Uveitis and Ocular Inflammation
Core concepts
Classify uveitis by location: anterior, intermediate, posterior, and panuveitis. Know the signs: cells and flare in the anterior chamber, keratic precipitates, and posterior synechiae. Understand the systemic associations: HLA-B27 (ankylosing spondylitis), sarcoidosis, Behçet disease, and juvenile idiopathic arthritis (JIA) - JIA uveitis is often asymptomatic and chronic, requiring screening. Master treatment: topical steroids for anterior uveitis, periocular or systemic steroids for posterior, and immunosuppression for refractory disease. Know the trap of using prostaglandin analogs in uveitic glaucoma.
Traps
Questions test that JIA-associated uveitis can be silent and needs regular screening. Another trap: distinguishing infectious uveitis (needs antimicrobials, not just steroids) from autoimmune. Also know that syphilis and tuberculosis can cause any pattern of uveitis.
Worked example / rule of thumb
A child with JIA has a white, quiet eye on exam but has anterior chamber cells. That is chronic asymptomatic uveitis requiring treatment and screening. Rule of thumb: any child with JIA needs periodic slit-lamp screening even without symptoms.