Uveitis

Background

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

Causes

1. Inflammatory
   1. Associated with HLA B-27
   2. 50% have associated systemic disease
      1. Ankylosing spondylitis
      2. Psoriatic arthritis
      3. Reactive arthritis
      4. inflammatory bowel disease
      5. Sarcoidosis
      6. Juvenile idiopathic arthritis
      7. Behcet disease
      8. Kawasaki disease
      9. Multiple sclerosis
      10. Wegener’s granulomatosis
2. Traumatic
3. Infectious (uncommon)

Workup

1. Slit-lamp
2. Consider CXR (uveitis often associated with sarcoidosis, TB)

Diagnosis

Anterior

1. Sudden red/painful eye
2. Deep pain, worse with eye movement
3. Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
4. Sluggish pupil
5. Consensual photophobia
6. Cell & flare

Posterior

1. Floaters
2. Visual changes
3. Generally does not cause redness or significant pain
4. Blind spots or flashing lights
5. Cell & flare

By Type

1. Anterior uveitis
   1. Pain
   2. Redness (primarily noted at the limbus)
   3. Constricted pupil
2. Posterior uveitis
   1. Reduced visual acuity
   2. Floaters

DDx

Eye Algorithm (Main)

Treatment

1. Infectious
   1. Treat the underlying infection
2. Noninfectious
   1. Topical Steroid (anterior only)
      1. Prednisolone 1%
   2. Mydriatics (sympathomimetics)
      1. Phenylephrine HCl or Hydroxyamphetamine HBr
      2. prevent the formation of synechiae
   3. Cycloplegics
      1. Relieves pain
      2. Scopolamine 0.25% OR cyclopentolate 1%
3. Ophtho consult within 24 hours

Complications

1. Cataracts
2. Glaucoma (from synechia)
3. Retinal detachment