Uveitis
- Epidemiology & Etiology:
- HLA-B27 diseases: Ankylosing spondylitis (most common), reactive arthritis, psoriatic arthritis, IBD.
- Systemic dz: Sarcoidosis, Behçet dz, JIA (oligoarticular, ANA(+), often asymptomatic/painless).
- Infections: HSV, VZV, CMV, Syphilis, TB, Toxoplasmosis.
- Clinical Features:
- Anterior uveitis: Unilateral eye pain, ciliary flush (circumcorneal injection), consensual photophobia, miotic/sluggish pupil, ± hypopyon.
- Posterior uveitis: Painless, floaters, decreased visual acuity.
- Diagnosis:
- Slit-lamp (Diagnostic): Cells and flare (WBCs/protein) in anterior chamber, keratic precipitates on corneal endothelium.
- Etiology workup: Pelvic/SI-joint X-ray (spondyloarthropathy), CXR (sarcoid/TB), HLA-B27, RPR/treponemal tests.
- Differential Diagnosis:
- Conjunctivitis: Peripheral injection, discharge, normal pupil, no consensual photophobia.
- Acute angle-closure glaucoma: Severe pain/nausea, mid-dilated non-reactive pupil, steamy cornea, IOP > 30 mmHg.
- Keratitis: Corneal infiltrate, (+) fluorescein staining defect (e.g., dendrites in HSV).
- Episcleritis: Localized injection, mild discomfort, blanches with topical phenylephrine.
- Management:
- Immediate: Urgent ophthalmology referral; rule out infection.
- Anterior (Non-infectious):
- 1st-line: Topical corticosteroids (prednisolone) + topical cycloplegics/mydriatics (cyclopentolate/atropine to relieve ciliary spasm and prevent synechiae).
- 2nd-line / Severe: Systemic corticosteroids.
- Refractory: Biologics (anti-TNF like adalimumab) or DMARDs (methotrexate).
- Infectious: Pathogen-specific antimicrobials (e.g., IV penicillin for syphilis).
- Key Complications:
- Posterior synechiae (iris-to-lens adhesion leading to secondary glaucoma).
- Cataracts (secondary to inflammation or chronic steroid use).
- Cystoid macular edema (leading cause of permanent vision loss).