uveitis: ocular inflammatory disease

1. BY: AMIT CHANDANSHIVE
F.Y.M.PHARM.
GUIDE: Mrs. VIJAYA BHOGALE.

2. Content
 INTRO OF EYE STRUCTURE AND FUNCTION.
 INTRO OF UVEITIS.
 SIGNS AND SYMPTOMS.
 CAUSES.
 PATHOPHYSIOLOGY.
 DIAGNOSIS.
 TREATMENT.
 ROLE OF SOME NATURAL PRODUCT IN UVEITIS.
 PROGNOSIS.
 EPIDEMIOLOGY.
CONCLUSION.
 REFERENCES.

3. Introduction to Eye
Most complicated organ in the human body.
 A number of parts fitted together in a near-spherical
structure.
 Each part in the system is responsible for a certain action.

4. Classification of Eye Structure
 External structure .
 Internal structure .

5. External structure of Eye
Sclera: protects the inner parts of Eye.
Conjunctiva: Thin transparent membrane spread across the sclera.
Cornea: job of cornea is to refract the light that enters the eyes.
Iris: to control the size of the pupil.
Pupil: small opening located at the middle of the Iris.

6. Internal structure of Eye
Retina: Photosensitive cells that detect dim and colored lights.
Lens: Focuses light to the retina.
Aqueous Humor: Watery fluid present in area bet lens and cornea.
Vitreous Humor: Transparent semi-solid, jelly-like substance that
fills the interior of the eyes.
Optic nerve: Responsible for carrying the nerve impulses from
the photoreceptors to brain.

7. INTRODUCTION OF UVEITIS
• Inflammation of the uvea.
• Twentieth century referred ‘‘ophthalmia.”
• Pigmented layer that lies between inner retina and
outer sclera and cornea.
• Uvea consists of middle layer of pigmented vascular
structures of the eye,
• Includes the iris, ciliary body, and choroid.

8. CLASSIFICATION OF
UVEITIS
• ANTERIOR
• INTERMEDIATE
• POSTERIOR
• PAN UVEITIC

9. Anterior uveitis
 Includes iridocyclitis and iritis.
 Iritis is inflammation of the anterior chamber and iris.
 Iridocyclitis presents the same symptoms as iritis, but also includes inflammation
in the ciliary body.
 From two-thirds to 90% of uveitis cases are anterior in location.
 This condition can occur as a single episode and subside with proper treatment.

10. Intermediate uveitis
 Known as pars planitis.
 Consists of vitritis -inflammation of cells in vitreous cavity.
 Deposition of inflammatory material on the pars plana.
 "Snowballs“,Inflammatory cells in the vitreous.

11. Posterior uveitis
 Chorioretinitis.
 The inflammation of the retina and choroid.

12. Pan-uveitis
 Is the inflammation of all layers of the uvea.

13. SYMPTOMS AND SIGNS
 Anterior uveitis
 Burning.
 Redness.
 Blurred vision.
 Headaches.
 Irregular pupil.
 Eye pain.
 Photophobia or sensitivity to light.
 Floaters, which are dark spots that float in the visual field.

14. Intermediate uveitis
Most common:
 Floaters.
 Blurred vision.

15. Posterior uveitis
 Floaters.
 Blurred vision.
 Photopsia or seeing flashing lights.

16. CAUSES
Widely administered vaccines cause uveitis.
Noninfectious Causes.
Infectious causes.
Associated with systemic diseases.
Drug related side effects.

17. Noninfectious Causes
 Behcet disease.
 Crohn's disease.
 HLA-B27 related uveitis.
 Sarcoidosis.
 Spondyloarthritis.
 Sympathetic ophthalmia.

18. Infectious Causes
 Brucellosis.
 Leptospirosis.
 Lyme disease.
 Syphilis.
 Tuberculosis.
 Zika Fever.

19. Associated with systemic diseases
 Inflammatory Bowel Disease.
 Kawasaki's Disease.
 Multiple Sclerosis.
 Reactive Arthritis.
 Sarcoidosis.
 Whipple's Disease.

20. Drug related side effects
 Rifabutin, a derivative of Rifampin has been
shown to cause uveitis.
 Quinolones especially Moxifloxacin may lead
to uveitis.
 All of the widely administered vaccines have
been reported to cause uveitis.

21. PATHOPHYSIOLOGY
Immunologic
factors
Genetic
Factors
Infectious
agents

22. Immunologic factors
 Uveitis Is Driven By Th17t Cell Sub-population That Bear T-cell
Receptors Specific For Proteins Found In The Eye.
 Not Detected Centrally Whether Due To Ocular Antigen Not Being Presented In
The Thymus.
 Autoreactive T Cells Must Normally Be Held In Check By The Suppressive
Environment Produced By Microglia And Dendritic Cells In The Eye.
 These Cells Produce Large Amounts Of TGF Beta And Other
Suppressive Cytokines,
 Including IL-10, To Prevent Damage To The Eye By Reducing Inflammation And
Causing T Cells To Differentiate To Inducible T Reg Cells.

23. Cont….
 Immune stimulation by bacteria and cellular stress is
normally suppressed by myeloid suppression while
inducible T reg cells prevention and clonal expansion of the
autoreactive Th1 and Th 17 cells that possess potential to
cause damage to the eye.
 Infection or other causes, this balance can be upset and auto
reactive T cells allowed to proliferate and migrate to the eye.
 Entry to the eye, these cells may be returned to an inducible
T reg state by the presence of IL-10 and TGF-beta from
microglia.

24. Genetic Factors
 The cause of non-infectious uveitis is unknown.
 But there are some strong genetic factors that predispose
disease onset .
 Including HLA-B27 and the PTPN22 genotype.

25. Infectious agents
 Recent evidence has pointed to reactivation of herpes
simplex, varicella zoster and other viruses as
important causes.
Bacterial infection is another significant contributing
factor in developing uveitis.

26. DIAGNOSIS
 Diagnosis includes dilated fundus examination to rule out
posterior uveitis, which presents with white spots across the
retina along with retinitis and vasculitis.
 Laboratory testing is usually used to diagnose specific
underlying diseases, including rheumatologic tests (e.g.
antinuclear antibody, rheumatoid factor, angiotensin converting
enzyme inhibitor) Serology for infectious diseases (e.g. Syphilis,
Toxoplasmosis, Tuberculosis).
fig. Keratic precipitates

27. TREATMENT
What should treatment achieve?
1. Relieve pain and discomfort.
2. Prevent sight loss due to the disease or its
complications.
3. Treat the cause of the disease where possible, that
is, treat the inflammation.
The drugs used to treat uveitis fall into 3 main
groups.
1) Steroids
2) Immunosuppressant.
3) Mydriatics.

28. STEROIDS
Steroids have wide ranging effects but their action may
be looked on as being anti-inflammatory and
immunosuppressant".
They are used in different forms:
• Eye drops.
• Periocular injections.
• By oral (tablets).
• Intra-venous infusion (drip).

29.  Eye Drops:
 Used for Anterior Uveitis.
 Drops can penetrate the part of the eye in front of the lens, where anterior uveitis occurs.
 Frequency of taking the drops depending on severity of the uveitis.
 Severe Cases strongest drop-every hour .
 Mild inflammation weakest drop once or twice a day.
 Periocular Injections:
 Use of injections around the eye to deliver the steroid treatment.
 In certain situations injections offer a better way than either tablets or drops.
 They are used along with other forms of treatment.
 Situations where injections are used include:
• Severe cases of anterior uveitis which can not be controlled by drops alone.
• Intermediate uveitis.

30.  Systemic Steroids:
• Oral Steroids E.g. Prednisolone Tablet.
• The use of systemic steroids is more serious than, steroid drops because in this form
there are potentially significant side effects.
• Many different situations in which oral steroids are considered.
• If anterior uveitis is resistant to treatment with drops and injections then systemic
steroids considered.
• The main use of oral steroids is to treat posterior uveitis , panuveitis.
Dosage: Prednisolone tablet 1mg and 5mg.
 Intra-venous Steroids:
E.g. Methylprednisolone.
• when rapid control of inflammation is needed high dosage of steroid needs to be
delivered quickly.

31. Side Effects
Of Steroids
Nausea ,
Dyspepsia
Increased
Appetite ,
Weight
Gain, Fluid
Retention
Diabetes ,
Osteoporosis
Glaucoma ,
Cataract.

32. IMMUNOSUPPRESSANT
 Steroids do suppress the immune system,but there are
a different group of drugs that may be used to treat
uveitis.
 These drugs tend to target the immune system more
precisely than steroids.
 They are usually used in conjunction with steroids.
The main examples are:
 Cyclosporine.
 Azathioprine (Imuran).
 Methotrexate.
 Mycophenolate mofetil (cellcept).
 Tacrolimus (Prograf 500).

33. MYDRIATICS
Mydriatics have 2 main aims:-
 To relieve pain and light sensitivity.
 To prevent sight threatening complications.
 Mydriatic eye drops, Eg. Atropine and Cyclopentolate are used.
 It works by "paralyzing" the muscles of the iris and the ciliary
body.
 It taken their effect the pupils will be dilated. This may cause
Blurring of the vision.
 Useful because they help prevent complication which may occur
in anterior uveitis.

34. ROLE OF SOME NATURAL
PRODUCT IN UVEITIS
TURMERIC:
Benefits for Uveitis:
 From 2010.
 Antioxidant properties, protect and boost the functioning of
the immune system.
 Turmeric help in the reduction of chronic uveitis symptoms.
 Research studies which have found that turmeric can prove
beneficial for uveitis.

35. Study
 study on a curcumin-phosphatidyl choline compound called
Meriva or Norflo tablets, treating chronic anterior uveitis.
 given twice daily to patients with differing etiologies of this
condition.
 There were 106 patients studied over a 12 month period.
They were divided into 3 groups
 Autoimmune Uveitis.
 Herpetic Uveitis.
 Different Uveitis Etiologies.
 results found that all patients well tolerated Meriva Tablet.
 It reduced eye discomfort in around 80% of patients after a few
weeks.
 Conclusion: curcumin based medications could benefit those
with anterior uveitis .

36. Dosage: 375mg Tablet 3 times daily.
Precautions:
 Diabetes or Gall Bladder problems must avoid turmeric
supplements.
 Taken in excess, it can cause Diarrhea Or Nausea.
 Contraindicated in Pregnant and Breastfeeding women.
MARKETED PREPARATION:
 Uvical pills.
 Curcumin phytosome 500mg caps.
 Turmeric curcumin 500mg caps.

37. PROGNOSIS:
 Prognosis is good for those who receive prompt diagnosis and treatment.
 But serious complication including Cataracts, Glaucoma, And Permanent
Vision Loss may result.
EPIDEMIOLOGY:
 Uveitis affects approximately 1 in 4500 people and is most common between
the ages 20 to 60 with men and women affected equally.
 In western countries, anterior uveitis accounts for between 50% -90% , in
Asian countries the proportion is between 28% -50%.
 Uveitis is responsible for approximately 10%-20% of the Blindness in the
United States.
CONCLUSION:
 Corticosteroids is the main stay of treatment in uveitis.
 Immunosuppressives have the treatment in chronic uveitis.
 Better understanding of immunology and uveitic diseases help providing
more targeted treatment in uveitis.
 The future holds great promise for uveitis with continuing development of
newer drugs.

38. REFERENCES
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6. CDC: Department of Human Services (9 September 1994). "Uveitis Associated
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