Uveitis

UVEITIS (uveitis), inflammation of the entire uveal tract of the eye, its middle membrane. Disease of one part of the uveal tract, for example, the iris (iritis), can spread to the ciliary body and choroid, as a result of which irido-cyclo-chorioiditis, s. uveitis, arises. Less frequently, the second path of development of U. is observed, when inflammation begins in the choroid and spreads to the ciliary body and iris. Epidemic cerebrospinal meningitis, relapsing typhus, dysentery, septic diseases, influenza, syphilis, tbc create conditions for the development of U. in acute form. In this case, we have clearly expressed symptoms of iridocyclitis (see Iritis). Often already at the beginning of its development, U. takes a chronic course. In this case, the signs of chronic iridocyclitis come to the forefront. Usually, U. begins with disease of the ciliary body, the expression of which is clouding of the vitreous body. Causing a gradually increasing decline in vision, this clouding has the form of flakes and is perceived as floating flies in the field of vision. Further, the choroid becomes involved in the pathological process, which is accompanied by the appearance of flickering and sparks in the eyes, distortion of objects. The latter circumstance finds its explanation in the hyperemia and edema of the retina that accompany U. The so-called s e r o u s U. (uveitis serosa) represents the most typical form of inflammation of the uveal tract, including the iris. In addition to the usual phenomena of iridocyclitis, precipitates are particularly often observed here. Sometimes exudation reaches a high degree, forming hypopyon, expressed to varying degrees. But the main symptom of the process is diffuse clouding of the vitreous body, sharply reducing visual acuity. Often, serous U. is accompanied by an increase in intraocular pressure. The plastic form of U. is usually accompanied by the formation of posterior synechiae, often circular with the development of complete adhesion and closure of the pupil. At the same time, abundant exudation into the vitreous body occurs with its strong clouding. The process ends in the death of the eye due to shrinkage of the vitreous body and detachment of the retina. Chronically occurring plastic uveitis develops on the basis of chronic infections (tbc, chronic gonorrhea, oral sepsis, etc.). An example of a severe disease of the uveal tract leading to blindness is septic endophthalmitis, endophthalmitis septica of Fuchs. Two types of septic endophthalmitis are distinguished: a) primary traumatic endophthalmitis, arising after fresh penetrating wounds of the eyeball wall, and b) secondary endophthalmitis, developing as a result of late infection of the cornea in the presence of a fistula, cyst-like scars and scars with anterior synechiae. Clinically, septic endophthalmitis proceeds like iridochorioiditis (see Iris). Septic endophthalmitis takes an especially severe course in the so-called plastic form, when organization of the exudate is accompanied by the formation of connective tissue strands. In this case, uneven deepening of the anterior chamber occurs due to a change in the position of the iris and lens, being pulled backward and to the side. Sometimes, conversely, the anterior chamber is absent and at the same time there is hypotony. The prognosis for the disease becomes especially severe when light perception begins to decline: the patient distinguishes light at a distance that becomes shorter and shorter, and the projection of light gradually becomes incorrect; finally, light perception disappears, and the eye atrophies. In exceptionally rare cases, with preservation of light perception, some restoration of vision is possible through surgical intervention, however, the latter is indicated only with the complete disappearance of inflammatory phenomena.-P a t h o -anatomical changes in U. of the type of primary traumatic endophthalmitis come down to thickening of the uveal tract of the eye due to engorgement of its vessels, exudation and infiltration with mono- and multi-nuclear leukocytes. In the uveal tract, hemorrhages and foci of necrosis appear. The uveal tract as a whole is also affected in U., known under the name: metastatic ophthalmia and sympathetic ophthalmia (see Ophthalmia).-Gilbert (Gilbert, 1920) particularly highlights a variety of chronic ophthalmia called recurrent hypopyon-uveitis. This disease clinically manifests as recurrent iritis with the appearance of pus in the anterior chamber (hypopyon). Hypopyon develops periodically in the presence of more or less severe inflammation of the anterior part of the uveal tract and quickly disappears along with all inflammatory phenomena. Gilbert considers recurrent hypopyon-uveitis as a septic metastasis from some focus in the body, where the virus finds its place in the uveal tract, especially in its anterior part. Stahli attributes etiological significance to tbc in the development of the described process. In any case, chronic sepsis plays a significant role in the occurrence of recurrent hypopyon-uveitis. Treatment of U.: general-intravenous injections of a 3% solution of collargol (1-2 cm³), 40% solution of glucose (25-40 cm³), urotropin, intramuscular injections of milk, autogenous blood therapy. Local-atropin (monitor fluctuations in intraocular pressure), subconjunctival injections of mercuric cyanide, opening of the anterior chamber. In severe cases of traumatic endophthalmitis, enucleation is indicated.