Uveitis: Difference between revisions
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##Hypopyon (with severe disease) | ##Hypopyon (with severe disease) | ||
#CXR (uveitis often associated with sarcoidosis, TB) | #CXR (uveitis often associated with sarcoidosis, TB) | ||
==DDx== | ==DDx== | ||
[[Eye Algorithm (Main)]] | *[[Eye Algorithm (Main)]] | ||
==Treatment== | ==Treatment== | ||
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##Treat the underlying infection | ##Treat the underlying infection | ||
#Noninfectious | #Noninfectious | ||
##Topical Steroid (anterior only) | ##Anterior Uveitis | ||
###Prednisolone 1% | ###Topical Steroid (anterior only) | ||
##Mydriatics (sympathomimetics) | ####Prednisolone 1% | ||
###Phenylephrine HCl or Hydroxyamphetamine HBr | ###Mydriatics (sympathomimetics) | ||
### | ####Prevents the formation of synechiae | ||
# | ####Phenylephrine HCl or Hydroxyamphetamine HBr | ||
###Relieves pain | ###Cycloplegics | ||
###Scopolamine 0.25% OR cyclopentolate 1% | ####Relieves pain | ||
####Scopolamine 0.25% OR cyclopentolate 1% | |||
##Posterior Uveitis | |||
###Generally not responsive to topical treatment | |||
###Consult ophtho for obs vs intraocular steroid injection | |||
==Disposition== | ==Disposition== | ||
*Ophtho consult within | *Ophtho consult within 24-48hr | ||
==Complications== | ==Complications== |
Revision as of 02:28, 26 October 2011
Background
- Uveitis = inflammation of iris, ciliary body, and/or choroid
- Anterior Uveitis
- Inflammation of iris and/or ciliary body
- Types:
- Iritis
- Iridocyclitis
- Posterior uveitis = choroiditis
- Anterior Uveitis
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
- Wegener’s granulomatosis
- Environmental
- Trauma
- Corneal foreign body
- UV keratitis
- Infectious (uncommon)
- TB
- Lyme
- HSV
- Toxo
- VZV
- Syphilis
- Adenovirus
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
- Limbic redness (as opposed to perilimbal sparing seen in conjunctivitis)
- Poorly reactive pupil
Posterior
- Floaters
- Visual changes
- Generally does not cause redness or significant pain
- Blind spots or flashing lights
Work-Up
- Slit-lamp
- Cell (WBCs from uveal vessels) & flare (proteinaceous transudate from uveal vessels)
- Hypopyon (with severe disease)
- CXR (uveitis often associated with sarcoidosis, TB)
DDx
Treatment
- Infectious
- Treat the underlying infection
- Noninfectious
- Anterior Uveitis
- Topical Steroid (anterior only)
- Prednisolone 1%
- Mydriatics (sympathomimetics)
- Prevents the formation of synechiae
- Phenylephrine HCl or Hydroxyamphetamine HBr
- Cycloplegics
- Relieves pain
- Scopolamine 0.25% OR cyclopentolate 1%
- Topical Steroid (anterior only)
- Posterior Uveitis
- Generally not responsive to topical treatment
- Consult ophtho for obs vs intraocular steroid injection
- Anterior Uveitis
Disposition
- Ophtho consult within 24-48hr
Complications
- Cataracts
- Glaucoma (from synechia)
- Retinal detachment
Source
Tintinalli