Symptoms of uveitis

Symptoms of uveitis may vary depending on the location of the inflammatory process, the body's resistance and the pathogenicity of the microorganism.

Acute anterior uveitis

Acute anterior uveitis is characterized by photophobia, pain, redness, decreased visual acuity, and lacrimation. Chronic anterior uveitis may be asymptomatic or may be accompanied by slight redness and a sensation of “floating spots” before the eyes.

Pericorneal (ciliary) injection in acute anterior uveitis has a purple tint.

Corneal precipitates are cellular deposits on the corneal endothelium. Their pattern and distribution can be used to determine the suspected type of uveitis. Corneal precipitates are most often located in the middle and inferior portions of the cornea due to its shape and fluid movement in the anterior chamber. However, in uveitis associated with Fuchs syndrome, corneal precipitates are scattered throughout the endothelium.

• endothelial dust caused by multiple cells occurs in acute anterior uveitis and in subacute chronic inflammation;
• medium corneal precipitates are more common in acute and chronic anterior uveitis;
• Large corneal precipitates usually have the appearance of “fat droplets” with a waxy sheen and are characteristic of granulomatous uveitis;
• old corneal precipitates - usually pigmented; remnants of large corneal precipitates may appear as hyalinized deposits.

Cells determine the activity of the inflammatory process.

• cells in the fluid of the anterior chamber are distributed according to degrees depending on their quantity, detected during biomicroscopy with an oblique slit 3 mm long and 1 mm wide, with maximum illumination and magnification;
  • <5 cells - +/-0
  • 5-10 cells = +1;
  • 11-20 cells = +2;
  • 21-50 cells = +3;
  • >50 cells = +4.
• The cells in the anterior vitreous body should be compared in number with the cells located in the aqueous humor. In iritis, the cells in the aqueous humor of the anterior chamber greatly exceed their number in the vitreous body.

Opalescence of the aqueous humor is caused by light scattering by proteins (Tyndall effect) that penetrate the aqueous humor through damaged vessels of the iris. In the absence of cells, opalescence is not an indicator of the activity of the inflammatory process and does not require treatment. Classification by degrees is the same as when counting cells in the anterior chamber.

• Mild degree: newly diagnosed = +1.
• Moderate: iris details are clearly visible = +2.
• Severe degree: details of the iris are not clearly visible = +3.
• Intensive degree: formation of fibrinous exudate - +4.

Nodules on the iris are a characteristic feature of the granulomatous nature of inflammation:

• Coerre's nodes are small in size and are located along the pupillary margin;
• Busacca nodes are less common and are located closer to the periphery of the pupillary margin.

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Posterior synechiae

Posterior synechiae are adhesions between the iris and the anterior capsule of the lens. They form in acute anterior uveitis, as well as in chronic anterior uveitis of moderate and severe degrees. Posterior synechiae, located around the pupillary margin at 360 (seclusion pupilaе), lead to a disruption in the circulation of aqueous humor from the posterior chamber to the anterior, thereby causing iris bombage. This, in turn, contributes to the closure of the angle of the anterior chamber by the root of the iris and the appearance of secondary ophthalmic hypertension. After rupture of posterior synechiae, traces of iris pigment may remain on the anterior capsule of the lens.

Other complications of chronic or recurrent uveitis include band keratopathy, cataracts, glaucoma, macular edema, formation of inflammatory membranes, and phthisis of the globe.

Posterior uveitis

Patients with peripheral inflammatory foci complain of "floating dots" before the eyes and blurred vision. In acute choroiditis, the foveal or paramacular areas are involved in the pathological process, which causes loss of central vision. Opacities in the vitreous body remain unnoticed by the patient.

Signs of posterior uveitis:

• Vitreitis. Characterized by the presence of cells, opacities, opalescence, and detachment of the vitreous body. Inflammatory precipitates cover the surface of the posterior hyaloid membrane.
• Choroiditis. Deep, yellowish or grayish foci with clear boundaries appear. In the case of an inactive inflammatory process, chorioretinal atrophic foci are white with clear boundaries and pigmented edges.
• Retinitis. The retina takes on a white, cloud-like appearance, and the vessels are not clearly visualized. The contour of the inflammatory focus is unclear. It is difficult to draw a dividing line between the healthy and affected areas of the retina.
• Vasculitis. The retinal veins are most often affected (periphlebitis), less often - arteries (ieriarteritis). Active periphlebitis is characterized by the presence of white stripes along the retinal vessels. The lesion is focal in nature with uneven protrusions of the vascular wall outward. In some cases of periphlebitis, perivascular accumulation of granulomatous tissue occurs, which causes the appearance of a "dripping wax" picture.

Macular edema

These include macular involvement, cystic macular edema, macular ischemia, epiretinal membrane formation, retinal vascular occlusion, choroidal neovascularization, retinal detachment, and optic neuropathy.