Uveitis: Difference between revisions
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==Background== | ==Background== | ||
*Uveitis = inflammation of iris, ciliary body, and/or choroid | |||
[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]] | |||
[[File:Hypopyon.jpg|thumb|Anterior uveitis with hypopyon]] | |||
== | ===Types=== | ||
*Anterior Uveitis | |||
**Inflammation of iris and/or ciliary body | |||
**Types: | |||
***[[Iritis]] | |||
***Iridocyclitis | |||
*Posterior uveitis = choroiditis | |||
* | ===Causes=== | ||
** | *Inflammatory | ||
** | **Associated with HLA B-27 | ||
** | **50% have associated systemic disease | ||
* | ***[[Ankylosing spondylitis]] | ||
** | ***[[Psoriatic arthritis]] | ||
** | ***[[Reactive arthritis]] | ||
***[[Inflammatory bowel disease]] | |||
***[[Sarcoidosis]] | |||
***[[Juvenile idiopathic arthritis]] | |||
***[[Behcet disease]] | |||
***[[Kawasaki disease]] | |||
***[[Multiple sclerosis]] | |||
***[[Granulomatosis with polyangiitis]] | |||
*Environmental | |||
**Trauma | |||
**[[Corneal foreign body]] | |||
**[[UV keratitis]] | |||
*Infectious (uncommon) | |||
**[[Corneal ulcer]] | |||
**[[TB]] | |||
**[[Lyme]] | |||
**[[HSV]] | |||
**[[Toxoplasmosis]] | |||
**[[VZV]] | |||
**[[Syphilis]] | |||
**[[Adenovirus]] | |||
===Complications=== | |||
*[[Cataracts]] | |||
*[[Glaucoma]] (from synechia) | |||
*[[Retinal detachment]] | |||
* | ==Clinical Features== | ||
* | ===Anterior=== | ||
* | *Sudden [[red eye|red]]/[[eye pain|painful eye]] | ||
*Deep pain; worse with eye movement | |||
**Due to ciliary muscle spasm which irritates CN V | |||
***Causes consensual photophobia | |||
*Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis) | |||
*Typically small, poorly reactive pupil | |||
* | ===Posterior=== | ||
*[[Floaters]] | |||
*[[visual disturbances|Visual changes]] | |||
*Generally does not cause redness or significant pain | |||
*Blind spots or flashing lights | |||
==== | ===[[Slit-lamp exam]]=== | ||
*Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels) | |||
*[[Hypopyon]] (with severe disease) | |||
== | ==Differential Diagnosis== | ||
{{Unilateral red eye DDX}} | |||
{{Acute onset flashers and floaters DDX}} | |||
==Evaluation== | |||
*Clinical | |||
*Consider [[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]]) | |||
== | ==Management== | ||
===Infectious=== | |||
*Treat the underlying infection | |||
===Noninfectious=== | |||
Anterior uveitis | |||
**[[Topical steroid]] (anterior only; typically in consultation with ophthalmology) | |||
***[[Prednisolone]] 1% | |||
**Mydriatics ([[sympathomimetics]]) | |||
***Dilate the iris | |||
***Prevents the formation of synechiae | |||
***[[Cyclopentolate]], [[homatropine]] or [[phenylephrine]] HCl | |||
**[[Cycloplegic]]s | |||
***Relieves pain | |||
***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1% | |||
*Posterior Uveitis | |||
**Generally not responsive to topical treatment | |||
**Consult ophtho for observation vs intraocular steroid injection | |||
==Disposition== | |||
*Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours | |||
* | |||
== | ==See Also== | ||
*[[Acute onset flashers and floaters]] | |||
*[[Red Eye (Unilateral)]] | |||
==References== | |||
<references/> | |||
[[Category:Ophthalmology]] | |||
[[Category: | |||
Latest revision as of 18:59, 5 February 2021
Background
- Uveitis = inflammation of iris, ciliary body, and/or choroid
Types
- Anterior Uveitis
- Inflammation of iris and/or ciliary body
- Types:
- Iritis
- Iridocyclitis
- Posterior uveitis = choroiditis
Causes
- Inflammatory
- Associated with HLA B-27
- 50% have associated systemic disease
- Environmental
- Trauma
- Corneal foreign body
- UV keratitis
- Infectious (uncommon)
Complications
- Cataracts
- Glaucoma (from synechia)
- Retinal detachment
Clinical Features
Anterior
- Sudden red/painful eye
- Deep pain; worse with eye movement
- Due to ciliary muscle spasm which irritates CN V
- Causes consensual photophobia
- Due to ciliary muscle spasm which irritates CN V
- Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
- Typically small, poorly reactive pupil
Posterior
- Floaters
- Visual changes
- Generally does not cause redness or significant pain
- Blind spots or flashing lights
Slit-lamp exam
- Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
- Hypopyon (with severe disease)
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Acute onset flashers and floaters
- Ocular causes
- Floaters and/or flashes
- Posterior vitreous detachment
- Retinal tear or retinal detachment
- Posterior uveitis
- Predominantly floaters
- Vitreous hemorrhage secondary to proliferative retinopathy
- Sympathetic ophthalmia
- Predominantly flashes
- Oculodigital stimulation
- Rapid eye movements
- Neovascular age-related macular degeneration
- Floaters and/or flashes
- Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
Evaluation
- Clinical
- Consider CXR (uveitis often associated with sarcoidosis, TB)
Management
Infectious
- Treat the underlying infection
Noninfectious
Anterior uveitis
- Topical steroid (anterior only; typically in consultation with ophthalmology)
- Prednisolone 1%
- Mydriatics (sympathomimetics)
- Dilate the iris
- Prevents the formation of synechiae
- Cyclopentolate, homatropine or phenylephrine HCl
- Cycloplegics
- Relieves pain
- Scopolamine 0.25% OR cyclopentolate 1%
- Topical steroid (anterior only; typically in consultation with ophthalmology)
- Posterior Uveitis
- Generally not responsive to topical treatment
- Consult ophtho for observation vs intraocular steroid injection
Disposition
- Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours