Uveitis Flashcards
Type of uveitis in JIA
Chronic, predominantly anterior, nongranulomatous inflammation affecting the iris and ciliary body (iridocyclitis) of insidious onset
Anterior Uveitis
Anterior chamber
Includes Iritis, Iridocyclitis, anterior cyclitis
Intermediate Uveitis
Vitreous humor
Pars Planitis, posterior cyclitis, Hyalitis
Posterior Uveitis
Retina or Choroid
Focal, multifocal or diffuse choroiditis
Chorioretinitis, Retinochoroiditis, Retinitis, Neuroretinitis
Risk factors for JIA associated Uveitis
Age of onset (young)
Sex (female)
JIA subtype (Psoriatic, oligo, RF negative poly)
ANA positivity
HLA B27 positivity
*anti histone antibodies were also a significant predictor of uveitis only in girls
Elevated ESR at time of diagnosis
Posterior synechiae
Adhesions between iris and anterior lens capsule capsule
Anterior Synechiae
Adhesions between iris and the cornea
Band Keratopathy
Deposition of calcium in the corneal epithelium as can occur from chronic anterior uveitis in JIA
Iris Bombe
Synechiae that are circumferential prevent free flow of aqueous humor between posterior and anterior chambers, resulting in bulging of the iris and increased intraocular pressure
Sudden, bilateral, anterior uveitis with eye redness and photophobia with renal Disease
Child is typically systemically ill with fever, arthralgia, fatigue and abdominal pain (renal disease manifested by sterile pyuria may be transient
TINU
Common infections causing uveitis
HIV
Bartonella (neuroretinitis characterized by exudates in the retina (macular star))
Lyme disease (anterior and intermediate)
EBV (anterior)
Toxoplasma gondii (pan uveitis)
Toxocara (focal chorioretinitis)
TB (granulomatous uveitis affecting both the anterior and posterior uvea
Defect in Vogt Koyanagi Harada syndrome
Tyrosinase
Clinical features of Vogt- Koyanagi Harada
vitiligo, aseptic meningitis, encephalitis, uveitis, hearing loss, changes in the retinal pigment epithelium, poliosis (patchy loss of pigment of eyelashes, eyebrows or hair ) is a characteristic finding
Clinical features of pars planitis
Blurred vision, visual floaters, macular edema is common
Bilateral
Usually not associated with systemic disease in children, but associated with MS in adulthood
Investigations for all patients with uveitis of uncertain etiology
ANA UA HLA b27 Lyme, Bartonella, Toxacara, Toxoplasma, Syphilis Urine beta 2, BUN, CR, ESR and CBC
Investigations for patients with granulomatous uveitis
Quant or PPD
Chest x ray if suspicious for TB and Sarcoid
Investigations for posterior uveitis
CMV, Herpes, HIV
For focal choroidal lesion, both Toxos
Risk factors for poor prognosis
Male gender
young age at onset of uveitis
Short duration between onset of arthritis and uveitis
presence of synechie
Percentage of uveitis in different JIA subtypes
Oligo 30% RF negative JIA 15% Psoriatic 10% RF positive JIA sJIA ERA less than 1 percent
Most common cause of anterior uveitis
- JIA
Most common cause of intermediate uveitis
- Pars planitis
Most common cause of posterior uveitis
- Infections (TB, CMV, herpes, Varicella, syphilis)
Most common cause of Panuveitis
- Idiopathic followed by VKH, behcets and sarcoid
