Uveitis and Ocular Inflammation
Concept anchors
Classify anatomically as anterior, intermediate, posterior or panuveitis, and by course (acute, chronic, recurrent). Granulomatous disease (sarcoidosis, tuberculosis, sympathetic ophthalmia, Vogt-Koyanagi-Harada) shows large mutton-fat keratic precipitates and iris nodules; non-granulomatous disease is more typical of HLA-B27 states. Key associations: HLA-B27 with anterior uveitis and spondyloarthropathy; sarcoidosis with chest changes and raised angiotensin-converting enzyme; Behçet with hypopyon and oral ulcers; toxoplasmosis with a focal retinochoroidal scar; cytomegalovirus retinitis in immunosuppression; juvenile idiopathic arthritis with chronic silent anterior uveitis.
Workup and treatment
Targeted workup, not a shotgun panel: syphilis serology and chest imaging are commonly justified, others depend on history. Treatment escalates from topical steroid and cycloplegia, to periocular or intravitreal steroid, to systemic steroid-sparing agents and biologics. Complications include posterior synechiae, cataract, glaucoma and cystoid macular edema.
Traps
Steroid response and pupil block after synechiae; missing an intraocular lymphoma or masquerade syndrome in chronic refractory vitritis; Fuchs heterochromic iridocyclitis with diffuse iris atrophy and no synechiae. In children, chronic uveitis is often asymptomatic, so screening intervals depend on age at onset and disease duration.
Worked example
A young adult with recurrent unilateral anterior uveitis, low back pain and a positive HLA-B27 needs rheumatology referral, not repeated steroid alone.