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
+[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]]
-### Types:
+[[File:Hypopyon.jpg|thumb|Anterior uveitis with hypopyon]]
-#### Iritis
-#### Iridocyclitis
+===Types===
-## Posterior uveitis = choroiditis
+*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]]
-#Traumatic
+*Environmental
-#Infectious (uncommon)
+**Trauma
+**[[Corneal foreign body]]
+**[[UV keratitis]]
+*Infectious (uncommon)
+**[[Corneal ulcer]]
+**[[TB]]
+**[[Lyme]]
+**[[HSV]]
+**[[Toxoplasmosis]]
+**[[VZV]]
+**[[Syphilis]]
+**[[Adenovirus]]
-==Workup==
+===Complications===
-#Slit-lamp
+*[[Cataracts]]
-#Consider CXR (uveitis often associated with sarcoidosis, TB)
+*[[Glaucoma]] (from synechia)
+*[[Retinal detachment]]
-==Diagnosis==
+==Clinical Features==
 ===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
-#Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
+**Due to ciliary muscle spasm which irritates CN V
-#Sluggish pupil
+***Causes consensual photophobia
-#Consensual photophobia
+*Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
-#Cell & flare
+*Typically small, poorly reactive pupil
 ===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
-#Cell & flare
+===[[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]])
-==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%
-##Topical Steroid (anterior only)
+**Mydriatics ([[sympathomimetics]])
-###Prednisolone 1%
+***Dilate the iris
-##Mydriatics (sympathomimetics)
+***Prevents the formation of synechiae
-###Phenylephrine HCl or Hydroxyamphetamine HBr
+***[[Cyclopentolate]], [[homatropine]] or [[phenylephrine]] HCl
-###Prevents the formation of synechiae
+**[[Cycloplegic]]s
-##Cycloplegics
+***Relieves pain
-###Relieves pain
+***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1%
-###Scopolamine 0.25% OR cyclopentolate 1%
+*Posterior Uveitis
+**Generally not responsive to topical treatment
+**Consult ophtho for observation vs intraocular steroid injection
 ==Disposition==
-*Ophtho consult within 24hr
+*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]]