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Uveitis

  • The term Uveitis refers to intraocular inflammation of layers internal to the sclera and cornea, and in particular, the uveal tract (the vascular layer including the choroid, ciliary body and iris) but can also refer to inflammation of the retina and vitreous. 
  • Entities of Anterior, Posterior, Intermediate Uveitis are described and refer to the parts of the eye affected. Anterior uveitis is the most common form of involvement.
  • Uveitis may present without a systemic association (idiopathic) or as part of multi-system disease such as JIA, sarcoidosis or Behcet’s disease. 
  • Uveitis is much less common in children compared to adults.
  • In children, presentation of uveitis may be vague and with little localising features; red or watery eyes are more often due to allergic disease or simply viral infections. Slit lamp examination is often the only way to make the diagnosis.
  • There are variations in the geographic and ethnic distribution of various infectious and non-infectious causes of uveitis. 
  • A review of paediatric uveitis is available
  • Juvenile idiopathic arthritis (JIA) associated anterior uveitis affects approximately 15% of children with JIA in Europe and North America ; the incidence varies in different parts of the world which may reflect referral bias or true differences in incidence. JIA associated uveitis is less frequent in Mediterranean and Middle Eastern countries and is less well reported in India. The incidence varies across the JIA subtypes, with the presence / absence of antinuclear antibody (ANA).
    • Chronic Anterior Uveitis in JIA is often asymptomatic in the early stages but undiagnosed and untreated can lead to visual loss due to cataract and band keratopathy. The highest risk is in young girls with oligoarticular JIA and who are ANA positive. 
    • Acute Anterior Uveitis in JIA in contrast results in a painful, red eye with photophobia and blurring - this form of uveitis associates with HLA-B27 and Enthesitis Related Arthritis. 
  • Behçet’s disease is a more common cause of paediatric uveitis in Turkey whereas this is very rare in European countries, North America and India.
  • Amongst the infectious causes of uveitis toxoplasmosis is most common. Tuberculosis (TB) as a cause of paediatric uveitis must always be considered is areas where TB is endemic.
  • Sarcoidosis is a cause a chronic granulomatous uveitis which is often asymptomatic in the early stages. Blau syndrome is a familial / genetic condition which also causes a chronic granulomatous uveitis, 
  • All patients with suspected JIA should be referred as soon as possible and once JIA is confirmed then regular eye screening in needed. 
  • An ophthalmological assessment is often indicated in children with suspected multisystem disease and the slit lamp examination is helpful in the diagnostic work up.
  • Treatment of uveitis is focused on reducing the inflammation and minimising structural complications to the eye. Long term steroid eye drops are associated with significant sequelae and it is increasingly accepted that early use of systemic immunosuppression in chronic anterior uveitis is required.

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