Uveitis In Kids Flashcards
Treatment for chalazion
Compresses
Tobradex (abx/steroid combo)
Leukocoria
- White pupil
- Seen in infancy and early childhood
- strab and/or nystagmus can be present (mainly sensory)
- difference in eye size-bupthalmos, microphthalmos
- there could also be increase IOP, cataract, or tumor
- decreased vision
- may have ab APD
Differentials for leukocoria
- cataracts
- retinoblastoma
- ROP/PHPV
- coats
- toxoccariasis
- toxoplasmosis
- myelinated nerve fiber
- coloboma
- RD
Eval for leukocoria
- complete evaluation-history, pupils, IOP, AC, lens, retinoscopy, vitreous, fundus eval
- B scan
- radiology
Treatment for leukocoria
Treat underlying problem
Prognosis of leukocoria
Poor to guarded prognosis (depending on the cause)
Phthisis bulbi
- function has decompensated
- eye shrinks after trauam, surgical truama, loss if function
- soft, low IOP
- intraocular disorganization
- B scan to rule out growths
- non painful blind eye
- enucleation, if it becomes a painful blind eye
Uveitis in chidlren
- more in females
- just like in adutls
- 62% are Caucasian
- major etiologies: idiopathic and juvenile idiopathic arthritis
Classifications of uveitis
Based on
- anatomical location (anterior, intermediate, posterior, or panuveiits)
- pathology (granulomatous or non granulomatous)
- course (acute, chronic, or recurrent)
- etiology (traumatic, immunologic, infectious, or idiopathic)
Differentials for anterior uveitis
JRA Trauma Sarcoidosis TB Syphilis Lyme Herpes Fuchs heterochromia Iridocyclitis Kawasaki disease Idiopathic anteiror uveitis
Intermediate uveitis DiffDx
Sarcoidosis TB Syphilis Lyme MS Idiopathic intermediate uveitis
Post uveitis and panuveitis diffdx
Toxoplasmosis Toxocariasis Sarcoidosis TB Syphilis Lyme Here Rubella or measles Candida albicans VKH Idiopathic
Juvenile idiopathic arthritis (JRA)
- anterior uveitis
- arteritis of at least 6 weeks without identifiable cause in chidlren < 16
- most common cause of anterior uveitis in chidlren
- risk of uveitis greater in the 1st 4 years after JRA diagnosis
- can be seen before or after joint symptoms
- more aggressive course if the interval between the arthritis and uveitis is short
- run antinuclear antibody lab (ANA)
Characteristics of anterior uveitis from JRA
- usually bilateral
- non-granulomatous with fine to medium KPs
- granulomatous precipitates can be seen in some kids
- chronic inflammation can lead to: band K, postieror synechiae, hypotony, cataract, glaucoma
- important for uveitis screening for children with JRA, especially in the 1st 4 years diagnosis. With with PCP on this
Intermediate uveitis in kids
-inflammation at the vitreous base over the CB, pars plana, anterior vitreous and peripheral retina
can occur with any of these disorder
- sarcoidosis
- TB
- Syphilis
- Lyme
- MS
- Idiopathic (pars planitis)
Snow banking
Vitreous cells
Toxoplasmosis
- posterior uveitis
- caused by toxoplasma Gondi
- cats are host
- cat feces can be ingested by animals and humans
- congenital or acquired from eating undercooked infected meat or contaminated water
- predilection for heart muscle, neural tissue and the retina
- reunion ELISA
Characteristics of toxoplasmosis
- remains dormant until cyst erupts
- systemic infection present as fever, lymphadenopathy, sore throat
- can also be congential via transplacental transmission
- once of the TORCH congenital infections
TORCH congential infections
Toxoplasmosis
Rubella
CMV
Herpes
Signs and symptoms of toxoplasmosis
- manifests as retinitis, choroiditis, iritis
- the active area of retinal inflammation is thickened and cream colored with overlying vitritis in the macualr scar
- Atrophic chorioretinal scar (satellite lesion)
- Dx based on the characteristic retinal lesion
- inflammation can come from reactivated toxoplasmosis
- systemic treatment includes antimicrobals with or without oral steroids
- vision can be compromised based on where the lesion is
Toxocariasis
- posterior uveitis
- nematodes in dogs and cats
- primarily in kids
- contracted though ingestion of soil contaminated by dogs and cats
- usually unilateral and not associated with systemic problems
- average age of onset is 11
- could appear as post pole granuloma, peripheral granuloma or endophthalmitis
- run ELISA
Appearance of toxocaraisis
- no external evidence of inflammation
- leukocoria, strab, or decreased VA present
- treatment by observing the peripheral lesion
- periocular or systemi steroids for the posterior lesions and endophthalmitis
- or surgical intervention for retinal traction, cataract, glaucoma
- parasite already dead so no anti parasitic
Sarcoidosis
- panuveitis
- if in kids under 5, there is a triad of uveitis, arthritis, and each
- in older kids, there ar pulmonary abnormalities and lymph node abnormalities (as seen in adutls)
- anterior uveitis is the most common but there can be panuveitis
- diagnosis and treatemtn is simialr to adults-ACE and chest X ray
- ACE in healthy kids higher than in adutls so can be misleading so careful systemic diagnosis
Masquerades of uveitis
Retinoblastoma Leukemia Intraocular FB Malignant melanoma RD
How to tell RB from anteiror uveitis
Ultrasound, MRI
How to tell leukemia from anterior uveitis
Bone marrow biopsy
How t tell FB from anteiror uveitis
X- ray or ultrasound
How to tell malignant melanoma from anteiror uveitis
FA, ultrasound
How to tell RD from anterior uveitis
Fundus eval
Masquerades of posterior uveitis in kids
RP
RB
MS
How to tell RP from posterior uveitis
ERG, VF
How to tell RB from posterior uveitis
Ultrasound, MRI
How to tell MS from posterior uveitis
Neuro exam
Evaluation of uveitis
- can defer workup of isolated anteiror uveitis until unresponsive or recurrent
- need detiualed history, throughout eval, and labs
Labs for JRA
ANA
Labs for sarcoidosis
ACE
chest x ray
TB labs
TB skin test, chest x ray
Labs for syphilis
FTA-ABS
Lyme labs
Lyme serology
Herpes labs
Presentation
Fuchs heterochromia iridocytltis labs
Presentation
Toxoplasmosis and toxocariases labs
ELISA
Ankylosing spondylitis labs
H:A B27
Uveitis managements
- eliminate inflammation before complications
- anterior: topical corticosteroids and cycloplegic agents
- sub-tenon steroid injections can be used to improve penetration for intermediate or postieror
- pred forte every 2 hours then taper, atropine 1% BID
- RTO frequently for IOP check (watch for steroid responders)
- short course of oral steroids. Caution with use
- glaucoma and cataracts are complications after oral steroids
- risk of systemic steroids include, growth retardation, osteoporosis and fractures, DM, HTN, diopathic intracranial HTN (pseudotumor)
- NSAIDs, be careful of GI probs
- systemic immunosuppressive therapy
- methotrexate
Surgeries for uveitis
Chidlren may need surgeries for uveitis complications
Indicated for
- band K
- cataracts
- glaucoma
