Uveitis: Difference between revisions
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**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 | ||
Revision as of 02:53, 12 March 2015
Background
- Uveitis = inflammation of iris, ciliary body, and/or choroid
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
- 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)
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
- Due to ciliary muscle spasm which irritates CN V
- Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
- Poorly reactive pupil
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)
Differential Diagnosis
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
- Floaters and/or flashes
- Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
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%
- Topical Steroid (anterior only)
- Posterior Uveitis
- Generally not responsive to topical treatment
- Consult ophtho for obs vs intraocular steroid injection
- Anterior Uveitis
Disposition
- Ophtho consult within 24-48hr
Complications
- Cataracts
- Glaucoma (from synechia)
- Retinal detachment
Source
Tintinalli