From the Guidelines
Posterior synechiae in a 9-year-old girl are most commonly caused by anterior uveitis, particularly chronic or recurrent inflammation, with juvenile idiopathic arthritis (JIA)-associated uveitis being the most frequent etiology in this age group. The primary causes to consider include:
- JIA-associated uveitis, which is the most frequent etiology in this age group 1
- Infectious uveitis from toxoplasmosis, herpes simplex virus, varicella-zoster virus, or tuberculosis
- Trauma to the eye, including surgical trauma, can lead to inflammation resulting in synechiae formation
- Less commonly, sarcoidosis, inflammatory bowel disease, or other systemic autoimmune conditions may be responsible
Evaluation should include a complete ophthalmologic examination, review of systems for associated symptoms, and appropriate laboratory testing including ANA, RF, HLA-B27, and infectious disease markers 2. Prompt referral to a pediatric ophthalmologist is essential as untreated inflammation can lead to permanent vision loss. Treatment typically involves topical corticosteroids such as prednisolone acetate 1% and cycloplegic agents like cyclopentolate or atropine to prevent further synechiae formation. Systemic immunosuppression may be necessary in cases associated with autoimmune disease, with adalimumab being a recommended treatment option for patients with uveitis refractory to conventional therapy 2. Early diagnosis and treatment are crucial to prevent complications including cataracts, glaucoma, and permanent visual impairment.
From the Research
Causes of Posterior Synechiae
The causes of posterior synechiae in a 9-year-old girl can be attributed to several factors, including:
- Chronic uveitis, which is a common extra-articular manifestation of juvenile idiopathic arthritis 3
- Infectious causes, such as syphilis, toxoplasmosis, tuberculosis, endogenous endophthalmitis, and viral causes (including herpes simplex virus, herpes zoster virus, and cytomegalovirus) 4
- Non-infectious uveitis, which can be idiopathic or associated with juvenile idiopathic arthritis, pars planitis, or other conditions 5, 6
Associated Conditions
Posterior synechiae can be associated with various conditions, including:
- Juvenile idiopathic arthritis, which increases the risk of uveitis and posterior synechiae 3, 6
- Anterior uveitis, which can lead to posterior synechiae as a complication 5, 6
- Panuveitis, which can also cause posterior synechiae 5
Risk Factors
Risk factors for posterior synechiae and vision loss include: