Uveitis

UVEITIS

Inflammation of the uveal tract is called uveitis and can affect the iris, the ciliary body, or the choroid. There are two types of uveitis: nongranulomatous and granulomatous.

The most common type of uveitis is the nongranulomatous type, which manifests as an acute condition with pain, photo-phobia, and a pattern of conjunctival injection, especially around the cornea. The pupil is small or irregular, and vision is blurred. There may be small, fine precipitates on the posterior corneal sur-face and cells in the aqueous humor (ie, cell and flare). If severe, a hypopyon (ie, accumulation of pus in the anterior chamber) may occur. The condition may be unilateral or bilateral and may be recurrent. Repeated attacks of nongranulomatous anterior uveitis can cause anterior synechia (ie, peripheral iris adheres to the cornea and impedes outflow of aqueous humor). The devel-opment of posterior synechia (ie, adherence of the iris and lens) blocks aqueous outflow from the posterior chamber. Secondary glaucoma can result from either anterior or posterior synechia. Cataracts may also occur as a sequela to uveitis.

Granulomatous uveitis can have a more insidious onset and can involve any portion of the uveal tract. It tends to be chronic. Symptoms such as photophobia and pain may be minimal. The keratic precipitate may be large and grayish. Vision is markedly and adversely affected. Conjunctival injection is diffuse, and there may be vitreous clouding. In a severe posterior uveitis, such as chorioretinitis, there may be retinal and choroidal hemorrhages.

Management

Because photophobia is a common complaint, patients should wear dark glasses outdoors. Ciliary spasm and synechia are best avoided through mydriasis; cylopentolate (Cyclogyl) and atropine are commonly used. Local corticosteroid drops, such as Pred Forte 1% and Flarex 0.1%, instilled four to six times a day are also used to decrease inflammation. In very severe cases, systemic corticosteroids, as well as intravitreal corticosteroids, may be used.

If the uveitis is recurrent, a medical workup should be initi-ated to discover any underlying causes. This evaluation should in-clude a physical examination, complete systems review, and diagnostic tests, including a complete blood cell count, erythro-cyte sedimentation rate, antinuclear antibodies (ANA), VDRL, and Lyme disease titer. Underlying causes include toxoplasmosis, herpes zoster virus, ocular candidiasis, histoplasmosis, herpes sim-plex virus, tuberculosis, and syphilis.