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uveitis

Classification: - anterior uveitis (see anterior uveitis) - posterior uveitis (see posterior uveitis) Etiology: - spondyloarthropathies (anterior uveitis) - ankylosing spondylitis - reactive arthritis - enteropathic arthritis - sarcoidosis (anterior uveitis & posterior uveitis) - Behcet syndrome (posterior uveitis) - juvenile rheumatoid arthritis (Still's disease)* - Wegener's granulomatosis posterior uveitis - eye infection - syphilis - tuberculosis - ocular Herpes simplex [3] - CMV - 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] Special laboratory: - slit-lamp examination - inflammatory 'flare' cell in the anterior chamber common - lacrimal gland biopsy if recurrent uveitis & lacrimal gland enlarged* * sarcoidosis 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]

Related

uveal tract (uvea, tunica vasculosa bulbi, Haller's tunica vasculosa)

Specific

acute posterior multifocal placoid pigment epitheliopathy (APMPPE) anterior uveitis (iritis, iridocyclitis) glaucomatocyclitic crisis (Posner-Schlossman Syndrome) panuveitis pars plantitis; intermediate uveitis posterior uveitis (choroiditis)

General

uveal disease eye infection (ocular inflammation including eyelid inflammation)

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 69-71
  3. Medical Knowledge Self Assessment Program (MKSAP) 16,17,18 American College of Physicians, Philadelphia 2012,2015,2018.
  4. NEJM Knowledge+. Question of the Week. Aug 9, 2016 http://knowledgeplus.nejm.org/question-of-week/1519/
  5. Hobbs BN Seeing Red: Five Eye Diagnoses Not to Miss Medscape - Apr 23, 2018. https://www.medscape.com/viewarticle/895295
  6. Jabs DA Antimetabolite Therapy for Uveitis. Methotrexate or Mycophenolate? JAMA Ophthalmol. Published online September 10, 2019. PMID: 31503274 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2749575
  7. NEJM Knowledge+ Ophthalmology