| Uveitis | |
|---|---|
| Classification and external resources | |
Hypopyon in anterior uveitis, seen as yellowish exudate in lower part of anterior chamber of eye |
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| ICD-10 | H20 |
| ICD-9 | 364 |
| DiseasesDB | 13676 |
| eMedicine | oph/580 emerg/284 |
| MeSH | D014605 |
Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye.
Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.[1] Uveitis requires an urgent referral and thorough examination by an optometrist or ophthalmologist along with urgent treatment to control the inflammation.
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Uveitis may be classified anatomically into anterior, intermediate, posterior and panuveitic forms, based on which part of the eye is primarily affected by the inflammation.
In 2004, a group of international uveitis specialists convened in Baltimore, MD, to standardize the method of reporting data in uveitis clinical trials, including anatomical classification. The results of this meeting were published in the American Journal of Ophthalmology in 2005.[2]
Myriad conditions can be associated with uveitis, including diseases with major extra-ocular involvement, as well as syndromes confined to the eye. In anterior uveitis, no associated condition or syndrome is found in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27. Presence this type of HLA allele has a relative risk of evolving this disease by approximately 15%.[3]
Systemic disorders that can be associated with uveitis include:[4]
Uveitis may be a (normal) immune response to fight an infection inside the eye. While representing the minority of patients with uveitis, such possible infections include:
In many cases, uveitis is not associated with a systemic (i.e. extraocular) condition: the inflammation is confined to the eye. In some of these cases, the presentation in the eye is characteristic of a described syndrome, and include the following diagnoses:
Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:
The prognosis is generally good for those who receive prompt diagnosis and treatment, but serious complication (including cataracts, glaucoma, band keratopathy, retinal edema and permanent vision loss) may result if left untreated. The type of uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all factor in to the outlook.[1]
Uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids. But before administration of corticosteroids, corneal ulcers are ruled out, typically by a Florescence Dye test. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA (posterior subtenon triamcinolone acetate) may also be given to reduce the swelling of the eye. [6]
Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatments with Infliximab or other anti-TNFs' infusions may prove helpful.
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