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.

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