Uveitis: Difference between revisions
 
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==Background==
==Background==
*Uveitis = inflammation of iris, ciliary body, and/or choroid
*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===
===Types===
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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]]
***[[Inflammatory bowel disease]]
***Sarcoidosis
***[[Sarcoidosis]]
***Juvenile idiopathic arthritis
***[[Juvenile idiopathic arthritis]]
***Behcet disease
***[[Behcet disease]]
***[[Kawasaki disease]]
***[[Kawasaki disease]]
***[[Multiple sclerosis]]
***[[Multiple sclerosis]]
***Wegener’s granulomatosis
***[[Granulomatosis with polyangiitis]]
*Environmental
*Environmental
**Trauma
**Trauma
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**[[UV keratitis]]
**[[UV keratitis]]
*Infectious (uncommon)
*Infectious (uncommon)
**[[Corneal ulcer]]
**[[TB]]
**[[TB]]
**[[Lyme]]
**[[Lyme]]
**[[HSV]]
**[[HSV]]
**[[Toxo]]
**[[Toxoplasmosis]]
**[[VZV]]
**[[VZV]]
**[[Syphilis]]
**[[Syphilis]]
**Adenovirus
**[[Adenovirus]]
 
===Complications===
*[[Cataracts]]
*[[Glaucoma]] (from synechia)
*[[Retinal detachment]]


==Clinical Features==
==Clinical Features==
===Anterior===
===Anterior===
[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]]
*Sudden [[red eye|red]]/[[eye pain|painful eye]]
*Sudden red/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
*Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
*Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
*Poorly reactive pupil
*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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{{Acute onset flashers and floaters DDX}}
{{Acute onset flashers and floaters DDX}}


==Diagnosis==
==Evaluation==
*Slit-lamp
*Clinical
**Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
*Consider [[CXR]] (uveitis often associated with [[sarcoidosis]], [[TB]])
**Hypopyon (with severe disease)
*CXR (uveitis often associated with [[sarcoidosis]], [[TB]])


==Treatment==
==Management==
===Infectious===
===Infectious===
*Treat the underlying infection
*Treat the underlying infection


===Noninfectious===
===Noninfectious===
*Anterior uveitis
Anterior uveitis
**Topical Steroid (anterior only)
**[[Topical steroid]] (anterior only; typically in consultation with ophthalmology)
***Prednisolone 1%
***[[Prednisolone]] 1%
**Mydriatics (sympathomimetics)
**Mydriatics ([[sympathomimetics]])
***Dilate the iris
***Prevents the formation of synechiae
***Prevents the formation of synechiae
***Phenylephrine HCl or Hydroxyamphetamine HBr
***[[Cyclopentolate]], [[homatropine]] or [[phenylephrine]] HCl
**Cycloplegics
**[[Cycloplegic]]s
***Relieves pain
***Relieves pain
***Scopolamine 0.25% OR cyclopentolate 1%
***[[Scopolamine]] 0.25% '''OR''' [[cyclopentolate]] 1%
*Posterior Uveitis
*Posterior Uveitis
**Generally not responsive to topical treatment
**Generally not responsive to topical treatment
**Consult ophtho for obs vs intraocular steroid injection
**Consult ophtho for observation vs intraocular steroid injection


==Disposition==
==Disposition==
*Ophtho consult within 24-48hr
*Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours


==Complications==
==See Also==
*Cataracts
*[[Acute onset flashers and floaters]]
*Glaucoma (from synechia)
*[[Red Eye (Unilateral)]]
*Retinal detachment


==References==
==References==
<references/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]

Latest revision as of 18:59, 5 February 2021

Background

  • Uveitis = inflammation of iris, ciliary body, and/or choroid
Anterior uveitis
Anterior uveitis with hypopyon

Types

  • Anterior Uveitis
    • Inflammation of iris and/or ciliary body
    • Types:
  • Posterior uveitis = choroiditis

Causes

Complications

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
  • Ciliary flush, marked injection at the limbus (as opposed to perilimbal sparing seen in conjunctivitis)
  • Typically small, poorly reactive pupil

Posterior

Slit-lamp exam

  • Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
  • Hypopyon (with severe disease)

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Acute onset flashers and floaters

Evaluation

Management

Infectious

  • Treat the underlying infection

Noninfectious

Anterior uveitis

Disposition

  • Generally may be discharged with urgent ophthalmology follow-up within 24-48 hours

See Also

References

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