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By ULY CLINIC

 

Uveitis

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Introduction

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This is Inflammation of the uveal tissue (Iris, choroid and ciliary body) and its adjacent structures. Majority of the cases are idiopathic where by other cases are due to autoimmune diseases e.g Rheumatoid Arthritis, Viral and systemic diseases like Tuberculosis, Leprosy, and Syphilis. 

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Diagnostic Criteria

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It has three main clinical presentations namely acute, chronic and acute on chronic. The commonest form is anterior uveitis. In acute type, patients present with:-

  • Painful red eye

  • Excessive tearing 

  • Severe photophobia 

  • Visual acuity is usually reduced and the pupil is small or it may be irregular due to syneachia

  • Slit lamp biomicroscopic examination reveals cells and keratic precipitates and hypopyon may be seen in the anterior chamber 

 

Investigations

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These are indicated in bilateral and granulomatous uveitis as they may not be helpful in unilateral and non granulomatous.

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Blood tests:

  • FBC

  • ESR

  • Antinuclear Antibody

  • VDRL

  • Urinalysis

  • HIV Testing

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Imaging:

 

Chect X-Rays if Tuberculosis and Sarcoidosis are suspected. 

 

Pharmacological Treatment

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Treatment for uveitis is mainly steroids and specific treatment according to the cause.

This should be initiated in a facility where workup and close monitoring can be done.

 

Give:

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Steroidal Anti-inflammatory medicines

  • Dexamethasone 1% eye drops, 1–3 hourly in the affected eye for 6 weeks

OR 

  • Prednisolone 0.5% or 1 % eye drops, 1–3 hourly in the affected eye for 6 weeks

AND

  • Prednisolone tablets 1mg/kg body weight, given in a tapering manner to maximum of 4–6 weeks    AND

  • Triamcinolone 20 mg subtenon start, it can be repeated after 4 weeks if need arise. 

AND

 

Pupil dilating eye drops

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  • Atropine eye drops or ointment 1% 12 hourly in the affected eye

OR

  •  Cyclopentolate 1 % eye drops, 1–2 drops 8 hourly in the affected eye. 

 

Treatment for uveitis is to be continued for a maximum of 6 weeks 

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Note:

  • Treatment of uveitis must involve various specialists 

  • Acute uveitis is a serious problem and the patient should be referred urgently for specialist treatment 

 

Recurrences may occur or acute disease may end up becoming a chronic uveitis

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Updated on, 2.11.2020

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References

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1. STG 

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