PEDBASE.org - The Pediatric Database - Detailed information of ANTERIOR UVEITIS

ANTERIOR UVEITIS

DEFINITION:

Inflammation of the anterior segment of the eye (including the iris and ciliary body).

EPIDEMIOLOGY:

incidence: ?
age of onset:
- any
risk factors:
- see below

PATHOGENESIS:

1. Etiology (%)

idiopathic (unknown) - 60%
JRA (pauciaurticular) - 20%
Fuch's heterochromic iridocyclitis (4%)
keratouveitis (HSV, herpes zoster) - 4%
Sarcoid (4%)
Syphillis, TB (4%)
Others - ankylosing spondylitis, trauma, ulcerative colitis, Reiter Syndrome, sympathetic ophthalmia, Kawasaki Disease, N. gonorrhoeae, SLE (4%)

2. Background

also called iritis, iridocyclitis, or cyclitis

CLINICAL FEATURES:

1. Ocular Manifestations

1. Symptoms

lacrimation - red eye
pain - altered visual acuity
photophobia +/- strabismus

2. Signs

ciliary flush
flare and cells in the anterior chamber
keratic precipitates +/- edema
small pupil

3. Complications

band keratopathy - phthisis bulbi (shrinkage of orbit)
cataracts - posterior synechiae
glaucoma

INVESTIGATIONS:

1. Serum

FTA-ABS (syphilis)
ANA
TB skin test

2. Imaging Studies

1. Chest X-Ray

TB, sarcoid

2. Skeletal X-Rays

sacroiliac joint
ankylosing spondylitis

MANAGEMENT:

1. Medical

1. Steroids

topical prednisolone actetate 1% (Diopred)
- able to penetrate the intact corneal epithelium
- mainstay of therapy

2. Cycloplegic-Mydriatic Agents

topical 1% atropine
- used to prevent synechiae formation
topical 5% homatropine
- use after the acute inflammation has subsided

3. Antiviral or Antibiotics

topical trifluridine or vidarabine for HSV

2. Supportive

close follow-up of all patients with pauciarticular JRA q3-6m

Pediatric Database - ANTERIOR UVEITIS

Pediatric Organization - Pedbase [at] Gmail.com