What is uveitis?
Inflammation of one or all parts of the uvea (middle vascular layer of the eye, between the retina and sclera)
What are the different types of uveitis?
- Anterior Uveitis (most common) → iris (iritis) and ciliary body. Usually associated with HLA-B27.
- Idiopathic
- Non-Infectious (autoimmune systemic disease) → reactive arthritis, ankylosing sponylitis, inflammatory bowel disease (CD & UC), sarcoidosis, multiple sclerosis - Intermidiate Uveitis → posterior ciliary body and pars plana
- Posterior Uveitis → choroid, retina and retinal vasculature. Usually associated with infections.
- Infectious → herpes simplex virus, varicella zoster virus, HIV, lyme disease, TB - Panuevitis → inlammation in all 3 segments
What are the risk factors for uveitis?
Inflammatory diseases, HLA-B27 positivity, ocular trauma, immunosuppression
Describe the epidemiology of uveitis?
Anterior uveitis represents the most common form in the UK, with peak incidence presenting between ages 20 and 50. The global distribution of uveitis differs according to the prevalence of HLA-B27 positivity.
What causes uveitis?
- Autoimmune diseases:
- Ankylosing spondylitis
- Behçet’s disease (associated with HLA-B27 positivity)
- Juvenile idiopathic arthritis
- Multiple sclerosis
- Systemic lupus erythematosus (SLE)
- Inflammatory bowel disease
- Granulomatosis with polyangiitis
- Reactive arthritis - Other causes:
- Infections (e.g., herpes, tuberculosis, syphilis, HIV)
- Trauma
- Iatrogenic causes (e.g., ocular surgery or medications)
Ischaemic conditions
What are the presenting symptoms of uveitis
- Anterior Uveitis
Symptoms:
- Painful red eye worsening over several days
- Photophobia
- Blurred vision
- Headache
Signs:
- Conjunctival injection
- Hypopyon
- Keratic precipitates
- Posterior synechiae and irregular pupil
- Anterior chamber flare
- Anterior chamber cells - Intermediate Uveitis
Symptoms:
- Often painless
- Floaters
- Blurred vision
- No external signs of inflammation in some cases
Signs:
- Inflammatory cells within the vitreous - Posterior Uveitis
Symptoms:
- Blurred vision
- Progressive vision loss
- Flashes or floaters
Signs:
- Yellow/white appearance of the retina
- Cystoid macular oedema
- Panuveitis
- Patients typically exhibit a combination of all of the above symptoms and signs.
What investigations are used to diagnose/ monitor uveitis?
Thorough examination and investigations are crucial to ascertain underlying disease processes causing inflammation. These may include:
- Complete ocular examination including slit-lamp testing
- Blood tests for autoimmune markers
- Infectious disease screening
How is uveitis managed?
Urgent review by ophthalmology
1. 1st Line → corticosteroid eye drops (prednisolone) = reduce inflammation
2. Cycloplegic Eye Drops (eg. atropine) = dilates the pupil helping to relieve pain and photophobia
3. Antibiotic/Antiviral for posterior uveitis if caused by infection
What complications may arise from uveitis?
cataract, macular oedema, glaucoma, band keratopathy (corneal degeneration), synechiae (adhesions that are formed between adjacent structures within the eye)
Describe the prognosis of uveitis?
Variable and depends upon the aetiology, location, and severity of uveitis. In a large study of uveitis patients, 35% had visual loss of >20/60 in at least one eye, whereas 22% became unilaterally or bilaterally blind.
