Inflammatory eye disorders
Uveitis
Uveitis is inflammation of the eye. It can be acute (sudden onset) or chronic (slow onset and persistent). There are four main types -:
- Anterior uveitis, affecting the front of the eye (anterior chamber).
- Intermediate uveitis, affecting the middle of the eye (vitreous and peripheral retina).
- Posterior uveitis, affecting the back of the eye (choroid and retina).
- Panuveitis, affecting the whole eye.
In children with Juvenile Immune Arthritis (Juvenile Idiopathic Arthritis (JIA) the uveitis may be silent (i.e. without symptoms or signs). A recommended national screening programme is in place for children with JIA.
Anterior uveitis and intermediate uveitis are the most common inflammatory disorders in children.
Acute anterior uveitis
This may be associated with a number of conditions including Ankylosing Spondylitis (an inflammatory condition affecting the spine), Reiter’s disease (an inflammatory condition affecting the joints and urethra), Kawasaki disease (an inflammatory condition that may cause coronary artery aneurysms) and acute viral infections. It may be asymptomatic (without symptoms) or may present as a painful red eye. The mainstay of treatment is steroid eye drops and treatment of the underlying condition. The condition usually settles quickly and the prognosis for visual acuity is usually good.
Intermediate uveitis
This usually occurs in young adults but may occur in childhood. It may be associated with a number of conditions such as infections and the severity of the condition varies widely. It may be asymptomatic in the early stages but the child usually presents with red, painful eyes, mild blurring of vision and sensitivity to light. Complications include cataract, vitreous haemorrhage and retinal detachment. Treatment usually involves use of steroid eye drops and other anti-inflammatory medication. The visual prognosis is usually fairly good.
Chronic anterior uveitis
This may be may be associated with a number of conditions including juvenile rheumatoid arthritis, infections and ulcerative colitis, but in the majority of children there is no obvious underlying cause. It may be unilateral or bilateral, and is frequently asymptomatic. However, it can cause secondary glaucoma or cataract formation. The mainstay of treatment is steroid eye drops and eye drops to dilate the pupil, monitoring and treatment of complications and management of the underlying condition, but may involve the use of more potent anti-inflammatory drugs or systemic steroids. The prognosis for visual acuity depends upon the severity of the inflammation and duration of the uveitis and ranges from good to poor.
Posterior uveitis
Posterior uveitis is usually caused by an underlying infection. The majority are due to toxoplasmosis and toxicariasis (parasitic infections transmitted by cats and dogs). There are a number of treatment options and visual prognosis varies.
Panuveitis
Panuveitis may result from Behcet’s disease (a multisystem disorder associated with oral and genital ulceration), endogenous endophthalmitis (infection spreads to the eye from somewhere else in the body via the bloodstream) and sympathetic ophthalmia (a bilateral panuveitis that follows a penetrating injury to one eye). Treatment varies according to the underlying cause and the visual prognosis varies widely.
A number of other conditions, for example retinoblastoma (the commonest intraocular tumour in children), leukaemia, retinal detachment and intraocular foreign body may be associated with intraocular inflammation.
Prognosis: The visual prognosis for these conditions also varies widely.
