Вы находитесь на странице: 1из 17

K.

Kazemi Zand Ophthalmologist Semnan University of Medical Sciences

Definition
Uveitis is a condition that involves inflammation of

the uveal tract (iris, ciliary body, choroid) or adjacent ocular structures (retina, optic nerve, vitreous, sclera).

Anatomical Classification
Type

Anterior uveitis
Intermediate uveitis Posterior uveitis

Primary Site of Inflammation Anterior chamber Vitreous Choroid

Includes

Iritis/iridocyclitis/anterior cyclitis Pars planitis/posterior cyclitis/hyalitis Focal, multifocal, or diffuse choroiditis/chorioretinitis/ retinochoroiditis/retinitis/ Neuroretinitis

Panuveitis

Anterior chamber, vitreous, and/or choroid

Further Classification
Onset (sudden or insidious) Duration (limited less than 3 months duration, or

persistent more than 3 months duration) Course (acute, recurrent, or chronic) Laterality (unilateral or bilateral)

Etiology
The most common etiology of uveitis is idiopathic.

A wide variety of infectious, traumatic, autoimmune

or neoplastic mechanisms are known to promote or trigger uveitis.

Systemic disorders associated with uveitis


Seronegative spondylarthropathies (Ankylosing spondylitis, Reiters
syndrome, Inflammatory bowel disease, psoriatic arthropathy)

Behets disease Systemic lupus erythematosus

Juvenile rheumatoid arthritis


Multiple sclerosis Chronic granulomatous disorders (tuberculosis, sarcoidosis)

Herpes simplex/zoster
Syphilis Toxoplasmosis

Brucellosis
HIV infection

Epidemiology
Age The majority of patients are aged 20-50 years. Race Racial predisposition to uveitis is related to the patient's underlying systemic disease.

Caucasian: HLA-B27 related diseases, multiple sclerosis African American: Sarcoidosis, SLE Mediterranean/Middle Eastern: Behet's disease (HLA-B5)

Sex In general, uveitis does not have a gender predisposition except in cases secondary to systemic disease, such as JRA and SLE

The most common type of uveitis presented to the emergency department is Acute Anterior Uveitis.

Clinical Presentation
Symptoms:
Red eye Pain Blurred vision Photophobia Excessive tearing

Clinical Presentation
Signs:
Perilimbal injection Direct and consensual photophobia Pupillary miosis (common but not always present) Keratic precipitates on corneal endothelium (granulomatous

or non-granulomatous)
Marked cell and flare reaction in the anterior chamber (WBC,

RBC, protein)
Hypopyon (seen in Behets disease & endophthalmitis) Various degrees of posterior synechiae (Iris bomb

pupillary

block glaucoma)

Differential Diagnosis
Consider all other causes of a red eye before uveitis is diagnosed. Acute conjunctivitis Corneal abrasion or ulceration Ultraviolet keratitis Foreign body Acute angle-closure glaucoma Scleritis

Workup & evaluation


Lab studies are not part of the emergency management of uveitis.
Lab workup is not necessary in all cases. (e.g. a mild, unilateral nongranulomatous uveitis or a known predisposing systemic disease) Indications for requesting lab studies: Unremarkable history and physical examination Bilateral uveitis Granulomatous uveitis Recurrent uveitis Lab studies should be individualized according to clinical suspicion.

Not all workups are necessary for all patients.

Lab studies
CBC, ESR (non-specific) ANA (autoimmune disorders)

Serum ACE, lysosyme (Sarcoidosis)


HLA-B27 (seronegative spondyloarthropathies) HLA-B5 (Behets disease)

VDRL, RPR, FTA-ABS (Syphilis)


PPD (Tuberculosis, Sarcoidosis) HIV antibody (AIDS)

Imaging studies
Chest X-ray is indicated if tuberculosis or sarcoidosis is

considered. Sacroiliac X-ray is indicated if HLA-B27 related diseases are suspected. Brain MRI may be needed if multiple sclerosis is a possibility.(intermediate uveitis) Fluorescein angiography or ocular sonography may be needed in certain types of posterior uveitis

Medical management
Corticosteroids (topical, periocular and/or systemic use) Reduces active inflammation in the eye Prevents and treats uveitis complications Beware of drug complications (cataract, glaucoma, HSV keratitis) Cycloplegics (Homatropine, cyclopentolate,...) Relief of pain and photophobia Breaking posterior synechiae/ pupillary block Immunosuppressive therapy (methotrexate, cyclophosphamide,) Severe uveitis Unresponsive to corticosteroids Severe corticosteroid induced complications

Follow up
Refer the patient to an ophthalmologist within 24

hours Cases of uveitis should be monitored every 1-7 days in the acute phase Steroids and cycloplegics should be tapered and not discontinued suddenly When the condition is stable, patients are monitored every 1-6 months

Вам также может понравиться