Uveitis

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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  whereby  other  cases  are  due  to  autoimmune  diseases  e.g.  Rheumatoid Arthritis, viral and systemic diseases like Tuberculosis, Leprosy, and Syphilis. 

Clinical presentation 

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
  • Loss of vision
  • Cells in anterior chamber
  • Irregular pupil with synechiae

Investigations

  • Visual acuity
  • Slit lamp bimicroscopic examination anterior chamber
  • Tonometry
  • B scan
  • Urinalysis

Laboratory blood tests for bilateral and granulomatous uveitis: 

  • FBC
  • ESR
  • Antinuclear Antibody
  • VDRL
  • HIV Testing

Imaging: Chest X-Rays if Tuberculosis and Sarcoidosis are suspected

Pharmacological Treatment 

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: 

Steroidal Anti-inflammatory medicines 

D: dexamethasone 1% eye drops, 1–3hourly in the affected eye for 6weeks 

OR

D: prednisolone 0.5% or 1% eye drops, 1–3hourly in the affected eye for 6weeks 

AND 

A: prednisolone (PO) 1mg/kg body weight, given in a tapering manner to maximum of 4–6 weeks

AND 

D: triamcinolone (subtenon) 20mg stat, it can be repeated after 4 weeks if need arises. 

AND 

Pupil dilating eye drops 

B: atropine eye drops or ointment 1% 12hourly in the affected eye 

OR 

C: cyclopentolate 1% eye drops, 1–2drops 8hourly in the affected eye

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

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