Uveitis: Difference between revisions

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==Background==
==Background==
*Uveitis = inflammation of iris, ciliary body, and/or choroid
*Uveitis = inflammation of iris, ciliary body, and/or choroid
**Anterior Uveitis
***Inflammation of iris and/or ciliary body
***Types:
****Iritis
****Iridocyclitis
**Posterior uveitis = choroiditis


==Causes==
[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]]
[[File:Hypopyon.jpg|thumb|Anterior uveitis with hypopyon]]
 
===Types===
*Anterior Uveitis
**Inflammation of iris and/or ciliary body
**Types:
***[[Iritis]]
***Iridocyclitis
*Posterior uveitis = choroiditis
 
===Causes===
*Inflammatory
*Inflammatory
**Associated with HLA B-27
**Associated with HLA B-27
**50% have associated systemic disease
**50% have associated systemic disease
***Ankylosing spondylitis
***[[Ankylosing spondylitis]]
***Psoriatic arthritis
***[[Psoriatic arthritis]]
***Reactive arthritis
***[[Reactive arthritis]]
***inflammatory bowel disease
***[[Inflammatory bowel disease]]
***Sarcoidosis
***[[Sarcoidosis]]
***Juvenile idiopathic arthritis
***[[Juvenile idiopathic arthritis]]
***Behcet disease
***[[Behcet disease]]
***Kawasaki disease
***[[Kawasaki disease]]
***Multiple sclerosis
***[[Multiple sclerosis]]
***Wegener’s granulomatosis
***[[Granulomatosis with polyangiitis]]
*Environmental
*Environmental
**Trauma
**Trauma
**Corneal foreign body
**[[Corneal foreign body]]
**UV keratitis
**[[UV keratitis]]
*Infectious (uncommon)
*Infectious (uncommon)
**TB
**[[Corneal ulcer]]
**Lyme
**[[TB]]
**HSV
**[[Lyme]]
**Toxo
**[[HSV]]
**VZV
**[[Toxoplasmosis]]
**Syphilis
**[[VZV]]
**Adenovirus
**[[Syphilis]]
**[[Adenovirus]]
 
===Complications===
*[[Cataracts]]
*[[Glaucoma]] (from synechia)
*[[Retinal detachment]]


==Clinical Features==
==Clinical Features==
===Anterior===
===Anterior===
*Sudden red/painful eye
*Sudden [[red eye|red]]/[[eye pain|painful eye]]
*Deep pain; worse with eye movement
*Deep pain; worse with eye movement
**Due to ciliary muscle spasm which irritates CN V
**Due to ciliary muscle spasm which irritates CN V
***Causes consensual photophobia
***Causes consensual photophobia
*Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
*Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
*Poorly reactive pupil
*Typically small, poorly reactive pupil


===Posterior===
===Posterior===
*Floaters
*[[Floaters]]
*Visual changes
*[[visual disturbances|Visual changes]]
*Generally does not cause redness or significant pain
*Generally does not cause redness or significant pain
*Blind spots or flashing lights
*Blind spots or flashing lights


==Work-Up==
===[[Slit-lamp exam]]===
*Slit-lamp
*Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
**Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
*[[Hypopyon]] (with severe disease)
**Hypopyon (with severe disease)
 
*CXR (uveitis often associated with sarcoidosis, TB)
==Differential Diagnosis==
{{Unilateral red eye DDX}}
 
{{Acute onset flashers and floaters DDX}}
 
==Evaluation==
*Clinical
*Consider [[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]])


==DDx==
==Management==
*[[Eye Algorithm (Main)]]
===Infectious===
*Treat the underlying infection


==Treatment==
===Noninfectious===
*Infectious
Anterior uveitis
**Treat the underlying infection
**[[Topical steroid]] (anterior only; typically in consultation with ophthalmology)
*Noninfectious
***[[Prednisolone]] 1%
**Anterior Uveitis
**Mydriatics ([[sympathomimetics]])
***Topical Steroid (anterior only)
***Dilate the iris
****Prednisolone 1%
***Prevents the formation of synechiae
***Mydriatics (sympathomimetics)
***[[Cyclopentolate]], [[homatropine]] or [[phenylephrine]] HCl
****Prevents the formation of synechiae
**[[Cycloplegic]]s
****Phenylephrine HCl or Hydroxyamphetamine HBr
***Relieves pain
***Cycloplegics
***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1%
****Relieves pain
*Posterior Uveitis
****Scopolamine 0.25% OR cyclopentolate 1%
**Generally not responsive to topical treatment
**Posterior Uveitis
**Consult ophtho for observation vs intraocular steroid injection
***Generally not responsive to topical treatment
***Consult ophtho for obs vs intraocular steroid injection


==Disposition==
==Disposition==
*Ophtho consult within 24-48hr
*Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours


==Complications==
==See Also==
*Cataracts
*[[Acute onset flashers and floaters]]
*Glaucoma (from synechia)
*[[Red Eye (Unilateral)]]
*Retinal detachment


==Source==
==References==
Tintinalli
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]

Latest revision as of 18:59, 5 February 2021

Background

  • Uveitis = inflammation of iris, ciliary body, and/or choroid
Anterior uveitis
Anterior uveitis with hypopyon

Types

  • Anterior Uveitis
    • Inflammation of iris and/or ciliary body
    • Types:
  • Posterior uveitis = choroiditis

Causes

Complications

Clinical Features

Anterior

  • Sudden red/painful eye
  • Deep pain; worse with eye movement
    • Due to ciliary muscle spasm which irritates CN V
      • Causes consensual photophobia
  • Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
  • Typically small, poorly reactive pupil

Posterior

Slit-lamp exam

  • Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
  • Hypopyon (with severe disease)

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Acute onset flashers and floaters

Evaluation

Management

Infectious

  • Treat the underlying infection

Noninfectious

Anterior uveitis

Disposition

  • Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours

See Also

References

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