Overview

• Inflammation of one or all parts of the uvea (middle vascular layer of the eye, between the retina and sclera)
  • Anterior Uveitis (most common) → iris (iritis) and ciliary body. Usually associated with HLA-B27.
    • Idiopathic
    • Non-Infectious (autoimmune systemic disease) → reactive arthritis, ankylosing sponylitis, inflammatory bowel disease (CD & UC), sarcoidosis, multiple sclerosis
  • Posterior Uveitis → choroid, retina and retinal vasculature. Usually associated with infections.
    • Infectious → herpes simplex virus, varicella zoster virus, HIV, lyme disease, TB
  • Intermidiate Uveitis → posterior ciliary body and pars plana
  • Panuevitis → inlammation in all 3 segments
• Risk Factors ⇒ inflammatory diseases, HLA-B27 positivity, ocular trauma, immunosuppression

Making Diagnosis

Clinical Features:

• Anterior Uveitis → acute onset, progressive dull pain in orbital region, red eye (no discharge), photophobia, decreased visual acuity (blurred), increased lacrimation, hypopyon (accumulation of pus in the anterior chamber, resulting in a visible fluid level), small (constricted) + fixed oval pupil
  • No pain on eye movement (as with scleritis, orbital cellulitis and optic neuritis)
• Posterior Uveitis → painless visual disturbances, floaters, decreased visual acuity (blurred)

Investigations:

• Clinical Diagnosis

Management Plan

Urgent review by opthalmology

• 1st Line → corticosteroid eye drops (prednisolone) ****= reduce inflammation
• Cycloplegic Eye Drops (eg. atropine) = dilates the pupil helping to relieve pain and photophobia
• Antibiotic/Antiviral for posterior uveitis if caused by infection

Complications → cataract, macular oedema, glaucoma, band keratopathy, synechiae