Uveitis

Uveitis

This can be anterior (iritis) or, more rarely , posterior. In anterior uveitis, the pupil is sometimes small and/or irregular owing to formation of posterior synechiae (adhesions between the iris and the lens). There is often circumcorneal injection and there may be keratic precipitates present on the posterior surface of the cornea. Pain, photophobia and some visual loss are usually present. Posterior uveitis can present with a white eye and blurred vision. It usually takes a chronic course. Granulomatous diseases, Behçet’s disease, Reiter’s syndrome, toxoplasmosis and cytomegalovirus infection should be excluded. Topical systemic steroids and, sometimes, immuno - suppressive drugs are useful in treating these conditions; management should be under the care of an ophthalmologist.

Figure 49.30 Dendritic staining caused by herpes keratitis.

Episcleritis or inflammation of the episcleral tissue often occurs as an idiopathic condition ( Figure 49.31 ). Scleritis is a less common, more serious, condition in which the deeper sclera is involved. There is often an associated uveitis and severe pain. Thinning of the sclera may result. Systemic non-steroidal anti-inflammatory drugs or steroids/other immunomodula tory agents may be required to treat the condition adequately . Approximately half of patients with scleritis have an under lying systemic disorder. Scleritis is often associated with severe rheumatoid con ditions . The presence of scleritis suggests that there is active systemic disease and this requires systemic work-up, including renal function tests. Uveitis

This can be anterior (iritis) or, more rarely , posterior. In anterior uveitis, the pupil is sometimes small and/or irregular owing to formation of posterior synechiae (adhesions between the iris and the lens). There is often circumcorneal injection and there may be keratic precipitates present on the posterior surface of the cornea. Pain, photophobia and some visual loss are usually present. Posterior uveitis can present with a white eye and blurred vision. It usually takes a chronic course. Granulomatous diseases, Behçet’s disease, Reiter’s syndrome, toxoplasmosis and cytomegalovirus infection should be excluded. Topical systemic steroids and, sometimes, immuno - suppressive drugs are useful in treating these conditions; management should be under the care of an ophthalmologist.

Figure 49.30 Dendritic staining caused by herpes keratitis.

Episcleritis or inflammation of the episcleral tissue often occurs as an idiopathic condition ( Figure 49.31 ). Scleritis is a less common, more serious, condition in which the deeper sclera is involved. There is often an associated uveitis and severe pain. Thinning of the sclera may result. Systemic non-steroidal anti-inflammatory drugs or steroids/other immunomodula tory agents may be required to treat the condition adequately . Approximately half of patients with scleritis have an under lying systemic disorder. Scleritis is often associated with severe rheumatoid con ditions . The presence of scleritis suggests that there is active systemic disease and this requires systemic work-up, including renal function tests. Uveitis

This can be anterior (iritis) or, more rarely , posterior. In anterior uveitis, the pupil is sometimes small and/or irregular owing to formation of posterior synechiae (adhesions between the iris and the lens). There is often circumcorneal injection and there may be keratic precipitates present on the posterior surface of the cornea. Pain, photophobia and some visual loss are usually present. Posterior uveitis can present with a white eye and blurred vision. It usually takes a chronic course. Granulomatous diseases, Behçet’s disease, Reiter’s syndrome, toxoplasmosis and cytomegalovirus infection should be excluded. Topical systemic steroids and, sometimes, immuno - suppressive drugs are useful in treating these conditions; management should be under the care of an ophthalmologist.

Figure 49.30 Dendritic staining caused by herpes keratitis.

Episcleritis or inflammation of the episcleral tissue often occurs as an idiopathic condition ( Figure 49.31 ). Scleritis is a less common, more serious, condition in which the deeper sclera is involved. There is often an associated uveitis and severe pain. Thinning of the sclera may result. Systemic non-steroidal anti-inflammatory drugs or steroids/other immunomodula tory agents may be required to treat the condition adequately . Approximately half of patients with scleritis have an under lying systemic disorder. Scleritis is often associated with severe rheumatoid con ditions . The presence of scleritis suggests that there is active systemic disease and this requires systemic work-up, including renal function tests.