Uveitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A nonspecific term used to describe any intraocular inflammatory disorder
  • Symptoms vary depending on depth of involvement and associated conditions.
  • The uvea is the middle layer of the eye between the sclera and retina. The anterior part of the uvea includes the iris and ciliary body. The posterior part of the uvea is the choroid.
    • Anterior uveitis: refers to ocular inflammation limited to the iris (iritis) alone or iris and ciliary body (iridocyclitis)
    • Intermediate uveitis: refers to inflammation of the structures just posterior to the lens (pars planitis or peripheral uveitis)
    • Posterior uveitis: refers to inflammation of the choroid (choroiditis), retina (retinitis), or vitreous near the optic nerve and macula
  • System(s) affected: nervous
  • Synonym(s): iritis; iridocyclitis; choroiditis; retinochoroiditis; chorioretinitis; anterior uveitis; posterior uveitis; pars planitis; panuveitis. Synonyms are anatomic descriptions of the focus of the uveal inflammation.

Geriatric Considerations
The inflammatory response to systemic disease may be suppressed.

Pediatric Considerations
  • Infection should be the primary consideration.
  • Allergies and psychological factors (depression, stress) may serve as a trigger.
  • Trauma is also a common cause in this population.

Pregnancy Considerations
May be of importance in the selection of medications

Epidemiology

  • Predominant age: all ages
  • Predominant sex: male = female, except for human leukocyte antigen B27 (HLA-B27) anterior uveitis: male > female, autoimmune etiology: female > male

Incidence
  • Overall prevalence is 38 to 714 cases/100,000 annual incidence.
  • Anterior uveitis is the most common.

Prevalence
Iritis is 4 times more prevalent than posterior uveitis.

Etiology and Pathophysiology

  • Infectious: may result from viral, bacterial, parasitic, or fungal etiologies
  • Suspected immune-mediated: possible autoimmune or immune-complex–mediated mechanism postulated in association with systemic (especially rheumatologic) disorders
    • Autoimmune uveitis (AIU) patients should be referred to an ophthalmologist for local treatment.
  • Isolated eye disease
  • Idiopathic (~25%)
  • Some medications may cause uveitis. The most causative medications include rifabutin, bisphosphonates, sulfonamides, metipranolol, topical corticosteroids, brimonidine, prostaglandin analogs, anti–vascular endothelial growth factor (VEGF) agents, bacillus Calmette-Guérin (BCG) vaccination, and systemic and intraocular cidofovir.
  • Masquerade syndromes: diseases such as malignancies that may be mistaken for primary inflammation of the eye

Genetics
  • No specific pattern for uveitis in general
  • Iritis: 50–70% are HLA-B27–positive.
  • Predisposing gene for posterior uveitis associated with Behçet disease may include HLA-B51.

Risk Factors

  • No specific risk factors
  • Higher incidence is seen with specific associated conditions.

Commonly Associated Conditions

  • Viral infections: herpes simplex, herpes zoster, HIV, cytomegalovirus, congenital Zika virus
  • Bacterial infections: brucellosis, leprosy, leptospirosis, Lyme disease, propionibacterium infection, syphilis, tuberculosis (TB), Whipple disease
  • Parasitic infections: acanthamebiasis, cysticercosis, onchocerciasis, toxocariasis, toxoplasmosis
  • Fungal infections: aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, sporotrichosis
  • Suspected immune-mediated: ankylosing spondylitis, Behçet disease, Crohn disease, drug or hypersensitivity reaction, interstitial nephritis, juvenile rheumatoid arthritis, Kawasaki disease, multiple sclerosis, psoriatic arthritis, Reiter syndrome, relapsing polychondritis, sarcoidosis, Sjögren syndrome, systemic lupus erythematosus, ulcerative colitis, vasculitis, vitiligo, Vogt-Koyanagi (Harada) syndrome
  • Isolated eye disease: acute multifocal placoid pigmentary epitheliopathy, acute retinal necrosis, birdshot choroidopathy, Fuchs heterochromic cyclitis, glaucomatocyclitic crisis, lens-induced uveitis, multifocal choroiditis, pars planitis, serpiginous choroiditis, sympathetic ophthalmia, trauma
  • Masquerade syndromes: leukemia, lymphoma, retinitis pigmentosa, retinoblastoma

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Citation

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TY - ELEC T1 - Uveitis ID - 116638 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116638/all/Uveitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -