DISORDERS OF UVEAL TRACT Uveitis Uveal melanoma Aniridia Albinism Nursing management

1. DISORDERS OF UVEAL
TRACT

2. Uveal tract
• Middle layer of tissues in eye ball
• Divided in 3 parts :
IRIS:
• Anterior portion of the uvea .
• Form diaphragm over the lens, called pupil.
Controls the intensity of light entering in eye.
Ciliary body:
• Middle part of the uveal tract and attached to the outer layer of
eye( sclera )
• About 5 to 6 mm long

3. • Produce the aqueous humor
Choroid:
• Posterior part of the uveal tract
• Layer of connective tissue rich in blood vessels
• It support and nourish the retinal cells.

4. Common uveal tract disorders
• Uveitis
• Uveal melanoma
• Aniridia
• Albinism

5. Uveitis
• Uveitis is the inflammation of uveal tissues or uveal tract
• It is the common cause of blindness
SYMPTOMS OF UVEITIS:
• Eye redness or irritation
• Blurred vision
• Eye pain
• Photophobia
• Floating spots before the eyes

6. Signs of uveitis:
• Ciliary/circumcorneal injection
• Keratic precipitates
• Irregular/ sluggish pupil
• Synechiae
• Raised intraocular pressure
Classification of uveitis:
 Anatomical classification:
1. Anterior uveitis: inflammation of anterior portion of uvea
• Also known as iritis (if the inflammation is of anterior chamber of
iris) and iridocyclitis (if it includes the ciliary body along with iris)
Keratic
precipitates

7. 2. Intermediate uveitis: inflammation of posterior part of ciliary
body and extreme periphery of retina (pars planitis)
3. Posterior uveitis: inflammation of the choroid (choroiditis) or
associated inflammation of the retina (chorioretinitis).
4. Pan uveitis: inflammation of the whole uvea.

8.  Clinical classification
1. Acute uveitis: sudden symptomatic onset, lasts for six weeks or
more
2. Chronic uveitis: insidious asymptomatic onset, lasts for more
than three months or even a year.
 Pathological classification
1. Non- granulomatous: the more common types of uveitis , which
manifest as an acute condition with pain , photophobia & pattern
of conjunctiva injection , especially around the cornea.
Clinical manifestation:
• Pupil will appear small or irregular , and vision is blurred.

9. • Small, fine precipitates on the posterior corneal surface and WBC
in aqueous humor.
• Pus may accumulate in the anterior chamber ( hypopyon) if the
uveitis is severe.
• Repeated attacks of non-granulomatous may cause synechiae.
2. Granulomatous: have a more insidious onset and can involve any
portion of the uveal tract.
Clinical manifestation:
• Photophobia
• Pain
• Adversely affected vision
• Conjunctival injection is diffuse
hypopyon

10. Etiology of uveitis
1. Infections:
• Viral- CMV, herpes virus
• Bacteria- TB, T. Pallidum, M. Leprae
• Fungal- candida
• Parasite- toxoplasmosis, toxocara
2. Non-infectious:
• Arthritis: ankylosing spondylitis
• Skin diseases: VKH, Behcet disease, psoriasis
• CNS disorders: multiple sclerosis
ANKYLOSING
SPONDYLITIS

11. • Respiratory diseases: sarcoidosis
• G.I.T. Diseases: ulcerative colitis
• Genitourinary diseases: reiter’s diseases
• Specific ocular disorders: fuchs heterochromic iridiocyclitis
• Non-specific idiopathic
3. Other potential causes:
• Exposure to a toxin that penetrates eye
• Bruising
• Injury
• Trauma

12. Uveal melanoma
Melanoma occuring in the uveal tract is uveal melanoma. It is
caused by the malignant transformation of melanocytes.
Risk factors:
• Sunlight exposure
• Predisposing diseases:
1. Family history of uveal melanoma
2. Uveal nevus
3. Congenital ocular melanocytosis
4. Dysplastic nevus syndrome
5. Xeroderma pigmentosum
Uveal
melanoma
Xeroderma
pigmentosum

13. Aniridia & albinism
 Aniridia: absence of iris. This can be caused by genetic factors or
environmental factors (trauma).
 Albinism: congenital defect, characterised by absence of melanin
in skin and eyes.
 Both these disorders cause significant increase of light energy
entering retina, result in photophobia.
Albinism
Aniridia

14. Investigations
• Collect medical history
• Physical exmination
• Anciliary tests:
1. Ultrasound biomicroscopy (UBM)
2. Fundus fluorescein angiography (FA)
3. Optical coherence tomography (OCT)
• Slit-lamp exam: consists of microscope and powerful beam of
light, Hazy fluid / keratic precipitates (clusters of WBC) will
appear in eyes under slit lamp
Slit-lamp exam

15. • Lab-investigations:
1. CBC
2. Erythrocyte sedimentation test (ESR)
3. Antinuclear antibody(ANA)
4. Rapid plasma reagin (RPR)
5. VDRL
6. Purified protein derivate (PPD)
7. Lyme titer
8. HLA- B27
9. Urine analysis
10.HIV test
• Imaging studies: chest x-ray, chest ct, sarciodosis radiography.

16. Medical management
• Mydriatics- such as cyclopentolate and atropine to avoid ciliary
spasm and synechiae.
• Local corticosteroids, such as pred forte 1% and flarex 0.1% to
decrease the inflammation.
• Systemic corticosteroids and intravitreal corticosteroids
• Daclizumab (zenapax), a monocolonal antibody, to prevent
specific chemical interaction

17. Complications
• Complicated cataract
• Secondary glucoma
• Posterior synechiae
• Occlusio pupillae
• Cystoid macular oedema
• Band shaped keratopathy
• Phthisis bulbi
• Retinal complications
Posterior synechiae
Glucoma

18. Nursing management
1. Disturbed sensory perception- visual:
• Administrate eye drops or medication as indicated
• Orient the patient to the surroundings and remove the extra
furniture from room
• Help the patient to perform activities of daily living
2. Pain:
• Administer analgesics or steroids as indicated
• Provide cold pads for eyes
• Instruct pt. To give adequate rest to eyes
• Prevent eyes from high intensity of light
• Advise pt. To wear sunglasses in outdoor area

19. 3. Anxiety:
• Maintain effective communication with pt.
• Allow pt. To acknowledge concerns and express feelings
• Discuss the probability that careful monitoring & treatment can
prevent additional complication.
4. Deficient knowledge:
• Review importance of maintaining drug schedule
• Tell the pt. About diagnosis , treatment, and related complication
& methods to prevent them.
• Encourage pt. To make necessary changes in lifestyle.

20. Bibliography
• Brunner & suddarth’s –text book of medical-surgical nursing , 12th
edition, wolters kluwer publications, page no. 1790.
• http://photobiology.info
• http://www.slideshare.net