Uveitis is a broad term for inflammation of one or all parts of the uvea, or the vascular area between the retina and sclera of the eye. Anterior uveitis involves inflammation of the iris and ciliary body. Intermediate uveitis involves the posterior ciliary body and pars plana. Posterior uveitis involves the posterior vitreous, retina, choroid, retinal vasculature, and optic nerve. Panuveitis involves inflammation in the anterior, intermediate, and posterior segments of the eye.
Uveitis can be acute, recurrent, or chronic. Acute uveitis is characterised by sudden onset (over hours or days) and limited duration (≤3 months' duration). In recurrent uveitis, there are repeated episodes separated by disease inactivity ≥3 months, whether on or off treatment. Chronic uveitis is defined as persistent uveitis (>3 months' duration) characterised by relapse within 3 months of therapy termination.
All types of uveitis are potentially blinding conditions and should be referred to and managed by an experienced ophthalmologist.
Diagnosis is clinical. Acute anterior uveitis may be idiopathic, or associated with human leukocyte antigen-B27-related disease or viral eye disease. Posterior uveitis is associated with localised infections or systemic infection, or systemic inflammatory disease. Onset and duration of the ocular symptoms offer clues to the aetiology. Diagnosis of underlying disease may require investigation. In the clinical setting of multiple recurrences or strong suspicion based on history and review of systems, a targeted work-up should be undertaken to rule out an underlying infectious cause or co-existent autoimmune disease. Rarely, uveitis can be caused by a previous eye injury or underlying neoplasm.
Even after full laboratory and diagnostic work-up and treatment, aetiology may not be determined.
Treatment for systemic disease causing uveitis must be given in conjunction with uveitis therapy.
Topical corticosteroids are usually adequate for acute non-infectious anterior uveitis, but intermediate and posterior uveitis usually requires injected local corticosteroids or systemic corticosteroids, or other immunosuppression.
Uveitis is an inflammation of one or all parts of the uvea, or the vascular area between the retina and sclera of the eye. The anterior uvea is composed of the iris and ciliary body; an irritation of this segment, or anterior uveitis, leads to acute painful symptoms and photophobia. Inflammation of the posterior uvea, including the choroid, retina, and retinal vasculature, carries a risk of painless visual loss. Uveitis of all types affects children and adults, and the aetiology is most commonly idiopathic.
History and exam
Key diagnostic factors
- presence of risk factors
- pain (anterior uveitis)
- decreased vision
- keratic precipitates
Other diagnostic factors
- eye redness without discharge
- constricted or non-reactive pupil
- decreased intra-ocular pressure
- retinal exudates and oedema, optic nerve oedema
- retinal vascular sheathing
- macular oedema
- optic disc swelling
- retinal haemorrhages
- ciliary flush
- corneal oedema
- inflammatory diseases of the joints, bowel, or skin
- human leukocyte antigen (HLA)-B27 positive
- ocular trauma
- age 30 to 40 years
1st investigations to order
- clinical diagnosis
Investigations to consider
- erythrocyte sedimentation rate
- fluorescent treponemal antibody (FTA-ABS), Venereal Disease Research Laboratory (VDRL), and rapid plasma reagin (RPR)
- serum ACE
- antinuclear antibodies
- Lyme titre
- purified protein derivative (PPD) skin test
- cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)
- perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)
- C3 and C4
- antidouble-stranded DNA antibody (anti-dsDNA)
- rheumatoid factor
- anticyclic citrullinated peptide (anti-CCP) antibodies
- Bartonella henselae titre
- toxoplasma serological titre
- other HLA antigens
- chemistry screen
- polymerase chain reaction (PCR)
- vitreous biopsy
non-infectious, initial presentation: not pregnant
non-infectious, initial presentation: pregnant
non-infectious, after immediate control of inflammation: not pregnant
non-infectious, after immediate control of inflammation: pregnant
- Ocular lymphoma
- Intra-ocular solid tumours
- Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis
- 2019 American College of Rheumatology/Arthritis Foundation guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis
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