PATHOLOGY OF UVEITIS

Inflammation of the uvea fundamentally has the same characteristics as any other tissue of the body, i.e, a vascular and a cellular response. However, due to extreme vascularity and looseness of the uveal tissue, the inflammatory responses are exaggerated and thus produce special results. Pathologically, inflammations of the uveal tract may be divided into suppurative (purulent) and nonsuppurative (non-purulent) varieties. ood has further classified non-suppurative uveitis into a nongranulomatous and granulomatous types. !lthough morphologic description is still of some value, the rigid division of uveitis by ood into these two categories has been "uestioned on both clinical and pathological grounds. #ertain transitional forms of uveitis have also been recognised. $ome of these (e.g., phacoanaphylactic endophthalmitis andsympathetic ophthalmia) showing pathological features of granulomatous uveitis are caused by hypersensitivity reactions. hile uveitis due to tissue invasion by leptospirae presents the manifestation of non-granulomatous uveitis. %onetheless, the classification is often useful in getting oriented towards the sub&ect of uveitis, its wor'up and therapy. (herefore, it is worthwhile to describe the pathological features of these overlapping (both clinically and pathologically) conditions as distinct varieties. 1. Pathology of suppurative uveitis. Purulent inflammation of the uvea is usually a part of endophthalmitis or panophthalmitis occurring as a result, of exogenous infection by pyogenic organisms which include staphylococcus, streptococcus, psuedomonas, pneumococcus and gonococcus. (he pathological reaction is characterised by an outpouring of purulent exudate and infiltration by polymorphonuclear cells of uveal tissue, anterior chamber, posterior chamber and vitreous cavity. !s a result, the whole uveal tissue is thic'ened and necrotic and the cavities of eye become filled with pus. 2. Pathology of non-granulomatous uveitis. %ongranulomatous uveitis may be an acute or chronic exudative inflammation of uveal tissue (predominantly iris and ciliary body), usually occurring due either to a physical and toxic insult to the tissue, or as a result of different hypersensitivity reactions. (he pathological alterations of the nongranulomatous reaction consists of mar'ed dilatation and increased permeability of vessels, brea'down of blood a"ueous barrier with an outpouring of fibrinous exudate and infiltration by lymphocytes, plasma cells and large macrophages of the uveal tissue, anterior chamber, posterior chamber and vitreous cavity. (he inflammation is usually diffuse. !s a result of these pathological reactions iris

becomes waterlogged, oedematous, muddy with blurring of crypts and furrows. !s a conse"uence its mobility is reduced, pupil becomes small in si)e due to sphincter irritation and engorgement of radial vessels of iris. *xudates and lymphocytes poured into the anterior chamber result in a"ueous flare and deposition of fine +Ps at the bac' of cornea. ,ue to exudates in the posterior chamber, the posterior surface of iris adheres to the anterior capsule of lensleading to posterior synechiae formation. In severe inflammation, due to pouring of exudate from ciliary processes, behind the lens, an exudative membrane called cyclitic membrane may be formed. !fter healing, pin-point areas of necrosis or atrophy are evident. $ubse"uent attac's lead to structural changes li'e atrophy, gliosis and fibrosis which cause adhesions, scarring and eventually destruction of eye. 3. Pathology of granulomatous uveitis. -ranulomatous uveitis is a chronic inflammation of proliferative nature which typically occurs in response to anything which acts as an irritant foreign body, whether it be inorganic or organic material introduced from outside, a haemorrhage or necrotic tissue within the eye, or one of the certain specific organisms of non-pyogenic and relatively nonvirulent character. (he common organisms which excite this type of inflammation are those responsible for tuberculosis, leprosy, syphilis, brucellosis, leptospirosis, as well as most viral, mycotic, proto)oal and helminthic infections. ! typical granulomatous inflammation is also seen in sarcoidosis, sympathetic ophthalmitis and .ogt-+oyanagi-Harada/s disease. (he pathological reaction in granulomatous uveitis is characterised by infiltration with lymphocytes, plasma cells, with mobili)ation and proliferation of large mononuclear cells which eventually become epithelioid and giant cells and aggregate into nodules. Iris nodules are usually formed near pupillary border (Koeppes nodules). $imilar nodular collection of the cells is deposited at the bac' of cornea in the form of mutton fat 'eratic precipitates and a"ueous flare is minimal. %ecrosis in the ad&acent structures leads to a repairative process resulting in fibrosis and gliosis of the involved area.