From the Guidelines
Uveitis physical findings can vary depending on the anatomical location and severity of inflammation, but typically include ciliary injection, cells and flare in the anterior chamber, keratic precipitates, and miosis in anterior uveitis, as well as vitreous cells and haze, snowballs, and snowbanking in intermediate uveitis, and retinal vasculitis, chorioretinal lesions, and optic disc edema in posterior uveitis 1.
Anatomical Location and Severity of Inflammation
The physical findings in uveitis can be categorized based on the anatomical location of the inflammation.
- Anterior uveitis typically presents with:
- Ciliary injection (redness around the cornea)
- Cells and flare in the anterior chamber (visible on slit lamp examination)
- Keratic precipitates on the corneal endothelium
- Miosis (constricted pupil)
- Intermediate uveitis shows:
- Vitreous cells and haze
- Snowballs (inflammatory aggregates in the vitreous)
- Snowbanking (exudates on the pars plana)
- Posterior uveitis findings include:
- Retinal vasculitis
- Chorioretinal lesions
- Retinal hemorrhages
- Optic disc edema
- Panuveitis combines findings from all three locations
Additional Findings and Complications
Additional findings may include:
- Elevated intraocular pressure
- Cataract formation
- Macular edema Visual acuity is often reduced proportional to the severity of inflammation and presence of complications, as noted in the guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis 1. Careful examination with a slit lamp is essential for accurate diagnosis and monitoring of treatment response in uveitis, considering the limitations and regional differences in the prevalence of certain diseases, such as tuberculosis, which should influence clinical advice 1.
From the Research
Uveitis Physical Findings
- Uveitis is characterized by intraocular inflammation involving the uveal tract, with etiologies generally falling into two broad categories: autoimmune/inflammatory or infectious 2
- The main physical findings of uveitis include inflammation of the uveal tract, which can lead to symptoms such as eye pain, redness, and vision loss
- Corticosteroids are a common treatment for uveitis, and can be administered systemically or locally, in the form of topical drops, periocular injection, intravitreal suspension, or intravitreal implant 2, 3
- The choice of treatment for uveitis depends on the cause and severity of the patient's underlying inflammation, as well as the presence or absence of associated systemic inflammation 4
Treatment Options
- Topical corticosteroids are effective anti-inflammatory drugs in the treatment of anterior uveitis, with lipophile derivatives such as dexamethasone and prednisolone acetate penetrating better into the anterior chamber than hydrophilic derivatives 5
- Periocular or intravitreal agents are employed most often in the management of intermediate or posterior intraocular inflammation 3
- Noncorticosteroid immunosuppressive agents play an important role in limiting the toxic effects of long-term corticosteroid use 4, 3
- Intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection 6
Adverse Effects
- The most common side effects of topical corticosteroids are corticosteroid-induced glaucoma and corticosteroid-induced cataracts 5
- Systemic corticosteroids can have serious side effects, such as osteonecrosis and adrenal insufficiency 2
- Non-steroidal anti-inflammatory drugs (NSAIDs) can inhibit the enzyme cyclooxygenase, but their therapeutic role in treating uveitis and cystoid macular edema secondary to uveitis has not yet been established 5