Uveitis

Question 1

Define uveitis.

Answer 1

Uveitis is inflammation of the uveal tract, which includes the iris, ciliary body and choroid. It is classified according to the part of the uveal tract that the inflammation affects.

Question 2

How common is uveitis? Who is usually affected?

Answer 2

• Usually 30-40yrs
• Ant age, sex, origin
• Anterior uveitis is the most common form (75% of cases)
• Intermediate uveitis is least common

Question 3

What are the different types of uveitis?

Answer 3

• Anterior uveitis - affects anterior uveal tract, including the iris (iritis), or both the iris and the ciliary body (iridocyclitis).
• Intermediate uveitis - affects middle part of the uveal tract or eye mainly vitreous +/- underlying retina
• Posterior uveitis - affects posterior eye e.g. choroid, optic nerve head and retina. Includes chorioretinitis, retinitis and neuroretinitis
• Panuveitis - affect the whole uveal tract

Best practice:

Anterior uveitis involves inflammation of the iris and ciliary body. Intermediate uveitis involves the posterior ciliary body and pars plana. Posterior uveitis involves the posterior vitreous, retina, choroid, retinal vasculature, and optic nerve. Panuveitis involves inflammation in the anterior, intermediate, and posterior segments of the eye.

Question 4

What is the most common type of uveitis?

Answer 4

Anterior uveitis

Question 5

What are the general features of uveitis?

Answer 5

• Blurred vision
• Pain
• Redness
• Photophobia
• Floaters

Symptoms determined by the location of inflammation e.g. photophobia and pain are more common in iritis while floaters in posterior uveitis.

Question 6

What is the triad of symptoms for anterior uveitis (iritis)?

Answer 6

1. Redness
2. Pain
3. Photophobia

Question 7

What are the other signs/symptoms for anterior uveitis?

Answer 7

Vision may be normal or blurred depending on degree of inflammation

Redness throughout of injection localised to the limbus

Anterior chamber features of inflammation: cells, keratic precipitates on corneal endothelium, fibrin or hypopyons (pus) and pupil may adhere to the lens (posterior synechiae)

IOP may be raised due to cells clogging trabecular mesh or due to posterior synechiae causing aq humou to build up behing iris and force iris against trabecular meshwork and so reduce aq drainage.

Question 8

What are the clinical features of intermediate uveitis?

Answer 8

• Painless blurred vision - most commonly associated with floaters
• BOTH eyes are affected

Unusual to experience photophobia/redness

Question 9

What are the signs/symptoms of posterior uveitis?

Answer 9

Painless, blurred vision can progress to severe visual loss

Floaters and scotomata/blind spots in the visual field are common

Question 10

What is the aetiology of anterior/posterior uveitis?

Answer 10

Autoimmune disease - RhA, Behcet’s disease, ankylosing spondylitis, positive HLA-B27, RA, sarcoidosis, psoriasis, IBD (Crohn’s disease and UC)

Infections (rare) - herpes simplex and zoster, toxoplasmosis, cytomegalovirus, syphilis, TB, HIV, Lyme disease

Idiopathic - sometimes no cause is found.

Question 11

What are the risk factors for anterior/posterior uveitis?

Answer 11

• Inflammatory disease of joints, bowel, skin
• HLA-B27 positive
• Ocular trauma
• Age 30-40yrs

Question 12

What investigations would you do for uveitis? What are the results?

Answer 12

Fundoscopy and slit lamp examination

Diagnosis is clinical - often linked to underlying conditions which may require investigation.

If aetiology still undetermined then idiopathic cause diagnosed.

Posterior uveitis is often found with systemic autoimmune diseases or infections; appropriate investigations should be performed and treatment given that is aimed at the cause.

Question 13

Compare and contrast anterior and posterior uveitis (4).

Answer 13

But this is more of a spectrum.

Question 14

What is the uvea?

Answer 14

The vascular area between the retina and the sclera