Uveitis

Background

• NB Uveitis can refer to inflammation of the iris (iritis), ciliary body (cyclitis) and/or choroid (chorioretinitis)
  • Anterior uveitis is inflammation of the anterior segment i.e. iritis and iridocyclitis (anterior chamber inflammation)
  • Intermediate uveitis is inflammation of the ciliary body, pars plana and anterior vitreous
  • Posterior uveitis is inflammation of the choroid or retina
  • Panuveitis can also occur
  • All can be acute (< 3 months), recurrent or chronic
• Potentially blinding; accounts for 10% of blindness in the developed world; 17-52/100,000/year

Aetiology

• Systemic autoimmune conditions e.g. seronegative spondyloarthropathies (ankylosing spondylitis; Reiter’s/reactive arthritis; inflammatory bowel disease); Behcet’s; Sarcoidosis; Psoriasis; Multiple sclerosis
  • Associated with HLA-B27
• Infection e.g. HSV, VZV, CMV, toxoplasmosis (also syphilis and tuberculosis)
• Trauma

Presentation

• Unilateral (usually)
• Pain is the main symptom
  • In AU, this is often accompanied by redness; in PU redness may be absent
    • Redness is often strongest at the iris border (circumcorneal injection)
• Dimished or blurred vision
• Watering of the eye
• Photophobia
• Flashes or floaters may be seen in posterior uveitis
• In chronic cases, there may be an unreactive and/or irregularly shaped pupil due to synechiae (adhesions)
• On examination with a slit-lamp, deposits of white blood cells are often seen in the anterior chamber and are a diagnostic feature
  • Often graded (from 0 to +4- >50 cells)
  • aqueous may be cloudy (flare)- also graded from 0 to +4 (fibrin deposition)
• Where possible a full examination of inside the eye (slit lamp or fundoscopy) should be attempted to look for evidence of intermediate (cells in vitreous) or posterior (deposits in the retina)

Investigations

• Often clinical diagnosis but investigation of an underlying cause may be useful
• Imaging (OCT or fluorescein angiography) may be helpful too.

Management

• The mainstay of management is eyedrops
  • Corticosteroid drops
  • Cycloplegic-mydriatic (dilating) drops e.g. cyclopentolate or atropine)
    • paralysis the ciliary body, relieving pain and preventing adhesions between the iris and lens
• If there is suspicion of infection, topical antibiotics (chloramphenicol) can also be given
• If an underlying cause e.g. systemic disease, is identified, manage this appropriately to prevent recurrence
• If patients do recur, systemic steroids may be a possibility.