Uveitis is an inflammation of the uveal tract, including the iris, ciliary body, and choroid. It may also involve other closed structures, such as the sclera, retina, and vitreous humor.
PHYSICAL FINDINGS AND CLINICAL PRESENTATION
● Symptoms of uveitis depend on the site of involvement and whether the process is acute or insidious.
● Acute anterior uveitis: pain and photophobia. Vision may not be affected initially.
● Posterior uveitis: fl oaters, hazy vision. Involvement of the retina may produce blind spots or fl ashing lights.
● Insidious anterior uveitis: symptoms may not be present until scarring cataracts and loss of vision occur.
● Blurred visual acuity
● Irregular pupil
● Hazy cornea
● Abnormal cells and flare in anterior chamber or vitreous humor
● Retinal hemorrhage, vascular sheathing
● Conjunctival injection
● Ciliary fl ush
● Keratitic precipitates (precipitates on the cornea; )
● Hazy vitreous
● Retinal infl ammation
● Iris nodules
● Rheumatoid arthritis
● Systemic symptoms related to cause
● Infections: herpes simplex virus, cytomegalovirus, toxoplasmosis, tuberculosis, syphilis, HIV
● Systemic disorders: sarcoidosis, Behçet’s syndrome, HLAB27– associated diseases (e.g., ankylosing spondylitis, reactive arthritis), inflammatory bowel disease, juvenile idiopathic arthritis
● A comprehensive history is essential for determining the cause of uveitis.
● Retinal detachment
● Masquerading syndromes: lymphoma, uveal melanoma, metastases (breast, lung, renal), leukemia, retinitis pigmentosa, retinoblastoma
● Laboratory tests for specific inflammatory causes (e.g., ANA,ESR, VDRL, HLA-B27, purifi ed protein derivative [PPD], Lyme titer)
● Visual field testing; slit-lamp examination, indirect ophthalmoscopy.
● Chest x-ray in suspected sarcoidosis, tuberculosis (TB), histoplasmosis
● Sacroiliac x-ray in suspected ankylosing spondylitis.
● Treat the underlying disease. Treatment is often multidisciplinary (ophthalmologist, internist, rheumatologist, infectious disease [ID] specialist).
● Treat photophobia and local pain.
● Acute general medical therapy
● Corticosteroids are the mainstay of therapy for noninfectious causes.
● Antibiotics for bacterial infections and antiviral agents, when viral infection is suspected, should be started to prevent retinal damage.
● Systemic steroids, if appropriate for the underlying disease. Systemic corticosteroid therapy is generally reserved for patients with systemic disorders and those with bilateral disease refractory to local medication or those with major ocular disability or retinitis.
● Antimetabolites, when indicated. Immunosuppressive medications used in steroid-dependent or refractory uveitis include methotrexate, sulfasalazine, azathioprine, cyclosporine, and tacrolimus. These medications can have signifi cant toxicity and should be prescribed only by physicians experienced with their use.