Uveitis

Question 1

Define uveitis

Answer 1

Uveitis is an inflammation of one or all parts of the uvea –iris and ciliary body

Question 2

What are the causes/risk factors of uveitis?

Answer 2

• Idiopathic
• Infectious: HSV, VZV, CMV, HIV, Lyme Disease.
• Non-infectious: A manifestation of inflammatory conditions:
• Seronegative Spondyloarthropathies: AnkSpond, Reactive Arthritis
• IBD
• Sarcoidosis
• Behcet’s disease – AI
• Round worms – toxoplasmosis and toxocariasis – pets (dogs and cats)
• Sympathetic ophthalmia: Inflammation of the contralateral eye weeks/months after penetrating injury (rare)

Question 3

What are the symptoms of uveitis?

Answer 3

• Pain due to inflammation
• Pain during accommodation
• Photophobia
• Red eyes
• Blurred vision
• Lacrimation
• Rarely associated with tubulointerstitial nephritis (causing flank pain, haematuria, proteinuria)
• Bilateral is more common in inflammatory conditions. Unilateral more commonly occurs in idiopathic and infective causes

Question 4

What are the signs of uveitis?

Answer 4

• Reduce visual acuity
• Ciliary flush/red eye
• Hypopyon (exudate and inflammatory cells in the inferior angle of the anterior chamber)
• Small irregular pupil due to adhesions of the iris to the lens
• Slit Lamp - Keratic precipitates (leucocyte deposits on the corneal endothelium) the cells part of cells and flare. The exudate is the flare part causing a form of inflammation on the surface causing an obscuration of the iris
• Fundoscopy to exclude retinal detachment
• Signs of Complications - increased IOP, cataract
• Signs of underlying aetiology

Question 5

What investigations are carried out for uveitis?

Answer 5

• Clinical diagnosis
• An investigation of the underlying infection (if infectious uveitis is suspected) may be warranted, e.g. in Lyme disease or HIV.
• If a patient has no medical history of a systemic inflammatory response, investigations may be considered o diagnose the underlying inflammation:
- CXR for sarcoidosis
- Serum ACE (elevated in sarcoidosis)
- c-ANCA, p-ANCA and other autoantibodies.
- Colonoscopy and biopsy for IBD.
- X-ray for ankylosing spondylitis