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INTRODUCTION

The distance from the surface of the eye to the optic nerve is only about 2.5 cm, but within that short distance, an incredible diversity of tissue resides and almost any portion of that tissue can become inflamed. A rheumatologist should have a working knowledge of uveitis, keratitis, scleritis, episcleritis, conjunctivitis, optic neuritis, anterior ischemic optic neuropathy, dry eye, and orbital inflammation because rheumatologic diseases can be associated with inflammation in each of these areas. Moreover, managing a patient with one of these problems may require systemic immunosuppression, a treatment strategy that is beyond the expertise of the vast majority of ophthalmologists. Ocular inflammatory diseases are the third leading cause of blindness worldwide and account for 10% of cases of blindness in the United States. Appropriate management can preserve sight in an organ that is intolerant of inflammation.

UVEITIS

ESSENTIALS OF DIAGNOSIS

  • Uveitis is categorized into anterior, intermediate, and posterior forms. Different systemic disease entities are associated with different forms of uveitis.

  • Panuveitis, the occurrence of anterior, intermediate, and posterior uveitis in the same patient, is particularly characteristic of Behçet disease and sarcoidosis.

  • Management strategies vary according to whether the uveitis is anterior, intermediate, or posterior.

General Considerations

The uvea—the middle layer of the eye—includes the iris, ciliary body, and choroid. Anatomic subsets of uveitis can be defined: anterior uveitis (or iritis); iridocyclitis, when the ciliary body is inflamed along with the iris; intermediate uveitis (inflammation in the vitreous humor); posterior uveitis (involvement of the choroid or retina); and panuveitis, when the iris, vitreous, and retina all show evidence of inflammation. Uveitis can also be classified by etiology (Tables 49–1 and 49–2). A rheumatologist is usually essential for treating inflammation that is confined to the uveal tract or part of a systemic disease involving the uveal tract.

Table 49–1.Causes of uveitis.
Table 49–2.Systemic immunologic diseases commonly associated with uveitis.

Clinical Findings

Anterior uveitis typically presents with symptoms of eye pain, light sensitivity, ocular erythema, and/or blurry vision. On clinical exam, patients will demonstrate cells in the anterior chamber (lymphocytes ...

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