Uveitis

Question 1

Definition of uveitis

Answer 1

Uveitis is inflammation of one or all parts of the uvea or the vascular area between the retina and clear of the eye

Question 2

2 parts of the uvea:

Answer 2

• Anterior uvea:
• Composed of iris and ciliary body
• Posterior uvea:
• Choroid, retina and retinal vasculature

Question 3

Aetiology of uveitis

Answer 3

• Can be divided into idiopathic, infectious and non-infectious causes:
• Infectious:
• Common causes are herpes simplex virus, Varicella zoster virus etc

• Non-infectious:
◦ Can be caused by systemic inflammatory conditions: Seronegative arthropathies, inflammatory bowel disease, autoimmune disease, HLA-B27 associated conditions etc or trauma

• Most cases are IDIOPATHIC

Question 4

Acute vs chronic uveitis:

Answer 4

• Acute uveitis has onset of hours-days and limited duration (3 months)
• Anterior uveitis is the most common form of uveitis

• Chronic uveitis is persistent (more than 3 months) that is characterised by relapse within 3 months of therapy termination

Question 5

Pathophysiology of uveitis

Answer 5

Insults to ocular structures, such as trauma and infection, leads to an inflammatory response within the uvea

Question 6

History and examination of anterior and posterior uveitis:

Answer 6

Anterior uveitis:
• Pain: dull pain in the orbital region, is also progressive
• Eye redness: without discharge
• Photophobia: Sensitivity to light
• Decreased visual acuity
• Lacrimation/tearing
• Flares: hallmark of anterior uveitis. Inflammation and leukocytes in the aqueous humour of the anterior chamber
• Keratic precipitates: lymphocyte aggregates on the corneal endothelium (can see in the anterior chamber)

Posterior uveitis
• Painless
• Decreased visual acuity
• Lacrimation/tearing
• Floaters/flashes

Question 7

Investigations for uveitis

Answer 7

• Clinical diagnosis
• Slit lamp: can see the Keratic precipitates, can see general signs of inflammation of iris (hypopyon, image on right). For posterior uveitis, there would be inflammation of choroid and retina

Question 8

Treatment for uveitis

Answer 8

Non-infectious:
1) Corticosteroid eye drops + Management of any underlying disease: Can give Prednisolone eye drops. Achieves immediate control of inflammation most rapidly and effectively

Infectious:
1) Specialty consultation: needs to be treated urgently as infection is often more aggressive and can lead to permenant blindness. May need antibiotic or antiviral therapy

Question 9

Complications and prognosis of uveitis

Answer 9

• Macular oedema: very common, may need corticosteroids
• Cataracts: as a result of inflammation and corticosteroid treatment, most commonly in anterior uveitis
• Glaucoma
• Synechia: Iris adheres to the cornea, which occurs along with iris inflammation

-Varies depending on aetiology, location etc. 35% had visual loss etc