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. Environmental
   1. Trauma
   2. Corneal foreign body
   3. UV keratitis
3. Infectious (uncommon)
   1. TB
   2. Lyme
   3. HSV
   4. Toxo
   5. VZV
   6. Syphilis
   7. Adenovirus

Clinical Features

Anterior

1. Sudden red/painful eye
2. Deep pain; worse with eye movement
   1. Due to ciliary muscle spasm which irritates CN V
      1. Causes consensual photophobia
3. Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
4. Poorly reactive pupil

Posterior

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

Work-Up

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

DDx

• Eye Algorithm (Main)

Treatment

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

Disposition

• Ophtho consult within 24-48hr

Complications

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

Source

Tintinalli