Uveitis: Difference between revisions

Revision as of 02:41, 12 March 2015

Background

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

Inflammatory
- Associated with HLA B-27
- 50% have associated systemic disease
  - Ankylosing spondylitis
  - Psoriatic arthritis
  - Reactive arthritis
  - inflammatory bowel disease
  - Sarcoidosis
  - Juvenile idiopathic arthritis
  - Behcet disease
  - Kawasaki disease
  - Multiple sclerosis
  - Wegener’s granulomatosis
Environmental
- Trauma
- Corneal foreign body
- UV keratitis
Infectious (uncommon)
- TB
- Lyme
- HSV
- Toxo
- VZV
- Syphilis
- Adenovirus

Clinical Features

Posterior

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

Work-Up

Slit-lamp
- Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
- Hypopyon (with severe disease)
CXR (uveitis often associated with sarcoidosis, TB)

DDx

Eye Algorithm (Main)

Treatment

Infectious
- Treat the underlying infection
Noninfectious
- Anterior Uveitis
  - Topical Steroid (anterior only)
    - Prednisolone 1%
  - Mydriatics (sympathomimetics)
    - Prevents the formation of synechiae
    - Phenylephrine HCl or Hydroxyamphetamine HBr
  - Cycloplegics
    - Relieves pain
    - Scopolamine 0.25% OR cyclopentolate 1%
- Posterior Uveitis
  - Generally not responsive to topical treatment
  - Consult ophtho for obs vs intraocular steroid injection

Disposition

Ophtho consult within 24-48hr

Complications

Cataracts
Glaucoma (from synechia)
Retinal detachment

Source

Tintinalli

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
+**Anterior Uveitis
-###Inflammation of iris and/or ciliary body
+***Inflammation of iris and/or ciliary body
-###Types:
+***Types:
-####Iritis
+****Iritis
-####Iridocyclitis
+****Iridocyclitis
-##Posterior uveitis = choroiditis
+**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
+***Wegener’s granulomatosis
-#Environmental
+*Environmental
-##Trauma
+**Trauma
-##Corneal foreign body
+**Corneal foreign body
-##UV keratitis
+**UV keratitis
-#Infectious (uncommon)
+*Infectious (uncommon)
-##TB
+**TB
-##Lyme
+**Lyme
-##HSV
+**HSV
-##Toxo
+**Toxo
-##VZV
+**VZV
-##Syphilis
+**Syphilis
-##Adenovirus
+**Adenovirus
 ==Clinical Features==
 ===Anterior===
-#Sudden red/painful eye
+*Sudden red/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)
+*Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
-#Poorly reactive pupil
+*Poorly reactive pupil
 ===Posterior===
-#Floaters
+*Floaters
-#Visual changes
+*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
+*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)
+*CXR (uveitis often associated with sarcoidosis, TB)
 ==DDx==
@@ Line 60: / Line 60: @@
 ==Treatment==
-#Infectious
+*Infectious
-##Treat the underlying infection
+**Treat the underlying infection
-#Noninfectious
+*Noninfectious
-##Anterior Uveitis
+**Anterior Uveitis
-###Topical Steroid (anterior only)
+***Topical Steroid (anterior only)
-####Prednisolone 1%
+****Prednisolone 1%
-###Mydriatics (sympathomimetics)
+***Mydriatics (sympathomimetics)
-####Prevents the formation of synechiae
+****Prevents the formation of synechiae
-####Phenylephrine HCl or Hydroxyamphetamine HBr
+****Phenylephrine HCl or Hydroxyamphetamine HBr
-###Cycloplegics
+***Cycloplegics
-####Relieves pain
+****Relieves pain
-####Scopolamine 0.25% OR cyclopentolate 1%
+****Scopolamine 0.25% OR cyclopentolate 1%
-##Posterior Uveitis
+**Posterior Uveitis
-###Generally not responsive to topical treatment
+***Generally not responsive to topical treatment
-###Consult ophtho for obs vs intraocular steroid injection
+***Consult ophtho for obs vs intraocular steroid injection
 ==Disposition==
@@ Line 80: / Line 80: @@
 ==Complications==
-#Cataracts
+*Cataracts
-#Glaucoma (from synechia)
+*Glaucoma (from synechia)
-#Retinal detachment
+*Retinal detachment
 ==Source==