Anatomy of the Uvea

7/18/2019 Anatomy of the Uvea

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ANATOMY OF THE UVEARUTH ANTOLIN, MDDOH EYE CENTER



UVEAL TRACT Main vascular compartmnt o! t" #

Uvea $as %riv% !rom t" Latin $or% uva& 'rap

Locat% (t$n t" sclra an% t" rtina

) parts* Iris

* Ciliar# (o%#

* C"oroi%



UVEAL TRACT Attac"mnt* +clral spur

* Eit points o! vort vins

* Optic nrv



EM-RYOLO.Y OF THE

UVEAL TRACT "as t$o componnts/• antrior t"r !ourt"s 0i//, t" stroma1 is !rom t" nural

crst clls, mso%rm

• postrior on !ourt" 0i//, t" muscls an% t" pi'mnt%

pit"lium1 is nurocto%rmal/• T" sp"inctr an% t" %ilator muscls & !rom t" outr lamina o! t" primitiv

optic cup,

• pi'mnt% pit"lium la#r& !rom t" innr la#r o! t" optic cup/

• T"us, t" pupillar# ru2 0mar'in1 in a !ull# %vlop% # rprsnts t"

antrior tip o! t" primitiv optic cup/



IRI+ Most antrior portion o! t" uva

Masurmnts&* 34mm %m

* )5 to )6mm circum!rnc

*7/8mm t"ic9nss

* iris is t"ic9st nar t" collartt an%t"innst at t" iris root

• musculovascular %iap"ra'm $it" a

cntral opnin', t" pupil ; (loo%

vssls, connctiv tissu an%mlanoc#ts 0pi'mntation1

•Divi%s t" antrior s'mnt o! t"# into ant an% postc"am(rs



IRI+& ANTERIOR

RELATION+• Antriorl#& A:uous "umor

• ;ostriorl#& lns

• ;rip"rall#& a:uous "umor in t" postrior c"am(r



IRI+ Macroscopically:*t" antrior sur!ac is

irr'ular, $it" !urro$san% cr#pts/

* T" pupillar# <on islocat% (t$n t"collartt an% t"pupillar# ru2/

*t" rmain%r o! t" irisis call% t" ciliary zone. T" !rin'% iris collarttis locat% approimatl#4 mm !rom t" pupillar#(or%r= an% is t"

t"ic9st portion o! t" iris



IRI+



IRI+• Posterior Iris Surface• smoot"r an% mor uni!orm

• 4 la#r%& antrior an% postrior iris pit"lia

• rlativl# s"allo$ !urro$s

• Radial folds:• Contraction folds of Sc!al"e# small sulci t"at tn%s

!rom t" pupillar# aprtur to t" antrior sur!ac o! t" iris

• Structural folds of Sc!al"e# tn%s 3/8mm !rom t"pupillar# (or%r an% is sn (t$n t" ciliar# procsss/



IRI+& +troma Contains pi'mnt% an% non pi'mnt% clls, colla'n>(rils, (loo% vssls, nrvs an% a matri o! "#aluronicaci%

Di2rnc in color is %u to t" amount o! pi'mntationo! t" stroma* -lu&

* li'"tr pi'mntation

* -ro$n&* "av# pi'mntation



IRI+& ANTERIOR

;I.MENTED E;ITHELIUM 4 parts&

*Muscular (asal portion&

*ma9s up t" pupillar# %ilator muscl

o

?microns in t"ic9nsso arran'% in an ovrlappin' mannr= @oin% (# ti'"t @unctions

* Epit"lial apical portiono Almost similar to t" postrior pi'mnt pit"lium

o

+parat% !rom t" postrior pi'mnt pit"lium via intrcllularspacs/



IRI+& ;ostrior

;i'mnt% La#r Continuous $it" t"nonpi'mnt% pit"liumo! t" C- an% $it" t"nurosnsor# rtina

Curvs aroun% t" pupillar#mar'in to !orm t" pi'mntru2



IRI+& ;ostrior

;i'mnt% La#r



IRI+& Vssls an% Nrvs +uppli% (# t" ma@or artrial circl$"ic" is !orm% (# t" lon' postriorciliar# artris an% antrior ciliar#

artris



IRI+& Vssls an% Nrvs Minor artrial 0vascular1circl !orm% (#

anastomoss (t$nartrial an% vnousarca%s at t" r'ion o!t" iris collartt

M#linat% an% nonm#linat% nrv >(rsar prsnt t"rou'"outt" stroma/



IRI+& Dilator Muscl Driv% !rom t" cto%rm=compos% o! smoot"muscl clls $it"m#o>lamnts an%

mlanosoms Has (ot" paras#mpat"tic0in"i(itor# rol1 an%s#mpat"tic innrvation



IRI+& Dilator Muscl +#mpat"tic c"ain

3st ON&

H#pot"alamus to T34n% ON&

T3 to sup crvical 'an'lion

)r% ON&

+up crvical 'an'lion to Dilatormuscl



IRI+& +p"inctr Muscl Also %riv% !rom t"nurocto%rm

Compos% o! circular (an%o! smoot" muscl >(rs

locat% nar t" pupillar#mar'in

;rimar# innrvation is viaparas#mpat"tics !rom CNIII



IRI+& +p"inctr Muscl ;aras#mpat"tic ;at"$a#

E nuclus to ciliar#'an'lion to iris sp"inctr



CILIARY -ODY



CILIARY -ODY Conncts t" antrior an%postrior s'mnts o! t"uva

Ap is %irct% to$ar%s t"

ora srrata -as 'ivs ris to t" iris=also srvs as attac"mnt o!t" C- to t" sclra via t"sclral spur

Ma@or !unctions&* a:uous "umor pro%uction

* lns accomo%ation



CILIARY -ODY B5 mm $i%

4 parts&* pars plana ?mm $i%=

tn%s !rom ora srrata tociliar# procsss* +a!st postrior sur'ical approac"

to t" vitrous cavit#

* Locat% )?mm !rom t" cornal

lim(us

* pars plicata "as ciliar#

procsss t"at srvs asattac"mnt o! t" <onular>(rs o! t" lns



CILIARY -ODY



CILIARY -ODY



CILIARY -ODY Eac" ciliar# procss is suppli% (# artriols !rom t"ma@or artrial circl

Vnous %raina' o! ac" procss is via 34 vnulslocat% at t" crst

A:uous "umor pro%uction is %pn%nt on t" (loo%o$ $it"in t" capillar# nt$or9 o! t" ciliar# procsss$"ic" is 'ovrn% (# sp"inctr ton, nuronal innrvationan% "umoral vasoactiv su(stancs

Functions&* 3/ !or accommo%ation

* 4/ !ormation o! a:uous "umor

* )/ 9ps t" lns in plac



CILIARY -ODY Microscopic structurs&* 3/ supraciliar# lamina

* 4/ Ciliar# (o%# stroma surroun%% (# attn%% >(roc#tsrat"r t"an colla'n >(rs

* )/ ;i'mnt% Epit"lium La#r* ?/ Non ;i'mnt% Epit"lium La#r

* 8/ Intrnal Limitin' Mm(ran



CILIARY -ODY& Histolo'# Dou(l la#r o! pit"lialclls

*Non pi'mnt%& innrla#r= situat%(t$n t" postc"am(r an% t"pi'mnt% pit"lium $onula occludentes%ti&t 'unctions() locat%

alon' t" latral intrcllularspacs nar t" apical (or%ro! t" N;E, maintain t"(loo% a:uous (arrir/



CILIARY -ODY& Histolo'#• ;i'mnt%&

• outr la#r= (asalla#r is locat% on

t" iris stroma

• Or'anlls 0ER an%.ol'i compl1 vitalin a:uous "umor

pro%uction



CILIARY -ODY& Histolo'#*PE Pi&+entedEpiteliu+

Location o!-asalLamina

i%t"

NuclusMlanosoms

Cll t#p

Innr-or%rs t"postc"am(r

T"in

Lar'F$

Cu(oi%al0parsplana1Columnar0pars

plicata1

OutrFacs t"iris stroma

T"ic9Mor"omo'nous

Lar'plnt#

Cu(oi%al0t"rou'"out1



CILIARY -ODY& -loo%

+uppl# Main artrial suppl#!rom t" antrior an%lon' postrior ciliar#artris

*+upr>cial pisclralplus

*Intramuscular plus

*Ma@or artrial circl



CILIARY -ODY& -loo%

+uppl# Vnous %raina' via t" vort s#stm, intrasclralvnous plus an% pisclral vins



CILIARY -ODY& NERVE

+U;;LY mainl# %riv% !rom t" paras#mpat"tic >(rs o! CN IIIvia s"ort ciliar# nrvs* G5 to t" ciliar# muscl

* ) to t" iris sp"inctr



CILIARY -ODY& Ciliar#

Muscl ) la#rs*Lon'itu%inal& outr la#r

attac"% to t" sclralspur

*Ra%ial mi%%l o(li:u

*Circular& innrmostportion

Ciliar# muscl "as also (n lin9%to t" %vlopmnt o! prs(#opia

%u to incrasin' amounts o!connctiv tissu (t$n muscl(un%ls an% loss o! muscllasticit# t"at is rsponsi(l in lnsaccommo%ation/




Muscl




Muscl -"av li9 smoot", non striat% muscl >(rs $it"multipl m#o>(rils, prominnt nuclus, lctron %nsattac"mnt (o%is, mitoc"on%ria, 'l#co'n particls

Ric" in t#p VI colla'n

Muscls insrts into t" sclral spur an% aroun% tips o!o(li:u an% circular muscl >(rs

Innrvation& paras#mpat"tic via ciliar# nrvs



CHOROID



CHOROID• postrior portion o! t" uva

•;rovi%s nouris"mnt to t" outr portion o!t" rtina• R'ulats IO;

• Hat %i2usr

•Masurs 7/48mm in t"ic9nss

•

Locat% (t$n t" sclra an% t" rtina=tn%in' !rom t" ora srrata to t" opticnrv



CHOROID• ) la#rs o! vssls• C"oriocapillaris

• Mi%%l la#r

0+attlr1 o! smallvssls

• Outr la#r0HallrJs1 o! lar'vssls



CHOROID



CHOROID• pr!usion coms !rom t"lon' an% s"ort ciliar#artris, pr!oratin'antrior ciliar# artris

•Vnour %raina' via t"vort vins

•-loo% o$ compar% toot"r tissus is "i'"=

o#'n contnt o! vnous(loo% 4) lss t"an t"ato! artrial (loo%



CHOROID& -ruc"Js

Mm(ran•Lamina situat% (t$n t" R;E an% t" c"oriocapillaris

•Etn%s !rom t" optic %isc mar'in to t" ora srrata

•8 lmnts&

• -asal lamina o! t" R;E• Innr colla'nous <on

• -an% o! lastic >(rs

• Outr colla'nous <on

• -asal lamina o! t" c"oriocapillaris



CHOROID& -ruc"Js

Mm(ran



CHOROID& -ruc"Js

Mm(ran•D!cts can %vlop spontanousl# suc" as in m#opia orpsu%oant"oma lasticum or via trauma or inammation

•+u(rtinal novascular mm(rans ma# %vlop !romt"s %!cts t"at can la% to %isci!orm macular c"an'san% ocular "istoplasmosis s#n%rom



CHOROID&

C"oriocapillaris• Continuous la#r o! lar'capillaris (nat" t" R;E/

• Vssls !acin' t" rtinalsur!ac ar trml# t"inan% contain multipl!nstrations $it" pric#tslin t" outr $all/

• Mi%%l an% outr c"oroi%al

vssls ar not !nstrat%/



CHOROID&

C"oriocapillaris• mlanoc#ts, macrop"a's, l#mp"oc#ts, mast clls an%plasma clls ar a(un%ant in t" c"oroi%al stroma/

• ;i'mntation %pn%s on t" num(r o! pi'mnt%mlanoc#ts in t" c"oroi% an% R;E

• D'r o! pi'mntation in t" c"oroi% must (consi%r% $"n on is pr!ormin' p"otocoa'ulation(caus it inuncs a(sorption o! lasr nr'#



CLA++IFICATION,+I.N+ AND

+YM;TOM+ OFUVEITI+



OVERVIE&• uva consists o! t" mi%%l, pi'mnt%, vascular o! t"#• Iris

• Ciliar# -o%#

• C"oroi%

•Uveitis- 0itis1 inammation 0uva1 uva

• stu%# o! uvitis can ( cat'ori<% into in!ctious an%non in!ctious

• uvitis is !r:untl# associat% $it" s#stmic %isass



CLA++IFICATION• Uvitis classi>cation is spar"a%% (# t"+tan%ar%i<ation o! Uvitis Nomnclatur 0+UN1 or9in''roup in 4778

•(as% on &• Anatom#& $"at portion o! t" uva is involv%K

• Cours& acutK C"ronicK RcurrntK

• Etiolo'#& in!ctious or non in!ctious

• Histolo'#& 'ranulomatous or non 'ranulomatous



Anatomical Classi>cation o!Uvitis 0+UN or9in' .roup1Type Pri+ary Site of

In,a++ationIncludes

Antrior Uvitis Antrior C"am(r IritisIri%oc#clitisAntrior c#clitis

Intrm%iatUvitis

Vitrous ;ars ;lanitis;ostrior c#clitisH#alitis

;ostriorUvitis

Rtina or c"oroi% Focal, multi!ocal,%i2us c"oroi%itisC"oriortinitis

Rtinoc"oroi%itisRtinitisNurortinitis

;anuvitis Antrior c"am(r,vitrous, rtina or c"oroi%



Anatomical Classi>cation o!Uvitis& Antrior Uvitis

• can ran' !rom a :uit loo9in' # $it" lo$ 'ra%inammator# raction to a pain!ul r% # $it" mo%ratto svr inammation

• Iritis: antrior c"am(r onl#

• Iridocyclitis: antrior c"am(r rtrolntal spac

• keratouveitis: corna

• sclerouveitis: sclra an% uval tract



Anatomical Classi>cation o!Uvitis& Intrm%iat Uvitis

• inammation o! t" mi%%l portion 0postrior ciliar#(o%#, pars plana1

• mani!sts primaril# as oatrs

• !r:untl# appars :uit trnall#

•Vision loss can rsult !rom c"ronic c#stoi% macular %ma0cm1, cataract !ormation



Anatomical Classi>cation o! Uvitis&;ostrior Uvitis an% ;anuvitis

• involvs t" rtina an%or c"oroi%

• ocular am& !ocal, multi!ocal, %i2us aras o! rtinitis orc"oroi%itis $it" var#in' %'rs o! vitrous cllular activit# an%involvmnt o! t" rtinal vasculatur

• structural complications o! uvitis suc" as macular %ma,rtinal vasculitis, rtinal c"oroi%al novasculari<ation notconsi%r% ssntial in classi!#in' postrior uvitis

•

;anuvitis&• %i2us uvitis

• Associat% $it" s#stmic 0non in!ctious in!ctious1%isass suc" asVH, s#p"ilis an% c#sticrcosis



ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" RETINITI+

-ocal Retinitis Multifocal Retinitis

To.oplas+osis +#p"ilis

Onc"ocrciasis H+V

C#sticrcosis VV

Mas:ura% s#n%roms CMV

Di2us Unilatral+u(acut Nurortinitis

Candida in!ction

+arcoi%osis

Cat scratc" %isas

Mas:ura% s#n%roms

O C C ++ C O



ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it"MULTIFOCAL RETINAL LE+ION+

/it Vitreal Cells /itout Vitreal Cells

-ir%s"otrtinoc"oroi%opat"#

Ocular Histoplasmosis+#n%

Multi!ocal c"oroi%itis

an% panuvitis

;unctat Innr

C"oroi%itis+u(rtinal Fi(rosis an%uvitis

;unctat Outr Rtinal Tooplasmosis

Vo't o#ana'i Hara%a Acut Rtinal ;i'mntEpit"litis

+arcoi%osis +u(acut +clrosin';anncp"alitis

st Nil Virus +rpi'inous c"oroi%itis

Cat +cratc" %isas

Mali'nant Mas:ura%+#n%roms

ANATOMICAL CLA++IFICATION



ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" RETINALVA+CULITI+

Pri+arily Arteritis Pri+arilyPle"itis

Arteritis Ple"itis

+LE +arcoi%osis Tooplasmosis

;ol#artritis no%osa Multipl +clrosis Rlapsin'

pol#c"on%ritis+#p"ilis -"ct 'nr

'ranulomatosis

H+V -ir%s"otC"oroi%opat"#

Cro"n %isas

VV HIV paravirals#n%rom

Frost% (ranc"an'iitis

I%iopat"ic RtinalVasculitis,Anur#sms an%Nurortinitis

Eals %isas

C"ur' +trauss

ANATOMICAL CLA++IFICATION



ANATOMICAL CLA++IFICATION&;O+TERIOR UVEITI+ $it" FOCALCHORIORETINAL LE+ION

/it Vitreal Cells /itout Vitreal Cells

Toocariasis Tumor

+arcoi%osis +rpi'inous c"oroi%itis

Tu(rculosis

Nocar%ia

Cat +cratc"



UVEITI+ CLA++IFICATION -A+EDON THE CLINICAL COUR+E

• Acute: su%%n onst an% limit% %uration t"at usuall#rsolvs $it"in $9s to mont"s

• Recurrent: rpat% piso%s sparat% (# prio%s o!inactivit# $it"out tratmnt !or ) mont"s%uration

• Cronic:prsistnt= rlaps occurs in lss t"an )mont"s a!tr %iscontinuin' tratmnt

• Furt"r %ivi%% into

• 'ranulomatous "as l#mp"oc#tic an% plasmain>ltrat

• non 'ranulomatous pit"loi% an% 'iant clls



+YM;TOM+



+YM;TOM+ OF UVEITI+• %pn%s on t" part o! t" uval tract a2ct%, onst,%uration• ;ain

• ;"otop"o(ia

• R%nss• -lurr% vision

• ;upillar# miosis irr'ularit#

• Floatrs s"a%o$s caus% (# vitrous clls an% sno$(alls ont" rtina

•

Dcras% visual acuit#• Distur(ancs in vision& p"otopsia, mtamorp"opsia,

scotomata

• n#ctalopia



+YM;TOM+ OF UVEITI+• Pain and Potopo"ia

• primaril# rlat% to ciliar# spasm/

• ;ain p"#siolo'# can ( plain% (# Paon rQ$"rin t"r is a rtro'ra% r !rom t" Pinam%Q

prip"ral nrvs 0corna an% iris1 to t" (loo% vsslscausin' vaso%ilation or to t" muscls causin'contraction

• C#clopl'ia is t"r!or us!ul in cass o! iritis an% insom cass o! 9ratitis (caus paral#sis o! t" ciliar#

muscl allviats t" pain o! ciliar# spasm



+YM;TOM+ OF UVEITI+• 0lurred vision

*ma# ( caus% (# clou%# m%ia, alt"ou'" vision iso!tn surprisin'l# 'oo% in t" prsnc o! %nsinammator# raction in t" antrior c"am(r an%

vitrous/* Floatrs ar a mor !r:unt mani!station o! clls

an% %(ris in t" vitrous cavit#/

*Macular %ma, $"ic" !r:untl# occurs $it" (ot"antrior an% postrior uvitis, can pro%uc (lurr%

vision, micropsia, an% mtamorp"opsia/



+YM;TOM+ OF UVEITI+• Ciliary In'ection

• Ciliar# in@ction, or Pciliar# us",Q is mani!st (# arin' o! %ilat% pisclral vssls ra%iatin' !rom t"lim(us/

• s"oul% ( %istin'uis"% !rom sclritis an% !rompisclritis/ Ovrl#in' con@unctival in@ction ma#mas9 ciliar# us" (ut topicall# appli%nos#np"rin (lanc"s t" ovrl#in' con@unctiva,

allo$in' visuali<ation o! %pr pisclral vssls/



-AND ERATO;ATHY



+I.N+

+I.N+ OF UVEITI+



+I.N+ OF UVEITI+&ANTERIOR CHAM-ER

• (rou'"t a(out (# inammator# rspons to in!ctious,traumatic, noplastic, autoimmun

• c"mical m%iators an% inammator# clls pla# a rol

•

ractions ar usuall# apprciat% in t" antrior c"am(r$"rin t"# can ( %scri(% as• srous

• purulnt 0prsnc o! "#pop#on1

• Fi(rinous 0plasmoi%1

•

san'uinoi% 0"#pop#on H#p"ma1

•

UVEITI+ 0+UN 9i



UVEITI+ 0+UN or9in'.roup1

• Accor%in' to t" num(r o! clls in >l% 03 3mm slit(am1

1rade Cells in -ield 23 .3++ slit "ea+

7 3

7/8 3 8

3 B 38

4 3B 48

) 4B 87

? 87

UVEITI+ 0+UN 9i



UVEITI+ 0+UN or9in'.roup1

• Accor%in' to t" ar intnsit#

1rade 4escription

7 Non

3 Faint4 Mo%rat 0iris an% lns

%tails clar1

) Mar9% 0iris an% lns%tails "a<#1

? Intns 0>(rin orplasmoi% a:uous1

+I.N+ OF UVEITI+



+I.N+ OF UVEITI+&ANTERIOR CHAM-ER

• i! $it" uvitic involvmnt o! C-an% TM, IO; is usuall# lo$ %u to%cras% a:uous pro%uctionor incras% altrnativ outo$

• I! iris is involv%, t" !ollo$in'ma# mani!st• s#nc"ia 0antrior or postrior1

• iris no%uls 0opp, -usacca,-rlin no%uls1

• Iris 'ranulomas

• "troc"romia

• stromal atrop"#

THE ANTERIOR



THE ANTERIOR+E.MENT

• 9ratic prcipitats

• inammator# clls

• ar

• >(rin

• H#pop#on

• pi'mnt %isprsion

• pupillar# miosis

• iris no%uls

• s#nc"ia (ot" antrior an% postrior

• (an% 9ratopat"#



+I.N+ OF UVEITI+&INTERMEDIATE +E.MENT

1rade *u+"er of Cells 4escription

7 No clls Clar

7/8 trac 3 37 Trac

3 33 47 F$ opacitis, mil%

(lurrin'

4 43 )7 +i'ni>cant (lurrin'(ut still visi(l

) )3 377 Optic nrv visi(il,no vssls sn

? 377 Dns opacit#o(scurs optic nrv"a%

Consnsus (t$n National Instituts o! Halt" 0NIH1 'ra%in's#stm an% +UN 'roup

&INTERMEDIATE



&INTERMEDIATE+E.MENT

• A%%itional uvitic c"an's• +no$(all opacitis

sarcoi%osis or intrm%iatuvitis

•

+no$(an9s pars planitis• Vitral stran%s

+I.N+ OF UVEITI+



+I.N+ OF UVEITI+&;O+TERIOR +E.MENT

• rtinal or c"oroi%al inammator# in>ltrats

• inammator# s"at"in' o! t" artris an% vins

• rtinal %tac"mnt 0u%ativ, tractional,

r"'mato'nous1• rtinal pi'mnt "#prtrop"# or atrop"#

• atrop"# or s$llin' o! t" rtina, c"oroi%, optic nrv"a%

• prrtinal su(rtinal >(rosis

• rtinal c"oroi%al novasculari<ation



+I.N+ OF UVEITI+• Eyelid and s5in: vitili'o an% no%uls

• Con'unctiva: prilim(al %i2us in@ction= no%uls

• Corneal endoteliu+: ;, >(rin, pi'mnt, (an%

9ratopat"#• Anterior6 posterior ca+"er: inammator# clls= ar=pi'mnt

• Iris: s#nc"ia, atrop"#, no%uls, "troc"romia,

pupillar# miosis

• An&le: ;A+, no%uls, vasculari<ation

• I7P: "#poton# or 'laucoma



+I.N+ OF UVEITI+

• Vitreous: inammator# clls, traction (an%s

• Pars plana: sno$ (an9in'

• Retina: inammator# clls, cuSn' o! (loo% vssls,%ma, CME, "#prtrop"# clumpin'loss o! R;E=pirtinal vssls

• coroid: inammator# in>ltrats= atrop"#=novasculari<ation

• 7ptic *erve: E%ma= novasculari<ation



T"an9 #ou3

Anatomy of the Uvea

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