UVEITIS
Uveitis is usually immunologic but may be due to infection or neoplastic. Uveitis is a ocular inflammatory disease. Intraocular inflammation in uveitis is classified into acute and chronic, into granulomatous or non granulomatous and into anterior or posterior by its distribution involving in eye’s anterior or posterior segment or into panuveitis in which both segments are affected.
The common types are acute non granulomatous anterior uveitis, granulomatous anterior uveitis, and posterior uveitis.
In most cases the pathogenesis of uveitis is primarily immunologic but infection may be the cause, particularly in immunodeficiency states. Chronic non granulomatous anterior uveitis occurs in juvenile idiopathic arthritis. Disease producing granulomatous anterior uveitis also tend to be causes of posterior uveitis. These include sarcoidosis, toxoplasmosis, syphilis, vitiligo, sarcoidosis, tuberculosis and hearing loss that occurs after penetrating ocular trauma.
SYMPTOMS
Anterior uveitis is characterized by inflammatory cells and flare within the aqueous. In severe cases there may be hypopyon ( layered collection of white cells) and fibrin within the anterior chamber. In non granulomatous uveitis the KPs (keratic precipitates ) are smaller and iris nodules are not seen. The pupil is usually small, and with the development of posterior synechiae (adhesions between the iris and anterior lens capsule ) it also becomes irregular. Non granulomatous anterior uveitis tends to present acutely with unilateral pain, redness, photophobia, and visual loss.
In posterior uveitis there are cells in the vitreous. Inflammatory lesions may be present in the retina or choroid. Posterior uveitis tends to present with gradual visual loss in a relatively quiet eye.
TREATMENT
Anterior uveitis usually responds to topical corticosteroids. Occasionally periocular corticosteroid injections or even systemic corticosteroids may be required. Dilation of the pupil is important to relieve discomfort and prevent posterior synechiae. Posterior uveitis more commonly requires systemic, periocular or intravitreal corticosteroid therapy and occasionally systemic immunosuppression with agents such as azathioprine, tacrolimus, cyclosporine, mycophenolate, or methotrexate, of which the last also can be administered by intraocular injection. The use of biologic therapies is increasing. Pupillary dilation is not usually necessary. If an infectious cause is identified, specific antimicrobial therapy may be indicated. In general, the prognosis for anterior uveitis, particularly the non granulomatous type, is better than for posterior uveitis.
For Informational purpose only. Consult your Physician for advice.
