Uveitis: Difference between revisions

No edit summary
 
(30 intermediate revisions by 9 users not shown)
Line 1: Line 1:
==Background==
==Background==
#Uveitis = inflammation of iris, ciliary body, and/or choroid
*Uveitis = inflammation of iris, ciliary body, and/or choroid
##Anterior Uveitis
###Inflammation of iris and/or ciliary body
###Types:
####Iritis
####Iridocyclitis
##Posterior uveitis = choroiditis


==Causes==
[[File:Anterior-uveitis.jpg|thumb|Anterior uveitis]]
#Inflammatory
[[File:Hypopyon.jpg|thumb|Anterior uveitis with hypopyon]]
##Associated with HLA B-27
 
##50% have associated systemic disease
===Types===
###Ankylosing spondylitis
*Anterior Uveitis
###Psoriatic arthritis
**Inflammation of iris and/or ciliary body
###Reactive arthritis
**Types:
###inflammatory bowel disease
***[[Iritis]]
###Sarcoidosis
***Iridocyclitis
###Juvenile idiopathic arthritis
*Posterior uveitis = choroiditis
###Behcet disease
 
###Kawasaki disease
===Causes===
###Multiple sclerosis
*Inflammatory
###Wegener’s granulomatosis
**Associated with HLA B-27
#Environmental
**50% have associated systemic disease
##Trauma
***[[Ankylosing spondylitis]]
##Corneal foreign body
***[[Psoriatic arthritis]]
##UV keratitis
***[[Reactive arthritis]]
#Infectious (uncommon)
***[[Inflammatory bowel disease]]
##TB
***[[Sarcoidosis]]
##Lyme
***[[Juvenile idiopathic arthritis]]
##HSV
***[[Behcet disease]]
##Toxo
***[[Kawasaki disease]]
##VZV
***[[Multiple sclerosis]]
##Syphilis
***[[Granulomatosis with polyangiitis]]
##Adenovirus
*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==
==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
#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==
{{Unilateral red eye DDX}}
 
{{Acute onset flashers and floaters DDX}}


==Work-Up==
==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)


==DDx==
==Management==
*[[Eye Algorithm (Main)]]
===Infectious===
*Treat the underlying infection


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


==Source==
==References==
Tintinalli
<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

Retrieved from "https://www.wikem.org/w/index.php?title=Uveitis&oldid=295789"