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Photophobia and Anterior Uveitis
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
The diagnosis of anterior uveitis is a clinical one but should systemic conditions such as sarcoidosis or tuberculosis be suspected then additional testing is required. From an emergency ophthalmology perspective only order those blood tests mentioned above, and only then if needed, plus a chest x-ray again if circumstances dictate.
Immunotherapy of Uveitis
Published in George S. Eisenbarth, Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Roberto de Bara, Alan G. Palestine, Robert B. Nussenblatt
Anterior uveitis or iritis refers to inflammation within the anterior chamber of the eye. Patients usually present with a red eye and complain of decreased vision, photophobia, increased lacrimation, and pain. This is the most common form of uveitis encountered by the general ophthalmologist and can occur as an isolated, self-limited event or in conjunction with systemic disease. Individuals with the HLA-B27 phenotype are at an increased risk for developing anterior uveitis.2 Patients suffering from ankylosing spondylitis3 and Reiter’s syndrome,4 where there is a high correlation with the HLA-B27 phenotype, can often present with anterior chamber inflammation. Anterior uveitis responds well to treatment with topical steroids and in severe cases may require the use of periocular steroid injections.
Rheumatology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Clarissa Pilkington, Kiran Nistala, Helen Lachman, Paul Brogan
The pattern is of a lower limb, large joint, asymmetric arthritis (Fig. 17.11). Acute, painful, anterior uveitis occurs, but rarely causes permanent visual loss if treated. Enthesitis (inflammation of ligament and tendon insertions) is typical, often very painful (Fig. 17.12). It affects the Achilles tendon insertion and proximal plantar fascial insertion into the calcaneum; inflammation of patella tendon (quadriceps) insertion also occurs.
Comparison of pediatric patients with idiopathic uveitis, and uveitis due to juvenile idiopathic arthritis and Behçet’s disease
Published in Postgraduate Medicine, 2023
Deniz Gezgin Yıldırım, Murat Hasanreisoğlu, Sevcan A. Bakkaloğlu
Uveitis, inflammation of the uvea comprising the iris, ciliary body, and choroid, can lead to visual loss when left untreated [1]. Uveitis is classified by the layer of the inflammation including anterior uveitis (iris and ciliary body), intermediate uveitis (vitreous), posterior uveitis (choroid and retina), and pan-uveitis (all layers of the uvea) [2]. Uveitis is a rare disease and approximately 10–15% of patients present in the childhood period. The main symptoms of uveitis are pain, redness, excessive tearing, photophobia, and blurred vision. Complications of uveitis are more common in children than those in adults because of the delayed diagnosis due to more insidious course and less self-expression in young children [3]. Topical corticosteroids are the initial treatment in anterior uveitis patients. Systemic corticosteroids and/or disease-modifying anti-rheumatic drugs (DMARDs) are prescribed to patients with posterior segment involvement and who do not get into remission with topical corticosteroids. In recent years, biological therapies have provided a significant benefit for uveitis patients who are unresponsive to traditional therapies [4].
Anterior Segment Inflammation in Pediatric Uveitis Is Associated with Reduced Retinal Vascular Density as Quantified by Optical Coherence Tomography Angiography
Published in Ocular Immunology and Inflammation, 2022
Yi Qu, Chan Zhao, Minghang Pei, Anyi Liang, Fei Gao, Meifen Zhang
All patients underwent a complete ophthalmic examination at each visit, which included measures of the best corrected visual acuity (BCVA), intraocular pressure (IOP) measured using non-contact tonometers, slit-lamp examination, and fundus examination under pupil dilation. A routine work-up, including a complete blood cell count; urinalysis; liver and renal function marker analysis which includes Alanine aminotransferase(ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), total protein (ΤP), albumin(Alb), total bilirubin (ΤBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), serum urea nitrogen (BUN), serum creatinine (Scr), β2-microglobulin (β2-MG) and uric acid (UA); human immunodeficiency virus antibody, hepatitis C virus antibody, rapid plasma reagin, and hepatitis B virus soluble antigen tests; chest X-ray analysis; purified protein derivative test; erythrocyte sedimentation rate analysis; and antinuclear antibody and human leukocyte antigen-B27 tests, were performed at presentation. Patients with definite or suspected posterior segment involvement also underwent fundus fluorescence angiography (FFA), optical coherence tomography (OCT), and B-ultra scan evaluations. Consultations with related specialists, including pediatricians, rheumatologists, dermatologists, hematologists, and neurologists, were sought when an underlying systemic disease was suspected. Patients were diagnosed with idiopathic anterior uveitis if the condition could not be attributed to an infectious agent, an underlying systemic disease, or any specific ocular cause.
Retinal Microcirculation Defects on OCTA Correlate with Active Inflammation and Vision in Vogt–Koyanagi–Harada Disease
Published in Ocular Immunology and Inflammation, 2021
Anyi Liang, Chan Zhao, Shanshan Jia, Fei Gao, Xiaoxu Han, Minghang Pei, Yi Qu, Junyan Xiao, Meifen Zhang
Recurrent anterior uveitis is a major clinical feature of VKH in chronic stage and may lead to substantial visual impairment.4,29-31 We only included cases of anterior uveitis recurrence in this study for better understanding whether clinically quiet posterior segment showed any circulation disturbances. While choroid alterations such as thickening17 and choriocapillary circulation disturbances32-34 were reported to precede anterior chamber inflammation, our study revealed that retinal microcirculation was also involved in anterior uveitis recurrence, as is indicated by significant decrease of SCP and DCP VDs. In addition, patients with a history of anterior uveitis recurrence were found to have lower SCP and DCP VDs, thinner retinal thickness, and worse VA in the convalescent phase. One explanation for this finding is that uveitic relapses in chronic stage, which clinically presented as anterior uveitis, can cause permanent and accumulating damage to the retina. It is also possible, on the other hand, that patients with a history of anterior uveitis attack had more severe ocular inflammation in the acute phase or less well-controlled disease in the chronic phase, which had resulted in more prominent and prolonged damages to the retinal vasculature. Since in our study there was a lack of OCTA images obtained immediately prior to recurrence, further studies are needed to investigate whether anterior uveitis relapses are heralded by changes in SCP and DCP VDs or vice versa.