Uveitis: Diagnosis, Types, Management and Associations

Uveitis: An Overview, Diagnosis, and Management Strategy

Uveitis is an inflammatory condition that affects the uveal tract and adjacent structures of the eye, including the iris, choroid, ciliary body, sclera, cornea, vitreous humor, retina, and optic nerve head. It can cause transient or permanent visual impairment and ocular complications that are not responsive to therapy. Uveitis can occur as a co-manifestation of various autoimmune disorders and infections or as a side effect of idiopathic ocular inflammation. It is particularly prevalent in younger people, with a mean age of onset under 40 years.

Diagnosis of Uveitis

Algorithmic Approach

To diagnose uveitis, ophthalmologists follow an algorithmic approach that includes defining the problem and deriving a clinical diagnosis, reviewing all possible causes, comparing with known uveitis patterns, and proving the diagnosis through diagnostic modalities. The comprehensive workup of uveitis takes the clinician through a systematic process of naming and meshing, differential diagnosis, and laboratory workup.

Naming and Meshing

The first step in diagnosing uveitis is to assign a specific name to the clinical entity by using a set of descriptive terminologies in uveitis. This step is followed by comparing the assigned name to known uveitis patterns, a process known as "meshing".

Differential Diagnosis

A probable list of etiologies or causes is constructed, and this is known as differential diagnosis (DD). After arriving at a DD, investigations are sought to confirm or rule out the specific diagnoses.

Laboratory Workup

A comprehensive workup takes the clinician to the list of differential diagnosis and then to a laboratory workup. The choice of laboratory tests depends on the suspected etiology of uveitis.

Types of Uveitis

Uveitis is classified into anterior, intermediate, posterior, and panuveitis, depending on the anatomic location. Anterior segment uveitis is the most common form, manifesting as iritis or iridocyclitis. Intermediate uveitis affects the vitreous humor, and posterior uveitis affects the retina, choroid, and vitreous.

Associations with Systemic Diseases

Uveitis is often associated with systemic diseases such as sarcoidosis, psoriatic arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis (JRA), multiple sclerosis (MS), Vogt-Koyanagi-Harada's disease, Behçet's disease, systemic lupus erythematosus (SLE), and collagen vascular diseases.

Treatment of Uveitis

The management of uveitis involves a multidisciplinary approach, and treatment varies depending on the etiology. Infectious uveitis is treated based on the pathogens, while non-infectious uveitis is primarily treated with systemic corticosteroids. However, due to the side effects and limited function of systemic corticosteroids, immunosuppressants and local therapy with steroid implants are increasingly used. Recent advances in uveitis management include new immunosuppressive therapies based on biological agents and local therapy with steroid implants. Imaging studies such as optical coherence tomography (OCT) and ultra-wide-field fluorescein angiography are also used in the evaluation of uveitis.