Uveitis @ INTRODUCTION = 271 Classification 271 Clinical features 274 @ TREATMENT 276 Mydriatics 276 Steroids 276 Immunosuppressive agents 278 © UVEITIS IN SPONDYLARTHROPATHIES — 278 Ankylosing spondylitis 278 Reiter syndrome 278 Psoriatic arthritis 279 © UVEITIS IN JUVENILE ARTHRITIS 279 Juvenile idiopathic arthritis 279 Other types of juvenile arthritis and uveitis 280 © UVEITIS IN INFLAMMATORY BOWEL DISEASE 280 Ulcerative colitis 280 Crohn disease 280 Whipple disease 280 @ UVEITIS IN NEPHRITIS 280 Tubulointerstitial nephritis 280 IgA glomerulonephritis 281 © UVEITIS IN NON-INFECTIOUS MULTI-SYSTEM DISEASES — 281 Sarcoidosis 281 Behcet disease 284 Vogt-Koyanagi-Harada syndrome 286 © VIRAL UVEITIS 287 Herpes zoster 287 Cytomegalovirus retinitis 288 Progressive outer retinal necrosis. 290 ‘Acute retinal necrosis 291 Congenital rubella 292 @ PARASITIC UVEITIS 293 Toxoplasma retinitis 293 Toxocariasis 296 Choroidal pneumocystosis 297 @ FUNGAL UVEITIS 298 Histoplasmosis 298 Candidiasis 300 Cryptococeal choroiditis 301 @ MYCOBACTERIAL UVEITIS 301 Tuberculosis 301 Leprosy 302 @ SPIROCHAETAL UVEITIS 303 Acquired syphilis 303 Lyme disease 304 © COMMON SPECIFIC UVEITIS ENTITIES 304 Fuchs uveitis syndrome 304 Intermediate uveitis 306 Juvenile chronic iridocycltis 308 ‘Acute anterior uveitis in young adults 308 © IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES 308 ‘Acute multifocal posterior placoid pigment epitheliopathy 308 Serpiginous choroidopathy 308 Birdshot retinochoroidopathy 310 Punctate inner choroidopathy 312 Muleifocal choroiditis with panuveitis 312 Multiple evanescent white dot syndrome 315 Acute retinal pigment epithelitis 316Introduction Classification Theis. by strict definition, is tract, However, the term i n inflammation of the uveal now used {o describe many forms ‘of intraocular inflammation involving not only the uvea, but Aisoadjacent structures. Uveitis may be classified on the basis {1 a) anatomy, (b) clinical features and (c) aetiology, atomical classification (tig, 10.1) Anterior uveitis may be subdivided into: brits, n which inflammation predominantly affects the Ae Iridocyctitis. in which both theirs and the anterior part af the eliary body (pars picata) are equally involved. Intermediate uveitis is characterized by involvement predominantly of the posterior part of the ciliary body {pars plana), the extreme periphery of the retina and the Underlying choroid. Posterior uveitis involves inflammation of the choroid fan retina posterior to the vitreous base. veitis implies involwement of the e uveal tract. “Anterior uveitis is the most common type, followed! mediate, posterior and panuveltis I classification ling o the mode of onset and duratio orchronic. uveitis may be uveitis usually has a sudden, symptomatic onset and for up to 3 months. If the inflammation recurs the initial attack, it isrelerred tos recurrent acute, ie uveitis persists for longer than 3 months. The js frequently insidious and may be asymptomatic mugh acute or subacute exacerbations may occur, Intermediate ‘Antic Aetiological classification Exogenous uveitis is caused by external injury to the uvea or invasion by micro-organisms (or other agents) from without Endogenous uveitis is caused by micro-organisms (or other agents) from within the patient, The following are the main types: iated with a systemic disease (c.g, sarcoidosis) ns with bacteria (e.g. tuberculosis), fungi (e.g candidiasis} and viruses (e.g. herpes zoster) 3. Infestations with protozoa (e.g. toxoplasmosis) or nematodes (e.g. toxocariasis) 4. Idiopathic specific uveitis entities are a group of unrelated disorders unassociated with underlying. sys- temic disease but with special characteristics of their own warranting independent description (e.g, Fuchs uveitis syndrome). 5. Idiopathic non-specific uveitis entities which do not fall into any of the above categories consititute about 25% of cases. Clinical features Anterior uveitis Symptoms |. Acute anterior uveitis is characterized by photophobia, pain, redness, decreased vision and lacrimation, 2. Chronic anterior uveitis may be asymptomatic or give rise to mild redness and the perception of floaters. Signs 1. Circumcorneal (ciliary) injection in acute anterior uveitis has a violaceous hue (Fig. 10.2, 2. Keratic precipitates (KP) are celular deposits on the coneal endothelium. Their characteristics and distribution indicate the probable type of uveitis. KP most Clary injection in acute anterior uveitisClinical Ophthalmology ‘ommonly form in the mid and inferior zones of the cor nea, due to convection currents in the anterior chamber. However, in Fuchs uveitis syndrome, they are scattered throughout the endothelium. a. Endothelial dusting by myriads of cells occurs in acute ing subacute exacer- anterior uveitis, as well as di bations of chronie inflammation (F b, Medium-size KP occur in most types of acute a chronic anterior uveitis (Pig. 10.4), ¢. Large KP ure usually of the ‘mutton fat’ variety, with @ greasy, waxy appearance, typically occurring in anulomatous uveitis (Fig. 10.5 d. Old KP are pigmented (Fig. 10.6) and, if large, may develop a ‘ground-glass’ (hyalinized) appearance (Eig. 10.7), 3. Cells are indicative of active inflammation. a. Aqueous cells are graded according to the number observed in a wide, with may in oblique slit beam, 3 mm long and 1 mm al light intensity and magnification, cells = +) © 5-10cells = +1 Fig. 10.3, Endothelial dusting in acute anterior uveitis Fig. 10.4 Medium-size keratic precipitates © 50 cells = +4 hypopyon (Fig. 10.8) Fig. 10.5 Mutton fat keratic precipitates (Old pigmented keratic precipitates Fig. 10.7 (Old ‘ground-glass’ keratic precipitates