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Uveitis

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Refers to a intraocular inflammation which may be related to an infectious agent or an immune mediated process.

Site threatening intraocular inflammation that is the fifth most common cause of severe vision loss in high income nations.

It Is estimated to be responsible for 10-15% of all cases of blindness in the US.

The uvea consists of the iris, ciliary body, and chotoid.

Can be associated with a systemic disease or be eye limited.

Affects people of all ages.

May lead to a greater years of vision loss than other age related diseases.

It is diagnosed when there is inflammation of the uvea, such as chorioretinitis, or when leukocytes are present in the anterior chamber of the eye or in the vitreous humor.

It is classified according to the inflamed portion of the uvea: anterior, intermediate, and posterior uveitis, as well as panuveitis.

The cause of uveitis is associated with the location of the inflammation in the uveal tract.

Causes of uveitis are divided into categories including: infection, immune mediated, reaction to medication, trauma, and syndromes that masquerade as uveitis such as cancer, usually B-cell lymphoma.

May be associated with systemic diseases such as sarcoidosis or a spondyloarthritis, or eye limited and presumed to be autoimmune or auto inflammatory along with an infectious nature.

Uveitis inflammation includes the uveal tract, and related structures including the retina, sclera and orbit.

Classified by the predominant location of inflammation, anterior uveitis, if in the anterior chamber, intermediate uveitis if in the vitreous, and posterior uveitis in the retina or choroid.

Panuveitis refers to inflammation in all of the above sites.

Limited type disease refers to uveitis of less than three months duration or persistent type that lasst longer than three months.

The prevalence of posterior uveitis 0.004%.

Anterior uveitis is the most common type and manifests with sudden onset of severe photo sensitivity, eye pain, blurred vision, and red eye.

Clinical examination with anterior uveitis reveals decreased vision, limbal injection, corneal endothelial precipitates, anterior chamber reaction with white cells and light scattering caused by increased protein concentration.

Anterior uveitis is associated with juvenile idiopathic arthritis.

Anterior uveitis is commonly idiopathic, but it may be associated with HLA B 27.

Anterior uveitis associated with psoriatic arthropathy, Reiter’s syndrome, inflammatory bowel disease, Behcet’s syndrome, SLE, granulomatous polyangitis, and sarcoidosis.

Anterior uveitis may be caused by postsurgical infectious endophthalmitis.

May be assoiated with lymphomas.

Infectious agents that can cause anterior uveitis include tuberculosis, syphilis, Lyme disease, herpes simplex virus, toxoplasmosis, tuberculosis, B henselae, and varicella-zoster virus.

Diagnosis requires history and dilated funduscopy.

Differential diagnosis includes: sarcoidosis, syphilis, tuberculosis, and herpetic infections.

Usually responds to topical and systemic corticosteroids.

Timely management is critical to prevent permanent vision loss.

Anti-metabolite methotrexate and mycophenolaye mofetil commonly used as an initial corticosteroid sparing treatments before progressing to biologic therapies.

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