye pain, photophobia, tearing, and blurred vision.
2. Physical signs
(1) Ciliary congestion or mixed congestion
(2) Posterior corneal deposit (KP): Inflammatory cells or pigment are deposited on the posterior surface of the cornea, which is called KP. Its formation requires corneal endothelial damage and inflammatory cells or pigments exist at the same time. According to the shape of KP, it can be divided into 3 types Types, namely dust-like, medium-sized and suet-like. The first two are mainly caused by deposited by neutrophils, lymphocytes, and plasma cells, the latter It is mainly composed of monocytes, macrophages and epithelial-like cells. suet KP is mainly seen in granulomatous uveitis.
(3) Anterior chamber flare: It is caused by the destruction of the blood-aqueous humor barrier function and the entry of proteins into the aqueous humor. Slit lamp During examination, it appears as a white beam in the anterior chamber.
(4) Iris changes: The iris can undergo various changes, including fibrous exudation and fibrosis on the front surface of the iris and lens. Proliferation can cause the two to adhere together, which is called posterior iris synechiae.
(5) Pupil changes: During inflammation, ciliary muscle spasm and continuous contraction of the pupillary sphincter can cause pupil constriction; the posterior synechiae of the iris cannot be opened, and various shapes of pupils often appear after dilation, such as plum blossom, Pear-shaped or irregular shape, if the iris is 360° adhesions, it is called pupillary atresia; if the fibrous membrane covers the entire pupil area, it is called pupillary atresia.
(2) Complications of anterior uveitis
3. Low intraocular pressure and eye atrophy: Recurrent or chronic inflammation can lead to ciliary body detachment or atrophy, reduced aqueous humor secretion, and hypotonia. Decrease, severe cases can cause eyeball atrophy.
(3) Acute anterior uveitis
Clinical manifestations: There are usually symptoms such as sudden eye pain, redness, photophobia, and tearing. During examination, ciliary congestion, dust-like KP, obvious anterior chamber flare, and A large number of anterior chamber cells may be accompanied by changes such as fibrin exudation, hypopyon, miosis, and posterior iris synechiae.
Diagnosis: A detailed history of acute anterior uveitis should be taken to determine whether it is accompanied by ankylosing spondylitis.
Treatment: The principle of treatment is to immediately dilate the pupil to prevent and open fresh posterior iris synechiae, and to quickly fight inflammation to prevent the occurrence of eye tissue destruction complications. Depend on The vast majority of anterior uveitis is caused by non-infectious factors, so antibiotic treatment is generally not required. For patients with highly suspected or confirmed pathogens, If it is caused by infection, corresponding anti-infective treatment should be given.
3. Intermediate uveitis
It mostly occurs in people under 40 years old.
clinical manifestations
1. Symptoms: The onset is insidious, and the exact onset time cannot be determined. In mild cases, there may be no symptoms or only floaters, and in severe cases, blurred vision and temporary myopia may occur; When the macula is involved or cataracts occur, there may be significant vision loss.
2. Signs: Snowball-like opacity in the vitreous body, snow bank-like changes in the pars plana of the ciliary body.
Diagnosis: The diagnosis can be made based on the typical vitreous snowball opacities, snowbank-like changes, and underlying peripheral retinal vasculitis.
4. Posterior uveitis
clinical manifestations
1. Symptoms: There may be dark shadows or dark spots in front of the eyes, flashes of light, visual distortion, blurred vision or decreased vision. Those with systemic diseases will have corresponding systemic symptoms.
Section 2 Several common special uveitis
1. Vogt-Koyanagi Harada disease
Vogt-Koyanagi Harada disease (VKH disease) is a disease characterized by bilateral granulomatous panuveitis, often accompanied by meningeal irritation, hearing impairment, vitiligo, and hair whitening or loss.
Clinical manifestations: Recurrent episodes of anterior uveitis (approximately 2 months after onset), typically manifesting as recurrent granulomatous anterior uveitis, often with sunset glow in the fundus. morphological changes, Dalen-Fuchs nodules, and ocular complications. Common complications include concurrent cataracts, secondary glaucoma, or exudative retina membrane detachment.
2. Behcet’s disease
Behcet's disease is a multisystem disease characterized by recurrent uveitis, oral ulcers, skin lesions, and genital ulcers. The disease is considered an autoinflammatory disease.
Diagnosis: The diagnostic criteria established by the International Behcet's Disease Study Group are: 1. Recurrent oral ulcers (recurrence at least 3 times within a year). 2. The diagnosis can be confirmed by the presence of two of the following four items: ① Recurrent genital ulcers or genital scars; ②Ocular damage (anterior uveitis, posterior uveitis, intravitreal cell or retinal vasculitis); ③Skin lesions (erythema nodosum, pseudofolliculitis or pus papules or post-developmental acne-like rash); ④The skin allergic reaction test is positive.
3. Sympathetic ophthalmia
Sympathetic ophthalmia refers to bilateral granulomatous uveitis that occurs in one eye after a perforation injury or intraocular surgery. The injured eye is called the triggering eye, and the other eye is called the sympathetic eye.
Clinical manifestations: It can occur from 5 days to 56 years after trauma or surgery, but it usually occurs within 2 weeks to 2 months.
4. Fuchs syndrome
Fuchs syndrome is a chronic nongranulomatous uveitis characterized by iris depigmentation.
Clinical manifestations: Posterior subcapsular opacity of the lens and increased intraocular pressure are prone to occur.
5. Acute retinal necrosis syndrome (ARN): The exact cause is not completely clear, but it may be caused by herpes virus infection. It manifests as retinal necrosis, vasculitis mainly retinal arteritis, and glass vasculitis. Vitreous opacification and later retinal detachment.
Section 3 Uveal cysts and tumors
1. Iris cyst There are many causes of iris cysts, including congenital, traumatic implantation, inflammation, exudation, and parasitic origin. Among them, traumatic implantation is the most common.
2. Choroidal malignant melanoma Choroidal malignant melanoma is the most common intraocular malignant tumor in adults. It is more common in adults aged 50 to 60 years and is often unilateral.
3. Choroidal metastasis cancer Choroidal metastasis cancer is more common in people aged 40 to 70 years old, more common in women, and can be in one or both eyes, with the left eye being more common than the right eye. Metastasis of breast cancer is the most common, followed by lung cancer, and others include metastasis of kidney cancer, digestive tract cancer, thyroid cancer or liver cancer. Because metastatic cancer grows quickly, it can compress the ciliary nerve, causing severe eye pain and headache in the early stages. The fundus appears as grayish-yellow or yellowish-white, nodular flat bulges under the retina at the posterior pole, and extensive retinal detachment may occur in the late stages. During diagnosis, a detailed history of the tumor should be asked to search for the primary lesion. CT, MRI, ultrasound and FFA examinations are helpful in diagnosis.
4. Choroidal osteoma The cause of choroidal osteoma is still unclear, but it is mostly thought to be a bony blurred tumor. It is more common in young women.
Section 4 Congenital anomalies of uvea
1. No iris Almost always both eyes are affected. It is often accompanied by abnormalities of the cornea, anterior chamber, lens, retina and optic nerve, and is an autosomal dominant inheritance. The iris is completely missing, and the equatorial edge of the lens, suspensory ligament, and ciliary process can be directly seen. There may be photophobia and low vision caused by various eye abnormalities.
2. Iris defect Typical iris coloboma is a complete iris defect located below, forming a pear-shaped pupil with the tip pointing downward. The difference from surgical resection is that the edge of the defect is covered by pigment epithelium. It is often accompanied by other congenital malformations of the eye, most of which are not Affect vision.