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Uveitis

Background knowledge ๐Ÿง 

Definition

  • Inflammation of the uveal tract (iris, ciliary body, and choroid)
  • Can involve adjacent structures: retina, vitreous, sclera
  • Divided into anterior, intermediate, posterior, and panuveitis based on the site of inflammation

Epidemiology

  • Annual incidence: 15-20 per 100,000 in the UK
  • Most common in people aged 20-50 years
  • Slightly higher prevalence in females
  • Associated with systemic autoimmune diseases

Aetiology and Pathophysiology

  • Idiopathic in 50% of cases
  • Infectious causes: viral (e.g., HSV, CMV), bacterial (e.g., TB, syphilis), fungal, parasitic
  • Autoimmune conditions: ankylosing spondylitis, sarcoidosis, Behรงet’s disease
  • Trauma, malignancy (e.g., lymphoma)
  • Immune response triggers inflammation of the uveal tissues

Types

  • Anterior uveitis (iritis): inflammation of the iris, most common form
  • Intermediate uveitis: inflammation of the ciliary body and vitreous
  • Posterior uveitis: inflammation of the choroid, retina
  • Panuveitis: inflammation of the entire uveal tract

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Eye pain, often described as a deep ache
  • Redness, especially around the limbus (ciliary flush)
  • Photophobia
  • Blurred vision
  • Floaters, particularly in posterior uveitis
  • Decreased visual acuity in severe cases

Signs

  • Ciliary injection
  • Anterior chamber cells (aqueous flare)
  • Keratic precipitates on corneal endothelium
  • Posterior synechiae (iris adhesions to the lens)
  • Vitreous cells in intermediate/posterior uveitis
  • Retinal/choroidal lesions in posterior uveitis

Investigations ๐Ÿงช

Tests

  • Slit-lamp examination: to assess anterior chamber activity
  • Ophthalmoscopy: to detect posterior segment involvement
  • Fluorescein angiography: for retinal vasculitis, choroidal involvement
  • OCT (Optical Coherence Tomography): for macular oedema assessment
  • Blood tests: FBC, ESR, CRP, HLA-B27, syphilis serology
  • Imaging: chest X-ray for sarcoidosis, TB; MRI for CNS involvement

Management ๐Ÿฅผ

Management

  • Topical corticosteroids: first-line for anterior uveitis
  • Mydriatic agents: to prevent synechiae and reduce pain
  • Systemic corticosteroids: for posterior uveitis or severe cases
  • Immunosuppressive agents: methotrexate, azathioprine for chronic cases
  • Antibiotics/antivirals: if infectious cause identified

Complications

  • Cataracts from prolonged corticosteroid use
  • Glaucoma: due to increased intraocular pressure
  • Macular oedema: leading cause of vision loss in uveitis
  • Retinal detachment: from chronic inflammation
  • Vision loss: due to untreated or severe uveitis

Prognosis

  • Generally good with prompt treatment
  • Risk of recurrence, especially in autoimmune-related cases
  • Chronic uveitis may require long-term immunosuppression
  • Early intervention reduces the risk of complications

Key Points

  • Uveitis is an ocular emergency; early diagnosis and management are crucial
  • Consider systemic associations, especially autoimmune diseases
  • Monitor for complications such as glaucoma and cataracts
  • Multidisciplinary approach may be required, involving ophthalmology and rheumatology

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