Uveitis
| Types of Uveitis | ||
| Common | Infrequent | Rare |
Painful Red Rapid Onset | Painless Rarely Red Gradual Onset | Painless Not Red Gradual Onset |
| Onset age | Any |
| Onset speed | Rapid or gradual |
| Pattern | Single episode or recurrent |
| Duration | Short or long (<3/12) |
| Severity | Mild or severe |
Acute Anterior Uveitis
Sudden onset over a few days
Unknown pathophysiology
>95% non-infectious
| Symptoms | |
| Pain | Increasing over hours |
| Redness | Increasing over hours |
| Mistiness | Increasing over hours |
| Photophobia | Increasing over hours |
| Watery | Maybe |
There will be NO foreign body sensation. If there is then it is NOT uveitis
| Symptoms | |
| Red | Circumcorneal injection 'ciliary blush' |
Cells in the anterior chamber - causes flare | Tyndall effect, light scattering Crucial for diagnosis |
| Fibrin | Plasmoid aqueous |
Synachiae, posterior | Can progress to ~ seclusion pupillae ~ Iris bombé |
| Keratic precipitates | endothelial deposition |
| Hypopyon | |
| Raised intra-ocular pressure (IOP) | associate signs |
| Possible symptoms |
| Photophobia |
| Reduced VA |
| Tearing |
| Lid puffiness |
| Some drooping of the eyelid |
| Usually unilateral, but can be bilateral |
Signs
Most commonly linked to HLA-B27 genotype & ankylosing spondylitis
May be linked to localised infection ie herpes simplex virus
May not be associated with illness or inflammation elsewhere
Immediate Action:
Differencial Diagnosis
Infectious
Inflammatory
Malignancy
Other
Treatment
The mainstay of therapy for AAU is topical drops. These usually include a topical corticosteroid drop such as prednisolone acetate 1% and often a dilating drop such as cyclopentolate. The corticosteroid drop treats the underlying inflammation. The dilating drop reduces pain and helps to prevent the complication of the pupil sticking to the adjacent lens. The frequency of the drops depends primarily on the intensity of the inflammation. Some forms of AAU are associated with an infection such as herpes and will also require therapy directed at the known infectious cause. Other patients may have an illness of other organs that will also impact the treatment recommendations. On occasion AAU is severe enough to warrant treatment by the local injection (shot) of corticosteroid near the eye itself or by oral therapy such as prednisone. Any treatment, including eye drops, may result in adverse effects; these must be balanced with potential benefits in recommending therapies. Complications of inflammation such as an elevated intraocular pressure and cystoid macular edema may also affect treatment choices.
For recurrent or chronic disease and flares that are vision threatening despite local therapy, systemic immunosuppression therapy may be indicated that sometimes requires the expertise of a rheumatologist or uveitis specialist.