Uveitis: Difference between revisions

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:
  - Iritis
  - Iridocyclitis
Posterior uveitis = choroiditis

Causes

Inflammatory
- Associated with HLA B-27
- 50% have associated systemic disease
Environmental
- Trauma
- Corneal foreign body
- UV keratitis
Infectious (uncommon)
- Corneal ulcer
- TB
- Lyme
- HSV
- Toxoplasmosis
- VZV
- Syphilis
- Adenovirus

Complications

Clinical Features

Posterior

Floaters
Visual changes
Generally does not cause redness or significant pain
Blind spots or flashing lights

Slit-lamp exam

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

Differential Diagnosis

Unilateral red eye

Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
Orbital trauma

^Emergent diagnoses ^^Critical diagnoses

Acute onset flashers and floaters

Ocular causes
- Floaters and/or flashes
  - Posterior vitreous detachment
  - Retinal tear or retinal detachment
  - Posterior uveitis
- Predominantly floaters
  - Vitreous hemorrhage secondary to proliferative retinopathy
  - Sympathetic ophthalmia
- Predominantly flashes
  - Oculodigital stimulation
  - Rapid eye movements
  - Neovascular age-related macular degeneration
Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension

Evaluation

Clinical
Consider CXR (uveitis often associated with sarcoidosis, TB)

Management

Infectious

Treat the underlying infection

Noninfectious

Anterior uveitis

- Topical steroid (anterior only; typically in consultation with ophthalmology)
  - Prednisolone 1%
- Mydriatics (sympathomimetics)
  - Dilate the iris
  - Prevents the formation of synechiae
  - Cyclopentolate, homatropine or phenylephrine HCl
- Cycloplegics
  - Relieves pain
  - Scopolamine 0.25% OR cyclopentolate 1%
Posterior Uveitis
- Generally not responsive to topical treatment
- Consult ophtho for observation vs intraocular steroid injection

Disposition

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

References

Authors:

@@ Line 1: / Line 1: @@
 ==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
-==Workup==
+[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]]
-#Slit-lamp
+[[File:Hypopyon.jpg|thumb|Anterior uveitis with hypopyon]]
-#Consider CXR
-##uveitis often associated with sarcoidosis, TB
-==Diagnosis==
+===Types===
-# Cell & flare
+*Anterior Uveitis
-# Hypopyon
+**Inflammation of iris and/or ciliary body
-# Photophobia
+**Types:
+***[[Iritis]]
+***Iridocyclitis
+*Posterior uveitis = choroiditis
-==By Type==
+===Causes===
-# Anterior uveitis
+*Inflammatory
-## Pain
+**Associated with HLA B-27
-## Redness (primarily noted at the limbus)
+**50% have associated systemic disease
-## Constricted pupil
+***[[Ankylosing spondylitis]]
-# Posterior uveitis
+***[[Psoriatic arthritis]]
-## Reduced visual acuity
+***[[Reactive arthritis]]
-## Floaters
+***[[Inflammatory bowel disease]]
+***[[Sarcoidosis]]
+***[[Juvenile idiopathic arthritis]]
+***[[Behcet disease]]
+***[[Kawasaki disease]]
+***[[Multiple sclerosis]]
+***[[Granulomatosis with polyangiitis]]
+*Environmental
+**Trauma
+**[[Corneal foreign body]]
+**[[UV keratitis]]
+*Infectious (uncommon)
+**[[Corneal ulcer]]
+**[[TB]]
+**[[Lyme]]
+**[[HSV]]
+**[[Toxoplasmosis]]
+**[[VZV]]
+**[[Syphilis]]
+**[[Adenovirus]]
-==Treatment==
+===Complications===
-# Infectious
+*[[Cataracts]]
-## Treat the underlying infection
+*[[Glaucoma]] (from synechia)
-# Noninfectious
+*[[Retinal detachment]]
-## Steroid
-### Prednisolone 1%
+==Clinical Features==
-## Cycloplegic
+===Anterior===
-### Relieves pain and prevents formation of posterior synechiae
+*Sudden [[red eye|red]]/[[eye pain|painful eye]]
-### Scopolamine 0.25% OR cyclopentolate 1%
+*Deep pain; worse with eye movement
-# Ophtho consult within 24 hours
+**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===
+*[[Floaters]]
+*[[visual disturbances|Visual changes]]
+*Generally does not cause redness or significant pain
+*Blind spots or flashing lights
+===[[Slit-lamp exam]]===
+*Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
+*[[Hypopyon]] (with severe disease)
+==Differential Diagnosis==
+{{Unilateral red eye DDX}}
+{{Acute onset flashers and floaters DDX}}
+==Evaluation==
+*Clinical
+*Consider [[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]])
+==Management==
+===Infectious===
+*Treat the underlying infection
+===Noninfectious===
+Anterior uveitis
+**[[Topical steroid]] (anterior only; typically in consultation with ophthalmology)
+***[[Prednisolone]] 1%
+**Mydriatics ([[sympathomimetics]])
+***Dilate the iris
+***Prevents the formation of synechiae
+***[[Cyclopentolate]], [[homatropine]] or [[phenylephrine]] HCl
+**[[Cycloplegic]]s
+***Relieves pain
+***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1%
+*Posterior Uveitis
+**Generally not responsive to topical treatment
+**Consult ophtho for observation vs intraocular steroid injection
+==Disposition==
+*Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours
 ==See Also==
-[[Eye Algorithm (Main)]]
+*[[Acute onset flashers and floaters]]
+*[[Red Eye (Unilateral)]]
+==References==
+<references/>
-[[Category:Ophtho]]
+[[Category:Ophthalmology]]