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For further information, see CMDT Part 7-12: Uveitis
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Essentials of Diagnosis
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Usually immunologic but possibly infective or neoplastic
Inflammation may be confined to the eye or may be systemic
Acute anterior uveitis: sudden redness and blurry vision, often with photophobia
Posterior uveitis: gradual loss of vision, commonly with floaters (moving spots or strands like cobwebs in the visual field), in a variably inflamed eye
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General Considerations
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Systemic disorders associated with acute nongranulomatous anterior uveitis include
Ankylosing spondylitis
Reactive arthritis
Psoriasis
Ulcerative colitis
Crohn disease
Chronic nongranulomatous anterior uveitis occurs in juvenile idiopathic arthritis
Behçet syndrome produces
Anterior uveitis, with recurrent hypopyon
Posterior uveitis, characteristically with branch retinal vein occlusions
Both herpes simplex and herpes zoster infections may cause nongranulomatous anterior uveitis as well as retinitis
Diseases that produce granulomatous anterior uveitis also tend to be causes of posterior uveitis and include
In toxoplasmosis, there may be evidence of previous episodes of retinochoroiditis
In HIV infection, principal pathogens responsible for ocular inflammation are
Retinal vasculitis and intermediate uveitis
Predominantly manifest as posterior uveitis with central or peripheral retinal abnormalities in retinal vasculitis and far peripheral retinal abnormalities (pars planitis) in intermediate uveitis
Retinal vasculitis can be caused by a wide variety of infectious agents and noninfectious systemic conditions but also may be idiopathic
Intermediate uveitis is often idiopathic but can be due to multiple sclerosis or sarcoidosis
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Anterior uveitis
Characterized by inflammatory cells and flare within the aqueous humor
In severe cases, there may be hypopyon and fibrin within the anterior chamber
Cells may also be seen on the corneal endothelium as keratic precipitates
In granulomatous uveitis, the keratic precipitates are large, and iris nodules may be seen
In nongranulomatous uveitis,
The keratic precipitates are smaller or absent with no iris nodules
The pupil is usually small, and with the development of posterior synechiae, it also becomes irregular
Nongranulomatous anterior uveitis tends to present acutely with unilateral pain, redness, photophobia, and visual loss
In juvenile idiopathic arthritis, there tends to be an indolent, often initially asymptomatic, process with a high risk of sight-threatening complications
Granulomatous anterior uveitis is more frequently indolent, causing blurred vision in a variably inflamed eye
Posterior uveitis
Can be unilateral or bilateral with floaters and visual loss
Symptoms are commonly slower in onset, though acute presentations can occur
Inflammatory lesions may be present in the retina or choroid
New retinal lesions are yellow, with indistinct margins, ...