Uveitis
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Uveitis is the inflammation of the uveal tract, which includes the iris, ciliary body, and choroid. It can be classified as anterior, intermediate and posterior depending on the anatomical location of inflammation.
Aetiology
- Autoimmune diseases: associated with conditions such as ankylosing spondylitis, sarcoidosis, Behçet’s disease, and inflammatory bowel disease.
- Infectious causes: tuberculosis, syphilis, toxoplasmosis, herpes simplex virus, cytomegalovirus.
- Idiopathic: no identifiable cause in a significant number of cases.
- Trauma related: following ocular injury or surgery.
Pathophysiology
- Inflammatory cytokine release leads to disruption of the blood-aqueous or blood-retinal barrier.
- Cellular infiltration causes anterior chamber flare, keratic precipitates, and vitreous haze.
- Chronic inflammation can lead to complications such as glaucoma, cataracts, and macular oedema.
Risk Factors
- History of autoimmune or systemic inflammatory disease.
- Previous ocular trauma or surgery.
- Exposure to infectious agents such as tuberculosis or syphilis.
- Use of immunosuppressive therapy.
Signs and Symptoms
- Anterior uveitis: redness, pain, photophobia, blurred vision.
- Intermediate uveitis: floaters, mild blurred vision, minimal pain.
- Posterior uveitis: visual disturbances, floaters, scotomas.
Investigations
- Slit-lamp examination: identifies anterior chamber inflammation (cells and flare).
- Fundoscopy: evaluates posterior segment involvement.
- Blood tests (not often required): inflammatory markers (ESR, CRP), HLA-B27 typing, syphilis and tuberculosis screening.
Management
1. Medical Management:
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If severe pain refer to same day opthalmologist, otherwise ref to 24hr opthalmology. Uveitis should be managed by them, treatment should not be initiated in primary care.
- Topical corticosteroids: prednisolone eye drops for anterior uveitis.
- Mydriatic agents: atropine 1% or cyclopentolate 1% to relieve pain and prevent synechiae.
- Systemic corticosteroids: for severe or posterior uveitis.
- Immunosuppressive therapy: methotrexate, azathioprine, or biologics in refractory cases.
- Antimicrobials: if an infectious cause is identified.
2. Surgical Management:
- Intravitreal steroid injections for macular oedema.
- Vitrectomy in cases of severe vitreous opacities.
3. Referral:
- Ophthalmology: all suspected cases require urgent ophthalmic assessment.
- Rheumatology: if associated with systemic inflammatory disease.
- Infectious diseases: for cases related to tuberculosis, syphilis, or other infections.