Uveitis: Difference between revisions

| image_size = 200px

| caption = Inflammation of the eye and keratic precipitates due to uveitis

| field = [[Ophthalmology]], [[optometry]]

| symptoms = Headaches, red eyes, blurred vision, photophobia, burning and redness of the eye

| alt =

}}

 

[[File:Blausen 0390 EyeAnatomy Sectional.png|thumb|Anterior eye showing uveal structures (iris, ciliary body, with adjacent choroid which connects them)|alt=Diagram of eye showing uvea]]

 

== Classification ==

 

 

== Causes ==

 

The most common form of uveitis is acute anterior uveitis (AAU). It is most commonly associated with HLA-B27, which has important features: HLA-B27 AAU can be associated with ocular inflammation alone or in association with systemic disease. HLA-B27 AAU has characteristic clinical features including male preponderance, unilateral alternating acute onset, a non-granulomatous appearance, and frequent recurrences, whereas HLA-B27 negative AAU has an equivalent male to female onset, bilateral chronic course, and more frequent granulomatous appearance.<ref name="larson" /> Rheumatoid arthritis is not uncommon in Asian countries as a significant association of uveitis.<ref>{{cite journal |vauthors=Shah IA, Zuberi BF, Sangi SA, Abbasi SA |year=1999 |title=Systemic Manifestations of Iridocyclitis |url=https://www.researchgate.net/publication/8479372 |journal=Pak J Ophthalmol |volume=15 |issue=2 |pages=61–64}}</ref>

* [[Tubulointerstitial nephritis and uveitis syndrome]]

 

 

===Associated with systemic diseases===

*[[Enthesitis]]

*[[Ankylosing spondylitis]]

*[[Vogt–Koyanagi–Harada disease]]

 

*[[Rifabutin]], a derivative of Rifampin, has been shown to cause uveitis.<ref name="cdc">{{cite web |author=CDC: Department of Human Services |date=9 September 1994 |title=Uveitis Associated with Rifabutin Therapy |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00032508.htm |url-status=live |archive-url=https://web.archive.org/web/20111018161249/http://cdc.gov/mmwr/preview/mmwrhtml/00032508.htm |archive-date=18 October 2011 |access-date=5 May 2013 |publisher=Morbidity and Mortality Weekly Report |location=43(35);658}}</ref>

 

Occasionally, uveitis is not associated with a systemic condition: the inflammation is confined to the eye and has unknown cause. In some of these cases, the presentation in the eye is characteristic of a described syndrome, which are called [[white dot syndromes]], and include the following diagnoses:

 

:*[[leukemia]]

:*[[reticulum cell sarcoma]]

 

==Signs and symptoms==

[[File:Ciliary-flush.jpg|thumb|Ciliary flush]]

[[File:Hypopyon.jpg|thumb|[[Hypopyon]] in anterior uveitis, seen as yellowish exudation in lower part of anterior chamber of eye]]

 

 

* Pain in the eye(s)

* Redness of the eye(s)

* Signs of anterior uveitis include dilated [[Ciliary body|ciliary vessel]]s, presence of cells and flare in the anterior chamber, and [[keratic precipitate]]s ("KP") on the posterior surface of the [[cornea]]. In severe inflammation there may be evidence of a [[hypopyon]]. Old episodes of uveitis are identified by pigment deposits on lens, KPs, and festooned pupil on dilation of pupil.

*''Busacca nodules'', inflammatory nodules located on the surface of the [[Iris (anatomy)|iris]] in [[granulomatous]] forms of anterior uveitis such as [[Fuchs heterochromic iridocyclitis]] (FHI).<ref>{{cite journal|title=Uveitis, Anterior, Granulomatous|author1=Abdullah Al-Fawaz|author2=Ralph D Levinson|date=25 Feb 2010|publisher=eMedicine from WebMD|access-date=15 December 2010|url=http://emedicine.medscape.com/article/1209505-overview|url-status=live|archive-url=https://web.archive.org/web/20101204142852/http://emedicine.medscape.com/article/1209505-overview|archive-date=4 December 2010}}</ref>

 

===Intermediate uveitis===

*[[Floaters]], which are dark spots that float in the visual field

* Blurred vision

 

===Posterior uveitis===

==Pathophysiology==

 

 

 

Whether through infection or other causes, this balance can be upset and autoreactive T cells allowed to proliferate and migrate to the eye. Upon entry to the eye, these cells may be returned to an inducible Treg state by the presence of IL-10 and TGF-beta from microglia. Failure of this mechanism leads to [[neutrophil]] and other [[leukocyte]] recruitment from the peripheral blood through [[interleukin 17|IL-17]] secretion. Tissue destruction is mediated by non-specific macrophage activation and the resulting cytokine cascades.<ref>{{cite journal | vauthors = Khera TK, Copland DA, Boldison J, Lait PJ, Szymkowski DE, Dick AD, Nicholson LB | title = Tumour necrosis factor-mediated macrophage activation in the target organ is critical for clinical manifestation of uveitis | journal = Clinical and Experimental Immunology | volume = 168 | issue = 2 | pages = 165–77 | date = May 2012 | pmid = 22471277 | pmc = 3390517 | doi = 10.1111/j.1365-2249.2012.04567.x }}</ref> Serum [[TNF-alpha|TNF-α]] is significantly elevated in cases while [[interleukin 6|IL-6]] and [[interleukin 8|IL-8]] are present in significantly higher quantities in the [[aqueous humour]] in patients with both quiescent and active uveitis.<ref>{{cite journal | vauthors = Valentincic NV, de Groot-Mijnes JD, Kraut A, Korosec P, Hawlina M, Rothova A | title = Intraocular and serum cytokine profiles in patients with intermediate uveitis | journal = Molecular Vision | volume = 17 | pages = 2003–10 | year = 2011 | pmid = 21850175 | pmc = 3154134 }}</ref> These are inflammatory markers that non-specifically activate local macrophages causing tissue damage.

 

===Genetic factors===

 

===Infectious agents===

 

==Diagnosis==

 

Laboratory testing is usually used to diagnose specific underlying diseases, including rheumatologic tests (e.g. antinuclear antibody, rheumatoid factor) and serology for infectious diseases (Syphilis, Toxoplasmosis, Tuberculosis).

<!--

--><ref>[[British National Formulary|BNF]] '''45''' March 2003</ref>

 

[[Antimetabolite]] medications, such as [[methotrexate]] are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatments with [[Infliximab]] or other anti-TNF infusions may prove helpful.

In the case of herpetic uveitis, anti-viral medications, such as [[valaciclovir]] or [[aciclovir]], may be administered to treat the causative viral infection.<ref>{{cite web|url=https://www.inkling.com/read/albert-jakobiecs-principles-practice-ophthalmology-3rd/chapter-49/herpetic-disease-of-the|title=Unsupported Browser|last=Inkling|website=Inkling|access-date=2 May 2018}}</ref>

 

 

 

 

==See also==

|30em}}

 

* {{cite book |last1=Bodaghi |first1=Bahram |last2=LeHoang |first2=Phuc |title=Uvéite |date= 2017 |origyear=2009|publisher=[[Elsevier|Elsevier Health Sciences]] |location=[[Issy-les-Moulineaux|Issy-les-Molineux]], France |isbn=978-2-294-74755-7 |edition=2nd |url=https://books.google.com/books?id=8Eq4DgAAQBAJ |language=fr}}

 

{{Medical resources