Uveitis

• Uveitis is inflammation in the uveal tract consisting of the iris, ciliary body, and choroid
• Causes of anterior uveitis

  • Idiopathic
  • HLAB27 spondyloarthropathies
  • Juvenile idiopathic arthritis
  • Herpes
  • Sarcoid and TB
  • Behcet disease
• Signs and symptoms of posterior uveitis

  • Floaters
  • Flashes
  • Decreased vision
  • Usually no pain or redness
• Methods of administering corticosteroids in uveitis

  • Topical eye drops
  • Local injection (Periocular or intravitreal)
  • Intravitreal sustained-release ocular implant
  • Systemic
• Posterior uveitis

  Treatment with POSTERIOR SUBTENON (NOZIK TECHNIQUE) 25G, 5/8 INCH NEEDLE
• Causes of uveitis

  • Toxoplasmosis
  • Sarcoid
  • TB
  • Syphilis
  • Behcet disease
  • Viral retinitis (herpetic)
  • Idiopathic
• Signs and symptoms of anterior uveitis

  • Pain
  • Photophobia
  • Ciliary injection
  • Decreased vision
• Acute anterior uveitis


  Treatment with TRANS-SEPTAL, 27G, 1 CC 4% TA
• Complications of local steroids

  • Vitreous hemorrhage
  • Endophthalmitis
  • Retinal detachment
  • Subtenon
  • Globe penetration
  • Ptosis
  • Muscle injury
  • Fat herniation
• Immunosuppressive drugs

  • Anti-metabolites: Methotrexate (MTX), Azathioprine (AZA), Mycophenolate Mofetil (MMF)
  • T-lymphocyte signal blockers/Antibiotics: Cyclosporine A (CSA), Tacrolimus
  • Alkylators: Cyclophosphamide, Chlorambucil
  • Biologic response modulators: Infliximab (Remicade), Adalimumab (Humira)
• Treatment for uveitis

  • Corticosteroids
  • Local topical eye drops
  • Local injection (Periocular or intravitreal)
  • Intravitreal sustained-release ocular implant
  • Systemic TRANS-SEPTAL, 27G, 1 CC 4% TA
  • POSTERIOR SUBTENON (NOZIK TECHNIQUE) 25G, 5/8 INCH NEEDLE, 0.5-1 CC 4% TA
• Treatment: Not specified
• Clinical example: Young female patient with sudden onset of decreased vision in one eye. History of numbness and weakness in upper limbs. Exam shows optic disc swelling with no uveitis and RAPD.
• Uveitis

  • Bilateral disease, non-infectious intermediate and posterior uveitis
• Treatment for acute anterior uveitis

  1. Intravitreal

  2. Periocular

  3. Topical
• Side effects of chronic use of systemic corticosteroids

  • Growth retardation (children)
  • Osteopenia
  • Cushingoid effect
  • Avascular necrosis of the hip
  • Suppression of hypothalamic-pituitary axis (if therapy >3 weeks)
  • Hyperglycemia
  • Hypertension
  • Delayed wound healing
  • Increased risk of infection
  • Hirsutism
  • Glaucoma
  • Cataract
  • CSCR
  • Psychological effects: anxiety, sleeplessness, mood changes, and psychosis (can occur even with short-term use)
• Optic neuritis


  • Inflammation of the optic nerve, can appear as optic disc swelling, may cause flashes and decreased vision and altered color vision, may cause RAPD
• Investigation needed: Not specified
• Diagnosis: Optic neuritis