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Peripheral uveitis: causes, symptoms, diagnosis, treatment

 
, medical expert
Last reviewed: 07.07.2025
 
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Peripheral uveitis was identified as a separate nosological group in 1967.

The primary inflammatory focus is localized in the pars plana of the vitreous body and the peripheral part of the choroid in the form of perivasculitis of the retina. As a result of inflammation, a preretinal cyclic membrane is formed, which can cause retinal rupture and detachment.

This is an inflammatory disease with a vascular factor. Most often, the first symptom is decreased vision due to clouding of the vitreous body, as well as edema and dystrophy of the macular area. It is more common in young people, occurs after flu, acute respiratory infections and other infections. The first symptom of this disease is decreased vision. If the process captures the ciliary body, there may be clouding of the fluid of the anterior chamber. If the exudate settles on the trabeculae, there may be secondary uveitis.

If vascular phenomena (periphlebitis, perivasculitis) predominate, hemorrhages in the retina and vitreous body may appear. The iris is usually clinically unchanged, and posterior synechiae do not form. Changes in the anterior layers of the vitreous body initially have the form of small powdery opacities, which after various periods (from 6 months to 2 years) accumulate in the area of the flat part of the ciliary body and on the extreme periphery of the retina in the form of snow-like opacities or exudative masses. Peripheral exudate is the most significant and constant sign of pars planitis. It is white or grayish-white, dense, well-defined, localized near the dentate line, spreading into the area of the ciliary body. Snow-like foci of peripheral exudate can be single or multiple. Their presence in the area of the pars plana of the ciliary body can be determined by examination with a three-mirror Goldman lens and scleral depression. The most frequent localization of such changes is in the area between 3 and 9 o'clock in the lower part of the anterior segment of the eye. By their nature, snow-like masses lying on the pars plana of the ciliary body are related to inflammatory, exudative changes or to condensed areas of the vitreous body. Their predominant localization in the lower zone of the pars plana of the ciliary body is possibly associated with the attraction of vitreous opacities to its inflammatoryly altered base or with the fact that the greatest number of vitreous cells are located in the lower ocular part.

In some cases, especially in young patients, posterior vitreous detachment occurs. The wrinkling of the vitreous caused by inflammation leads to traction of the retina, and sometimes to ruptures of the internal limiting membrane. The development of complex cataract, beginning at the posterior pole, is also noted. Sometimes gradually, and sometimes quite quickly, it becomes complete. Often the process is complicated by the development of secondary glaucoma.

Cystoid edema of the macular area and slight edema of the optic nerve head are typical symptoms accompanying pars planitis. Sometimes changes in the retinal vessels of the vasculitis or perivasculitis type appear. After partial resorption of the exudate, pigmentation characteristic of chornoid lesions appears in the atrophy zone. The percentage of complications of peripheral uveitis according to the literature is as follows: cataract - 60.7%, maculopathy - 42.8%, edema of the optic nerve head - 17.8%.

Less frequent complications include retinal detachment and retinal hemorrhages. Thus, with peripheral uveitis, three stages of the process are noted;

  1. early stage - decreased visual acuity, external accommodation, cellular reaction in the fluid of the anterior chamber and small corneal precipitates, the appearance of cells in the vitreous body;
  2. an intermediate stage, characterized by further deterioration of vision and the appearance of strabismus simultaneously with an increase in inflammatory phenomena in the vascular tract, expressed in photophobia, pain and the formation of exudate in the vitreous body;
  3. late stage, which is characterized by sudden loss of vision due to cystic macular degeneration, formation of posterior subcapsular cataracts and sometimes atrophy of the eyeball.

In the clinical manifestation of parsplapitis, diffuse and focal inflammation are distinguished. The diffuse form corresponds to the described picture of the disease. In focal inflammation, granulomatous foci appear along the entire circumference of the flat part of the ciliary body without localization in any meridian. At first, granulomas are grayish in color and are not clearly delimited. After their resorption, atrophic pigmented scars remain. In acute inflammatory processes at the recovery stage, infiltration in the lower part of the vitreous body base disappears.

Chronic inflammatory processes that exist for a long time lead to secondary changes in the form of scarring. Primarily affecting the vitreous cortex and the inner layers of the retina, they cause fibrous degeneration of the vitreous base and diffuse thickening of the retinal periphery. Scarring can be widespread with the formation of cysts. Sometimes newly formed vessels and retinal ruptures appear, leading to its detachment. An important sign that allows us to distinguish pars planitis is noted: scarring occurs only in the lower zone of the periphery of the retina, without affecting the flat part of the ciliary body. The sources of peripheral exudate deposits are all inflammatory processes that affect the vitreous cortex. Such deposits can quickly develop in focal chorioretinitis. In patients with disseminated peripheral chorioretinitis, the exudate can cover the entire periphery of the retina, simulating the picture of posterior cyclitis. However, the flat part of the ciliary body remains free of exudative deposits.

Analysis of clinical signs allows us to identify three criteria for differentiating anterior and posterior uveitis with pars planitis:

  • exudate is located on the lower periphery;
  • it is always intravitreal;
  • the flat part of the ciliary body does not show signs of inflammation in the initial phase of the disease, when certain morphological changes have not yet formed.

The etiology of the disease has not been established. The herpes virus and immunological factors may be involved.

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