Uveitis

Background

• Uveitis = inflammation of iris, ciliary body, and/or choroid

Anterior Uveitis

• • Inflammation of iris and/or ciliary body
  • Types:
    • Iritis
    • Iridocyclitis

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

Anterior

• Sudden red/painful eye
• Deep pain; worse with eye movement
  • Due to ciliary muscle spasm which irritates CN V
    • Causes consensual photophobia
• 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
• 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%
  • 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