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