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Uveitis/iritis (Clinical presentation (Eye pain Aching pain if anterior …
Uveitis/iritis
Clinical
presentation
Eye pain
Aching pain if anterior
Posterior often PAINLESS
Photosensitivity
Visual blurring
May be initially normal then worsen
Glare
Bright lights
Irregular appearrance
Posterior synechiae (sticky aqueous and adhesions)
Hypopyon (pus anterior chamber)
Red eye
Usually unilateral
Watery eye
Flashes/floaters
Aetiology
Autoimmune
Seroneg spondyloarthropathies (AS, juvenile RA, reactive arthritis, IBD)
Behcet's disease
Sarcoidosis
Psoriasis
MS
Infection
Viral: HSV, VZV, CMV
Parasite: toxoplasmosis, histoplasmosis
Bacteria: syphilis, Lyme disease, TB
Fungal: candida, aspergillus
Idiopathic
Unknown (commonest)
Trauma
Neoplastic
Rare
Epidemiology
Accounts for 10% visual impairment
Adults 20-60y
Rare
F>M
Diagnosis
External eye examination
Diffuse conjunctival injection, usually unilateral,
miosis, posterior synechiae, hypopyon
Investigations
Imaging
Slit lamp imaging: conjunctival injection, inflammatory precipitates, vessel flare, miosis, hypopyon, posterior synechiae
Bedside
Obs (?fever if septic)
History
DH
Current meds, eye drops, allergies
FH
Eye disorders, autoimmune disorders
PMH
Seronegative spondyloarthropathy,
recent infection, previous cancers
SH
Occupation, smoking, alcohol
PC/HPC
Pain (SOCRATES), acute onset, any vision change, glare/photosensitivity, redness of eye, photophobia, flashes/floaters, irregular/unreactive pupil; prev episodes
Management
Surgery
Cryotherapy
Indication: severe/chronic
Vitrectomy
Indication: severe posterior uveitis/chronic
Laser phototherapy
Indication: chronic/severe
Conservative
Information and advice
Refer to ophthalmology ASAP (URGENT)
Medical
Cycloplegic/mydriatic
Indication: ASAP
E.g. cyclopentolate, atropine
MOA: paralyses ciliary body and dilates of pupil breaks posterior
synechiae, preventing adhesions and spasm
Steroids
Indication: ASAP
E.g. topical, IV, IM, PO
MOA: reduce inflammation and
damage to the eye structures
Subconjunctival injection
Indication: severe uveitis
E.g. steroid +/- mydricaine
MOA: reduces inflammation and dilates pupil
Immunosuppressants
Indication: severe/chronic uveitis
Antibiotics
Indication: bacterial infection likely
E.g. topical, PO, IV
MOA: destroys bacteria
Complications
Visual impairment
35% uveitis worldwide
Other
Corneal calcification
Posterior synechiae (adhesions
between posterior iris and anterior lens)
Low IOP (hypotony)
Secondary glaucoma
Secondary cataracts
Macular oedema/ischemia
Retinal attachment
Optic neuropathy/atrophy
Visual loss
10-15% blindness
Prognosis
Often resolves quickly with treatment
May get chronic uveitis which
can cause visual impairment
Best prognosis with acute anterior uveitis;
chronic/posterior uveitis worst outcome
Pathophysiology
Timing
Acute: sudden onset, resolves <3m Recurrent: repeat episodes with resolution, >3,
Chronic: persistent inflammation >3m
Classification
Anterior (commonest): inflammation of anterior segment,
including iritis and iridocyclitis
Intermediate: inflammation of the ciliary body and anterior vitreous
Panuveitis: inflammation in anterior and posterior chambers
Risk
factors
HLA-B27 +ve
Prev uveitis
Definition
Inflammation of the uveal tract
(iris, ciliary body, choroid) +/-
inflammation of adjacent structures
(retina, optic nerve, vitreous)
