Uveitis: Difference between revisions
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**Inflammation of iris and/or ciliary body | **Inflammation of iris and/or ciliary body | ||
**Types: | **Types: | ||
***Iritis | ***[[Iritis]] | ||
***Iridocyclitis | ***Iridocyclitis | ||
*Posterior uveitis = choroiditis | *Posterior uveitis = choroiditis | ||
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**50% have associated systemic disease | **50% have associated systemic disease | ||
***[[Ankylosing spondylitis]] | ***[[Ankylosing spondylitis]] | ||
***Psoriatic arthritis | ***[[Psoriatic arthritis]] | ||
***Reactive arthritis | ***[[Reactive arthritis]] | ||
***[[ | ***[[Inflammatory bowel disease]] | ||
***Sarcoidosis | ***[[Sarcoidosis]] | ||
***Juvenile idiopathic arthritis | ***[[Juvenile idiopathic arthritis]] | ||
***Behcet disease | ***[[Behcet disease]] | ||
***[[Kawasaki disease]] | ***[[Kawasaki disease]] | ||
***[[Multiple sclerosis]] | ***[[Multiple sclerosis]] | ||
***Granulomatosis with polyangiitis | ***[[Granulomatosis with polyangiitis]] | ||
*Environmental | *Environmental | ||
**Trauma | **Trauma | ||
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**[[VZV]] | **[[VZV]] | ||
**[[Syphilis]] | **[[Syphilis]] | ||
**Adenovirus | **[[Adenovirus]] | ||
===Complications=== | ===Complications=== | ||
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==Clinical Features== | ==Clinical Features== | ||
===Anterior=== | ===Anterior=== | ||
*Sudden red/painful eye | *Sudden [[red eye|red]]/[[eye pain|painful eye]] | ||
*Deep pain; worse with eye movement | *Deep pain; worse with eye movement | ||
**Due to ciliary muscle spasm which irritates CN V | **Due to ciliary muscle spasm which irritates CN V | ||
***Causes consensual photophobia | ***Causes consensual photophobia | ||
* | *Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis) | ||
* | *Typically small, poorly reactive pupil | ||
===Posterior=== | ===Posterior=== | ||
*Floaters | *[[Floaters]] | ||
*Visual changes | *[[visual disturbances|Visual changes]] | ||
*Generally does not cause redness or significant pain | *Generally does not cause redness or significant pain | ||
*Blind spots or flashing lights | *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== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
* | *Clinical | ||
*Consider [[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]]) | |||
*[[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]]) | |||
==Management== | ==Management== | ||
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===Noninfectious=== | ===Noninfectious=== | ||
Anterior uveitis | Anterior uveitis | ||
**[[Topical steroid]] (anterior only; typically in consultation with | **[[Topical steroid]] (anterior only; typically in consultation with ophthalmology) | ||
***Prednisolone 1% | ***[[Prednisolone]] 1% | ||
**Mydriatics ([[sympathomimetics]]) | **Mydriatics ([[sympathomimetics]]) | ||
***Dilate the iris | ***Dilate the iris | ||
***Prevents the formation of synechiae | ***Prevents the formation of synechiae | ||
***Cyclopentolate or [[Phenylephrine]] HCl | ***[[Cyclopentolate]] or [[Phenylephrine]] HCl | ||
** | **[[Cycloplegic]]s | ||
***Relieves pain | ***Relieves pain | ||
***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1% | ***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1% |
Revision as of 02:57, 19 March 2020
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
- Nonocular causes
- 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 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