Clinical Review

Investigation and management of uveitis

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4976 (Published 13 October 2010) Cite this as: BMJ 2010;341:c4976
  1. Catherine M Guly, specialty registrar in medical ophthalmology1,
  2. John V Forrester, Cockburn professor of ophthalmology2
  1. 1Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
  2. 2Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD
  1. Correspondence to: C M Guly catherine.guly{at}doctors.org.uk
  • Accepted 7 September 2010

Summary points

  • Uveitis is a major cause of visual impairment in people of working age

  • Patients with suspected uveitis should have an assessment of visual acuity and a dilated slit lamp examination

  • Children with juvenile idiopathic arthritis should be screened with regular slit lamp examinations to enable early detection and treatment of uveitis

  • Optical coherence tomography is useful for detecting and monitoring cystoid macular oedema

  • Intravitreal treatments and biological agents show promise in treating sight threatening non-infectious uveitis, but trial based evidence is limited

Uveitis is estimated to account for 10% of blindness in people of working age in the Western world.1 A retrospective review of patients attending a uveitis clinic in the United Kingdom found that 70% of patients had visual impairment (visual acuity 6/18 or worse) and half of these patients had bilateral visual impairment.2 Acute anterior uveitis, which is the most common form of uveitis in the UK, usually has a good visual outcome, but other forms of uveitis have a poorer visual prognosis.

Uveitis is associated with many systemic diseases, including sarcoidosis, juvenile idiopathic arthritis, Behçet’s syndrome, and infectious diseases such as tuberculosis. For patients with systemic disease a management approach that involves collaboration with other specialties is important. In about half of cases, no systemic association is found and uveitis is presumed to be autoimmune.3 The introduction of biological treatments for many autoimmune conditions, and intravitreal injection of drugs for some eye diseases, has led to several of these treatments being used in patients with uveitis, despite limited evidence from randomised trials to support their use. This review discusses recent advances in the diagnosis of uveitis, ocular imaging, and treatments. It does not cover uveitis induced by ocular surgery.

What is uveitis and who gets it?

Uveitis describes a group of intraocular inflammatory disorders that may be related to infection or …

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