Description

• A nonspecific term used to describe any intraocular inflammatory disorder.
• Symptoms vary, depending on depth of involvement and associated conditions.
• The uvea is the middle layer of the eye between the sclera and retina. The anterior part of the uvea includes the iris and ciliary body. The posterior part of the uvea is the choroid:
  • Anterior uveitis: Refers to ocular inflammation limited to the iris (iritis) alone or iris and ciliary body (iridocyclitis)
  • Intermediate uveitis: Refers to inflammation of the structures just posterior to the lens (pars planitis or peripheral uveitis)
  • Posterior uveitis: Refers to inflammation of the choroid (choroiditis), retina (retinitis), or vitreous near the optic nerve and macula
• System(s) affected: Nervous
• Synonym(s): Iritis; Iridocyclitis; Choroiditis; Retinochoroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis; Pars planitis; Panuveitis. Synonyms are anatomic descriptions of the focus of the uveal inflammation.

Geriatric Considerations
The inflammatory response to systemic disease may be suppressed.

• Infection should be the primary consideration.
• Allergies and psychologic factors (depression, stress) may serve as a trigger.
• Trauma is also a common cause in this population.

Pregnancy Considerations
May be of importance in the selection of medications

Epidemiology

• Predominant age: All ages
• Predominant sex: Male = Female, except for HLA-B27 anterior uveitis: Male > Female (2.5:1)

Incidence
Anterior uveitis most common (8.2 cases/100,000 annual incidence)

Prevalence
Iritis is 4× more prevalent than posterior uveitis.

Risk Factors

• No specific risk factors
• Higher incidence seen with specific associated conditions

• No specific pattern for uveitis in general
• Iritis: Of patients, 50–70% are HLA-B27–positive.

Etiology

• Infectious: May result from viral, bacterial, parasitic, or fungal etiologies
• Suspected immune-mediated: Possible autoimmune or immune-complex–mediated mechanism postulated in association with systemic (especially rheumatologic) disorders
• Isolated eye disease
• Idiopathic (~25%)
• Autoimmune uveitis (AIU) patients should be referred to an ophthalmologist for local treatment.
• Masquerade syndromes: Diseases such as malignancies that may be mistaken for primary inflammation of the eye

Commonly Associated Conditions

• Viral infections: Herpes simplex, herpes zoster, HIV, cytomegalovirus
• Bacterial infections: Brucellosis, leprosy, leptospirosis, Lyme disease, propionibacterium infection, syphilis, tuberculosis (TB), Whipple disease
• Parasitic infections: Acanthamebiasis, cysticercosis, onchocerciasis, toxocariasis, toxoplasmosis
• Fungal infections: Aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, sporotrichosis
• Suspected immune-mediated: Ankylosing spondylitis, Behçet disease, Crohn disease, drug or hypersensitivity reaction, interstitial nephritis, juvenile rheumatoid arthritis, Kawasaki disease, multiple sclerosis, psoriatic arthritis, Reiter syndrome, relapsing polychondritis, sarcoidosis, Sjögren syndrome, systemic lupus erythematosus, ulcerative colitis, vasculitis, vitiligo, Vogt-Koyanagi (Harada) syndrome
• Isolated eye disease: Acute multifocal placoid pigmentary epitheliopathy, acute retinal necrosis, bird-shot choroidopathy, Fuchs heterochromatic cyclitis, glaucomatocyclitic crisis, lens-induced uveitis, multifocal choroiditis, pars planitis, serpiginous choroiditis, sympathetic ophthalmia, trauma
• Masquerade syndromes: Leukemia, lymphoma, retinitis pigmentosa, retinoblastoma