uveitis
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Classification
Etiology
- spondyloarthropathies (anterior uveitis)
- sarcoidosis (anterior uveitis & posterior uveitis)
- Behcet syndrome (posterior uveitis)
- juvenile rheumatoid arthritis (Still's disease)*
- Wegener's granulomatosis posterior uveitis
- eye infection
- idiopathic[3]
* not included in MKSAP17[3]
Pathology
- inflammation of the uveal tract (middle structure of the eye), including the iris, ciliary body & choroid
Clinical manifestations
- eye pain may be noted, not severe
- red eye
- visual impairment
- miosis
- may be floaters
- photophobia (key symptom)[5]
- clear cornea[4]
- ciliary flush (dilated conjunctival vessels)
- circumferential redness around border of sclera & cornea (corneal limbus)
- hypopyon
- may be unilateral or bilateral*
- recurrent lacrimal gland enlargement suggests sarcoidosis[7]
* bilateral suspicious for systemic association[5]
Diagnostic procedures
- slit-lamp examination
- inflammatory 'flare' cell in the anterior chamber common
- lacrimal gland biopsy if recurrent uveitis & lacrimal gland enlarged*
Radiology
- chest X-ray or chest CT for suspected sarcoidosis
Differential diagnosis
- scleritis
- eye pain & redness without severe photophobia
- vision variable, often associated with rheumatoid arthritis[7]
Management
- referral to an ophthalmologist[1][3]
- glucocorticoids for noninfectious uveitis[6]
- <=7.5 mg prednisone daily (goal)
- <= 2 drops of prednisolone acetate 1% daily (goal)
- mycophenolate mofetil vs methotrexate steroid-sparing[6]
More general terms
More specific terms
- acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
- anterior uveitis (iritis, iridocyclitis)
- glaucomatocyclitic crisis (Posner-Schlossman Syndrome)
- panuveitis
- pars plantitis; intermediate uveitis
- posterior uveitis (choroiditis)
Additional terms
References
- ↑ 1.0 1.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 69-71
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 16,17,18 American College of Physicians, Philadelphia 2012,2015,2018.
- ↑ 4.0 4.1 NEJM Knowledge+. Question of the Week. Aug 9, 2016 http://knowledgeplus.nejm.org/question-of-week/1519/
- ↑ 5.0 5.1 5.2 Hobbs BN Seeing Red: Five Eye Diagnoses Not to Miss Medscape - Apr 23, 2018. https://www.medscape.com/viewarticle/895295
- ↑ 6.0 6.1 6.2 Jabs DA Antimetabolite Therapy for Uveitis. Methotrexate or Mycophenolate? JAMA Ophthalmol. Published online September 10, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31503274 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2749575
- ↑ 7.0 7.1 7.2 NEJM Knowledge+ Ophthalmology