ISSN 2398-2977      

Uveitis: traumatic

pequis

Introduction

  • Cause: blunt penetrating trauma can damage the uveal tract directly or indirectly   →   a severe anterior +/- posterior uveitis.
  • Signs: sudden onset, unilateral acutely painful eye - possibly after known trauma event. May be combined with other traumatically induced ocular damage.
  • Treatment: rapid and intense topical and systemic therapy to minimize long-term sequelae.
  • Prognosis: guarded - affected by degree of other damage to eye.
Print off the Owner factsheet on Common eye problems to give to your clients.

Pathogenesis

Etiology

  • Direct injury to eye - either blunt or penetrating.
  • Intra-ocular surgery.

Pathophysiology

  • Trauma to eye, either blunt or penetrating   →   uveal inflammatory reaction.
  • Blunt trauma through the eyelids or directly against cornea will transmit shock waves through the eye   →   damage to various structures depending upon the severity of the trauma.
  • Penetrating or perforating ocular injuries can involve uveal tissue directly or allow contamination of the uvea and other intraocular structures by bacteria.
  • Intraocular surgery invariably produces some degree of uveitis which requires control via pre- and post-operative medical regimes and good surgical technique to minimize direct trauma.
  • Blunt trauma against the eyelids or cornea   →   shock waves in the eye   →   some or all of:
    • Damage to iridocorneal angle.
    • Tearing at the base of the iris   →   iridodialysis.
    • Damage to uveal tissue or blood vessels   →   hyphema   Anterior chamber: hyphema  .
    • Damage to lens zonules   →   lens subluxation (rare).
    • Lens capsule rupture leading to severe uveal inflammation.
  • Other injuries including:
    • Retinal detachment and hemorrhage.
    • Corneal/scleral perforation at limbus.
    • Lens luxation.
  • Penetrating/perforating ocular injuries can directly involve uveal tissue or allow bacterial contamination of the intraocular structures.
  • Foreign bodies may become embedded and the anterior chamber collapse with loss of aqueous and iris prolapse.
  • An initial acute uveitis will become recurrent if uveal tissue is trapped, the lens damaged or foreign bodies/hyphema persists.
  • Intraocular surgery and suture dehiscence.
  • The uveitis that follows blunt or penetrating trauma may be mediated by direct mechanical disruption of the ocular vasculature and other blood/ocular barriers or be a secondary reaction to chemical mediators of inflammation that are produced from damaged cell membrane phospholipids, eg prostaglandins, thromboxanes, etc.
  • Autoimmune reactions to the release of potential auto-antigenic intracellular material, eg lens substance, will contribute further to the uveitis inflammation.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Nasisse M P & Nelms S (1992) Equine ulcerative keratitis. Vet Clin North Am Equine Pract (3), 537-555 PubMed.

Other sources of information

  • Knottenbelt D C (2004) Managment and Prevention of Uveitis in Horses. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 151-152.
  • Brooks D E (1999) Equine Ophthalmology. In: Veterinary Ophthalmology. Ed: Gelatt K N. 3rd edn. 1053-1116.

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