Uveit – the general concept designating an inflammation of various parts of a vascular cover of an eye (an iris, a tsiliarny body, a horioidea). Uveit it is characterized by reddening, irritation and the morbidity of eyes increased by a photosensitivity, a sight illegibility, dacryagogue, emergence of floating spots before eyes. Ophthalmologic diagnostics of a uveit includes a vizometriya and perimetry, biomicroscopy, an oftalmoskopiya, measurement of intraocular pressure, carrying out a retinografiya, ultrasonography of an eye, an optical coherent tomography, elektroretinografiya. Treatment of a uveit is carried out taking into account an etiology; the general principles are appointment local (in the form of eye ointments and drops, injections) and system medicinal therapy, surgical treatment of complications of a uveit.
Uveit or the inflammation of a uvealny path meets in ophthalmology in 30-57% of cases of inflammatory damages of an eye. The Uvealny (vascular) cover of an eye anatomic is presented by an iris of the eye (iris), a tsiliarny or ciliary body (corpus ciliare) and horioidey (chorioidea) - actually vascular cover lying under a retina. From here the main forms of a uveit are Irit, tsiklit, iridotsiklit, horioidit, horioretinit, etc. In 25-30% of observations of a uveita lead to a slabovideniye or a blindness.
Big prevalence of uveit is connected with extensive vascular network of an eye and the slowed-down blood-groove in uvealny ways. This feature in a certain measure promotes a delay in a vascular cover of various microorganisms which under certain conditions can cause inflammatory processes. Other essentially important feature of a uvealny path consists in separate blood supply of its forward department presented by an iris and a ciliary body and back department – a horioidea. Structures of forward department are supplied with blood back long and forward ciliary arteries, and - back short ciliary arteries. At the expense of it defeat of forward and back departments of a uvealny path in most cases happens separately. The innervation of departments of a vascular cover of an eye is also various: an iris and a ciliary body tsiliarny fibers of the first branch of a trigeminal nerve plentifully innervate; has no sensitive innervation. The called features influence emergence and development of uveit.
Classification of uveit
Are divided by the anatomic principle of a uveita on forward, median, back and generalized. Forward uveita are presented by Irit, forward tsiklity, iridotsiklity; median (intermediate) – pars-planity, a back tsiklit, a peripheral uveit; back – horioidity, retinity, horioretinity, neyrouveity.
In forward uveit the iris and a tsiliarny body is involved – this localization of a disease meets most often. At median uveita the ciliary body and , a vitreous body and a retina is surprised. Back uveita proceed with involvement of a horioidea, a retina and optic nerve. When involving all departments of a vascular cover develops panuveit – a generalized form of a uveit.
The nature of inflammatory process at uveita can be serous, fibrinozno-lamellar, purulent, hemorrhagic, mixed.
Depending on an etiology of a uveita can be primary and secondary, exogenous or endogenous. Primary uveita are connected with the general diseases of an organism, secondary – directly with pathology of an organ of vision.
Are classified by features of a clinical current of a uveita on sharp, chronic and chronic recidivous; taking into account a morphological picture – on granulematozny (focal metastatic) and negranulematozny (diffusion toksiko-allergic).
Reasons of uveit
As causal and starting factors of uveit serve infections, allergic reactions, system and syndromic diseases, injuries, violations of exchange and hormonal regulation.
The biggest group is made by infectious uveita – they meet in 43,5% of cases. As infectious agents at uveita tuberculosis mikobakteriya, streptococci, toxoplasma, a pale treponema, a cytomegalovirus, , fungi most often act. Such uveita are usually connected with hit of an infection to the vascular course from any infectious center and develop at tuberculosis, syphilis, viral diseases, sinusitis, tonsillitis, caries of teeth, sepsis etc.
In development of allergic uveit the increased specific sensitivity to environment factors – medicinal and food allergy, hay fever and so forth plays a role. Quite often at introduction of various serums and vaccines serumal develops uveit.
Uveita etiologichesk can be connected with system and syndromic diseases: rheumatism, rheumatoid arthritis, spondiloartrity, psoriasis, sarkoidozy, glomerulonefrity, autoimmune tireoidit, multiple sclerosis, ulcer colitis, syndrome of Reuters, syndrome of Fogta-Koyanagi-Harada (uveomeningoentsefality), etc.
Development of a uveit can be promoted by violations of exchange and hormonal dysfunction (at diabetes, a climax etc.), to a disease of system of blood, a disease of an organ of vision (an otsloyka of a retina, a keratita, conjunctivitis, blefarita, sklerita, a cornea ulcer perforation), etc. pathological conditions of an organism.
Symptoms of a uveit
Manifestations of uveit can differ depending on localization of an inflammation, pathogenicity of microflora and the general reactivity of an organism.
In a sharp form forward uveit proceeds with pain, reddening and irritation of eyeballs, dacryagogue, a photophobia, narrowing of a pupil, deterioration in sight. The Perikornealny injection gets a violet shade, intraocular pressure often increases. At chronic forward twine a current quite often asymptomatic or with poorly expressed signs – insignificant reddening of eyes, "floating" points before eyes.
As indicator of activity of forward uveit serve corneal pretsipitata (a congestion of cages on a cornea endoteliya) and the cellular reaction in moisture of the forward camera revealed in the course of biomicroscopy. Back sinekhiya (unions between an iris of the eye and the capsule of a crystalline lens), glaucoma, a cataract, a keratopatiya, makulyarny hypostasis, inflammatory membranes of an eyeball can be complications of forward uveit.
At peripheral uveita damage of both eyes, floating turbidity before eyes, decrease in the central sight is noted. Back uveita are shown by feeling of a zatumanivaniye of sight, distortion of objects and "floating" points before eyes, decrease in visual acuity. At back uveita there can be makulyarny hypostasis, makula ischemia, occlusion of vessels of a retina, an otsloyka of a retina, optical neuropathy.
Serves as the most severe form of a disease widespread iridotsiklokhorioidit. As a rule, this form of a uveit arises against the background of sepsis and often is followed by development of an endoftalmit or panoftalmit.
At twine, Fogta-Koyanagi-Harada associated about a syndrome, headaches, neurotouch relative deafness, psychoses, vitiligo, an alopetion are observed. At a sarkoidoza, except eye manifestations increase in lymph nodes, plaintive and salivary glands, short wind, cough is, as a rule, noted. The knotty eritema, vaskulita, skin rash, arthritises can indicate communication of a uveit with system diseases.
Diagnostics of a uveit
Ophthalmologic inspection at uveita includes carrying out external examination of eyes (a condition of skin a century, conjunctivas), vizometriya, perimetry, a research of pupillary reaction. As uveita can proceed with hypo - or hypertensia, measurement of intraocular pressure is necessary (tonometriya).
By means of biomicroscopy sites of tape-like dystrophy, a pretsipitata, cellular reaction, back sinekhiya, a back kapsulyarny cataract etc. come to light Gonioskopiya at uveita allows to reveal exudate, forward sinekhiya, a neovaskulyarization of an iris and a corner of the forward camera of an eye.
In the course of an oftalmoskopiya existence of focal changes of an eye bottom, hypostasis of a retina and DZN, otsloyka of a retina is established. At impossibility of carrying out an oftalmoskopiya (in case of turbidity of optical environments), and also for assessment of the area of an otsloyka of a retina ultrasonography of an eye is used.
For differential diagnostics of back uveit, definition of a neovaskulyarization of a horioidea and a retina, hypostasis of a retina and DZN carrying out an angiography of vessels of a retina, an optical coherent tomography of a makula and DZN, the laser scanning retina tomography is shown.
At uveita of various localization the reooftalmografiya, an elektroretinografiya can supply with the important diagnostic information. The specifying tool diagnostics includes the forward camera, a vitrealny and horioretinalny biopsy.
In addition at uveita of various etiology consultation of the phthisiatrician with carrying out a X-ray analysis of lungs and reaction can be required by Mant; consultation of the neurologist, brain KT or MPT, lyumbalny puncture; consultation of the rheumatologist, X-ray analysis of a backbone and joints; consultation of the allergist-immunologist with conducting tests, etc.
The RPR test, definition of antibodies to a mycoplasma, an ureaplasma, hlamidiya, toxoplasma, a cytomegalovirus, herpes etc., definition of the CEC, S-jet protein, a rheumatoid factor, etc. is carried out from laboratory researches at uveita on indications.
Treatment of a uveit
Treatment of a uveit is performed by the ophthalmologist with the assistance of other experts. At uveita early differential diagnostics, timely performing etiotropny and pathogenetic treatment, a corrective and replaceable immunotherapy is necessary. Therapy of uveit is directed to the prevention of complications which can lead to sight loss. At the same time treatment of the disease which caused development of a uveit is required.
The basis of treatment of uveit is made by purpose of midriatik, steroids, system immunosupressivny medicines; at uveita of an infectious etiology - antimicrobic and antiviral means, at system diseases – NPVS, tsitostatik, at allergic defeats – antihistaminic medicines.
Instillations of midriatik (a tropikamid, a tsiklopentolat, a fenilefrin, atropine) allow to eliminate a spasm of a tsiliarny muscle, to prevent formation of back sinekhiya or to break off already created unions.
The main link in treatment of uveit is application of steroids locally (in the form of instillations in a conjunctival bag, a mortgaging of ointments, subconjunctival, parabulbarny, subtenonovy and intravitrealny injections), and also is system. At uveita use Prednisolonum, beta metazones, dexamethasone. In the absence of medical effect of steroid therapy purpose of immunosupressivny medicines is shown.
In case of a failure of a uveit and development of complications the section of forward and back sinekhiya of an iris, surgical treatment of pomutneniye of a vitreous body, glaucoma, cataract, an otsloyka of a retina can be required. At an iridotsiklokhorioidita quite often resort to carrying out a vitreoektomiya, and at impossibility to save an eye - eyeball evistseration.
Forecast and prevention of a uveit
Complex and timely treatment of sharp forward uveit, as a rule, leads to recovery in 3-6 weeks. Chronic uveita are inclined to a recurrence in connection with an exacerbation of the leading disease. The complicated current of a uveit can lead to formation of back sinekhiya, development of closed-angle glaucoma, cataract, dystrophy and heart attack of a retina, hypostasis of DZN, otsloyka of a retina. Owing to the central horioretinit or atrophic changes of a retina visual acuity considerably decreases.
Prevention of a uveit demands timely treatment of diseases of eyes and the general diseases, an exception of intraoperative and home accidents of an eye, an organism allergization etc.