uveopathy
Introduction
Introduction to uveopathy The uvea includes the iris, ciliary body and choroid. Uveal disease is most common in inflammation, called uveitis, divided into anterior uveitis (ie, iridocyclitis) and posterior uveitis (ie choroiditis), the cause of which is extra-factorial, secondary and endogenous. Internal factors are the main reason. The uveal blood vessels are too rich and highly permeable, and some systemic immune complex diseases such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and serum diseases are often accompanied by uveitis. In the aqueous humor analyzed by endogenous uveitis patients, the detection rate of immune complexes and the detection rate of human leukocyte antigen (HLA-B) were significantly higher than those of the control group. Clinical children with anterior uveitis have eye pain, shame, tearing, and vision loss; posterior uveitis has a sharp decrease in visual acuity when the eyes are flying, diffuse inflammation, or macular involvement. basic knowledge The proportion of illness: 0.001%-0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: corneal staphyloma glaucoma cystoid edema
Cause
Causes of uveal disease
Causes include infectious and non-infectious. Infectious persons such as bacteria, viruses, fungi, rickettsia, protozoa, parasites, etc., non-infectious persons such as physical, chemical, injury and other exogenous factors caused by allergic reactions and necrotic tumors or degenerative tissues Reactions caused by endogenous factors, immune responses caused by microorganisms (such as histoplasma) or autoantigens (such as lens-derived and sympathetic ophthalmia).
Prevention
Uveopathy prevention
1. If you find redness, pain, photophobia, tearing, decreased vision or no redness or pain, but there are black shadows floating in front of you, blurred vision or visual distortion, people with flashing sensation and decreased vision may have uveitis. Go to the relevant specialist for a detailed examination to confirm the diagnosis.
2. Actively exercise, enhance physical fitness, prevent colds, eat less irritating foods, pay attention to work and rest, maintain physical and mental health, and also have important significance in preventing uveopathy.
Complication
Uveal disease complications Complications, corneal grape, glaucoma, macular cystic edema
1, corneal edema: This is due to inflammation involving the corneal endothelial cells, destroying the hydration of the cornea. Corneal opacity, more common in children with anterior uveitis, more common in patients with chronic rheumatoid arthritis with chronic iridocyclitis.
2, anterior and posterior adhesion of the iris: severe adhesion of the pupillary margin, causing pupillary atresia and iris bulging, the pupil area is covered by the mechanical membrane, forming a pupillary membrane closure. Iris bulging or anterior chamber exudation is mechanized, so that the iris root can be pulled to the anterior chamber angle to cause pre-iris adhesion. All of the above can cause secondary glaucoma.
3, secondary glaucoma: due to pupillary atresia, the aqueous humor in the posterior chamber can not enter the anterior chamber through the pupil area, causing the posterior chamber pressure to rise, the intraocular pressure rises sharply; at the same time, there can also be the adhesion around the iris, blocking the angle of the chamber, so that The filtration function is reduced, resulting in an increase in intraocular pressure; the viscous water in the anterior chamber is increased in the acute phase, and the anterior chamber angle is blocked by the exudate, causing an increase in intraocular pressure.
4, complicated cataract: due to long-term inflammatory stimulation, affecting the nutrition and metabolism of the crystal, causing turbidity in the posterior and posterior cortex of the crystal. More common in chronic anterior uveitis and intermediate uveitis.
5, vitreous opacity: severe iridocyclitis or posterior uveitis, often with vitreous spots, strips or clumps of turbidity, located in the posterior part of the vitreous, fluttering with the rotation of the eyeball, and severe affect vision.
6, choroidal detachment: for exudative, disappeared as the inflammation subsided.
7, retinal and macular edema, degeneration: posterior uveitis often have severe retinal and macular edema, the retina becomes grayish white turbid, the macular can form diffuse or cystic degeneration, such as long duration, can cause severe vision loss.
Symptom
Symptoms of uveopathy common symptoms visual acuity vision often hazy blurry eye pain photophobia on the cornea point dark gray turbidity photophobia and tears
Pathologically there are two manifestations of non-granuloma and granuloma. Non-granulomatous type mainly means lymphocyte and plasma cell infiltration, which is mainly caused by invasion of anterior uveal membrane, and the course of disease is relatively short. In addition to lymphocytic infiltration, granulomatous local inflammation is mainly infiltrated by macrophages and epithelial cells, forming various valuable forms of nodules, with a longer course and a higher recurrence rate. Immunology, the former type may be mainly humoral immune response. Studies have shown that the immune response of antibodies is often good in the process of antigen-antibody binding to form immune complexes, which is conducive to the removal of antigens, but immune complexes can be locally deposited under certain conditions, activate complement, attract neutrophils, cause Tissue damage leads to the development of immune complex diseases. The vascular membrane of the uvea is rich in the past, with high permeability, and some systemic immune complex diseases such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and serum diseases are often accompanied by uveitis. In the aqueous humor analyzed by endogenous uveitis patients, the detection rate of immune complexes and the detection rate of human leukocyte antigen (HLA-B) were significantly higher than those of the control group. Clinical children with anterior uveitis have eye pain, shame, tearing, and vision loss; posterior uveitis has a sharp decrease in visual acuity when the eyes are flying, diffuse inflammation, or macular involvement.
The size, shape, color, number and distribution of post-corneal deposits, anterior chamber depth, aqueous humor and cells, exudate and vitreous opacity. The color of the iris (comparison between eyes), texture, neovascularization, nodule formation, anterior and posterior adhesions, and iris bulging. Pigment spots and exudates on the surface of the crystal, complicated cataract.
Examine
Uveal disease examination
1. Find the cause
(1) Pay attention to the presence or absence of rheumatism, tuberculosis, leptospirosis, severe bacillary dysentery, sexually transmitted diseases, trauma and surgery, and other immune diseases.
(2) systemic examination, pay attention to mucous membranes, skin, hair, bones, joints, lymph nodes, chest and abdomen organs, nervous system and metabolism, etc., pay attention to the presence or absence of Behcet disease and uveal encephalitis.
(3) Thoracic fluoroscopy, if necessary, X-ray of the spine and skull.
(4) Check blood routine, blood sedimentation, if necessary, anti-streptolysin O determination, blood smear examination parasite, cerebrospinal fluid examination and lymph node biopsy.
(5) routine examination of urine and feces, pay attention to the presence or absence of parasite eggs and urine sugar.
(6) Perform an immunological function test and, if necessary, perform an intradermal test of parasites such as cysticercosis.
2. Local inspection
(1) Slit lamp examination, pay attention to the size, shape, color, quantity and distribution of the posterior corneal deposit, anterior chamber depth, aqueous humor and cells, exudate properties (fibrous, serous, purulent or bloody) and The degree of vitreous opacity.
(2) Pay attention to the color of the iris (comparison between eyes), texture, presence or absence of new blood vessels, nodule formation, adhesion before and after, and iris bulging.
(3) Pay attention to the pupil size, shape and reaction to light, and check the fundus after dilation.
(4) Whether there are pigment spots and exudates on the surface of the crystal, and whether there is a complicated cataract.
(5) Measure the intraocular pressure, perform a three-sided mirror or indirect ophthalmoscopy to observe the peripheral part of the fundus and vitreous lesions.
Diagnosis
Diagnosis and differentiation of uveopathy
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
Can be distinguished from other eye diseases.
