uveitis

Question 1

Define uveitis

Answer 1

Conditions that cause inflammation of the uveal tract, including the iris, ciliary body, and choroid

Question 2

Types of uveitis

Answer 2

Anterior uveitis: anterior segment:
- Iritis
- Iridocyclitis
- Anterior cyclitis
Intermediate uveitis: vitreous (pars planitis, posterior cyclitis, hyalitis)
Posterior uveitis: retina or choroid
Panuveitis: anterior chamber, vitreous, retina, choroid

Question 3

Aetiology of uveitis

Answer 3

Autoimmune diseases (HLA-B27):
- Ankylosing spondylitis
- Reactive arthritis
- Inflammatory bowel disease
- Behçet’s disease (associated with HLA-B27 positivity)
- Sarcoidosis
- Juvenile idiopathic arthritis
- Multiple sclerosis
- Systemic lupus erythematosus (SLE)
- Granulomatosis with polyangiitis

Other causes:
- Infections (e.g., HSV, CMV, tuberculosis, syphilis, HIV)
- Trauma
- Iatrogenic causes (e.g., ocular surgery or medications)
- Ischaemic conditions

Question 4

Symptoms and signs of anterior uveitis

Answer 4

Acute onset:
Eye pain and discomfort
Red eye
Blurred vision
Intense photophobia
Lacrimation

Miosis ± irregular pupil (sphincter muscle contraction)
Red eye
Lacrimation
Ciliary flush: ring of red spread outwards
Hypopyon: pus and inflammatory cells in the anterior chamber resulting in a visible fluid level
Visual acuity normal then impaired

Question 5

Symptoms and signs of intermediate uveitis

Answer 5

Often painless
Floaters
Blurred vision
No external signs of inflammation in some cases

inflammatory cells within the vitreous

Question 6

Symptoms and signs of posterior uveitis

Answer 6

Blurred vision
Progressive vision loss
Flashes or floaters

Yellow/white appearance of the retina
Cystoid macular oedema

Question 7

Differentials for uveitis

Answer 7

Acute closed-angle glaucoma
Conjunctivitis
Keratitis
Scleritis

Question 8

Investigations for uveitis

Answer 8

Slit lamp testing
Sample for culture

Autoimmune markers
Serology

Question 9

Management for uveitis

Answer 9

Urgent ophthalmology review

Acute
Cycloplegic mydriatic drops e.g. cyclopentolate
- Iris dilates → prevents posterior synechiae
Corticosteroids (topical/PO/IV/IM)
- Hourly regiment then tapered off
Analgesia
Antimicrobials

Chronic
Steroid-sparing agents e.g. methotrexate, mycophenolate
Biologic therapies targeting specific elements of the inflammatory cascade, such as adalimumab.

Question 10

Complications of uveitis

Answer 10

Vision loss: Cystoid macular oedema, secondary cataract, secondary glaucoma
Visual impairment
Band keratopathy (calcium deposits in the cornea)
Cataracts
Glaucoma
Cystoid macular oedema
Posterior synechiae (adhesions between the posterior iris and anterior lens surface0
Hypotony (low intraocular pressure)
Macular cyst/hole, macular puckering or macular ischaemia
Retinal detachment
Choroidal/retinal neovascularisation
Optic neuropathy/optic atrophy
Vitreous opacities and vitreous haemorrhage.
Phthisis (shrinkage of the globe).

Question 11

prognosis for uveitis

Answer 11

Prognosis varies with the underlying aetiology, but often uveitis is self-limiting
With early intervention, treatment outcomes are generally favourable, recovering normal vision in 90% of patients; however, relapse occurs in two-thirds of cases
Bilateral uveitis is associated with chronic, systemic conditions, whereas unilateral conditions tend to be acute and idiopathic or infectious.
Non-infectious intermediate, posterior and panuveitis have a poorer prognosis with greater morbidity and a higher prevalence of irreversible sight-threatening pathologic features.