Makindo Medical Notes

Related Subjects: |Episcleritis |Scleritis |Assessing a Red eye |Acute Angle Closure Glaucoma |Allergic and Infective Conjunctivitis |Anterior and Posterior Uveitis |Atropine Sulfate |Herpes simplex keratitis (HSK) |Acute Blepharitis |Chalazion

🍇 “Uveitis” comes from the Latin word uva, meaning grape. ⚠️ If there is recent intraocular surgery (e.g. cataract or intravitreal injections), always consider endophthalmitis as the cause of pain and photophobia.

📖 About

• 🔴 Inflammation of the uveal tract: iris, ciliary body, and choroid.
• ⚡ Causes include trauma, iatrogenic sources, infection, drugs, systemic autoimmune disease, or idiopathic.
• 👁️ Anterior uveitis often affects young adults and can cause long-term, sight-threatening complications.

📊 Epidemiology

• ~50% of cases are idiopathic.
• Can occur at any age, but peak ~40 years.
• Anterior uveitis = ~90% of cases.

🔎 Types

• Anterior uveitis: Iritis, cyclitis, or iridocyclitis.
• Posterior uveitis: Choroiditis, retinitis, chorioretinitis, or retinal vasculitis.
• Intermediate uveitis: Involves vitreous and peripheral retina.
• Panuveitis: Inflammation of the entire uveal tract.

🧬 Aetiology (50% idiopathic)

• Idiopathic anterior uveitis (often HLA-B27 positive).
• Trauma or ophthalmic surgery.
• Ocular syndromes: Fuchs’ heterochromic cyclitis, Posner–Schlossman syndrome.
• Rheumatology: Ankylosing spondylitis, Psoriatic arthritis, Reactive arthritis, JIA, Behçet’s, PAN, GPA (Wegener’s).
• Infective: HSV, VZV, CMV, TB, syphilis, toxoplasmosis, brucellosis, Lyme, leptospirosis.
• Systemic: Sarcoidosis, MS, Crohn’s, ulcerative colitis, Whipple’s disease.
• Rare: Primary CNS lymphoma.

👁️ Clinical Features

• ⚡ Severe ocular pain, tearing, and photophobia.
• 👁️ Small pupil (miosis) due to iris spasm.
• 🔴 Diffuse redness, often worse at limbus (ciliary flush).
• 🌫️ Cloudy anterior chamber from WBCs/protein (“cells and flare”).
• ⬇️ Visual acuity may be reduced; look for hypopyon.
• 🔍 Posterior synechiae, keratic precipitates, corneal infiltrates may be seen.
• 📏 Always check IOP and corneal staining (exclude keratitis/trauma).

🧪 Investigations

• 🔬 Slit lamp: anterior chamber cells, flare, keratic precipitates (fine = nongranulomatous; “mutton-fat” = granulomatous).
• 🧬 PCR useful in herpetic uveitis/acute retinal necrosis.
• 🩺 Systemic work-up: FBC, ESR/CRP, ANA, HLA-B27, syphilis serology, TB screen, chest X-ray (sarcoid/TB).
• 🖼️ Ocular imaging (OCT, B-scan) for posterior disease.

❓ Differentials

• Endophthalmitis (post-surgery/injection).
• Keratitis (bacterial, viral, chemical burn).
• Acute angle-closure glaucoma.
• Intraocular foreign body.

⚠️ Complications

• Glaucoma (raised IOP).
• Cataracts (from disease or steroid treatment).
• Corneal scarring or band keratopathy.
• Cystoid macular oedema.
• Steroid-related systemic side effects.

💊 Management (Ophthalmology referral essential)

• 📞 Urgent referral if suspected endophthalmitis or corneal involvement.
• 🌿 Idiopathic anterior uveitis:
  • Topical corticosteroids (prednisolone acetate) tapered over 4–6 weeks.
  • Cycloplegics (homatropine 5%, scopolamine 0.25%, or atropine) → relieve spasm & prevent synechiae.
  • Mydriatics (phenylephrine) sometimes used in-office to break synechiae.
• 😎 Sun protection: sunglasses, brimmed hat, dimmed lighting during acute flare.
• 💊 Herpetic anterior uveitis: topical steroids + oral aciclovir 400 mg BD (long-term prophylaxis if recurrent).
• 💉 Severe or posterior uveitis: systemic steroids, immunosuppressants (methotrexate, azathioprine, biologics).

📚 References

• Management and treatment of Uveitis
• Case reports