From the Guidelines
Uveitis, conjunctivitis, glaucoma, and cataract are distinct eye conditions with different clinical findings, requiring different treatment approaches to minimize morbidity, mortality, and improve quality of life. Uveitis presents with eye pain, photophobia, redness, and blurred vision due to inflammation of the uveal tract, often requiring treatment with topical or systemic corticosteroids like prednisolone 1. Conjunctivitis manifests as redness, discharge, and mild discomfort due to conjunctival inflammation, typically treated with antibiotic drops like moxifloxacin for bacterial causes or artificial tears for viral or allergic types 1. Glaucoma is characterized by increased intraocular pressure causing optic nerve damage and peripheral vision loss, managed with pressure-lowering medications such as timolol 0.5% drops twice daily or latanoprost 0.005% once daily. Cataracts involve lens opacity causing gradual, painless vision deterioration with glare sensitivity, requiring surgical extraction and lens implantation when visually significant. On examination, uveitis shows cells and flare in the anterior chamber with possible synechiae; conjunctivitis displays conjunctival hyperemia with discharge but normal vision; glaucoma may appear normal early on but shows increased pressure on tonometry and optic nerve cupping later; while cataracts reveal lens opacity on slit lamp examination with normal pressure and minimal inflammation. These differences reflect their distinct pathophysiological mechanisms: inflammatory for uveitis, infectious or allergic for conjunctivitis, pressure-related for glaucoma, and degenerative for cataracts. In the management of uveitis, particularly in juvenile idiopathic arthritis-associated uveitis, the use of anti-tumor necrosis factor (TNF) agents such as adalimumab is recommended for patients refractory to conventional therapy 1. Early detection and treatment of these conditions are crucial to prevent complications and improve visual outcomes, emphasizing the importance of regular ophthalmology screening and a multidisciplinary approach to management.
From the Research
Uveitis
- Uveitis is characterized by intraocular inflammation involving the uveal tract, with etiologies generally falling into two broad categories: autoimmune/inflammatory or infectious 2.
- Corticosteroids are a powerful and important class of medications used in the treatment of uveitis, but they can have serious side effects, such as cataract and elevated intraocular pressure 2.
- Non-infectious uveitis can be an expression of a systemic autoimmune condition, or it can be idiopathic, and is a serious disease associated with possible severe complications leading to visual impairment and blindness 3.
Conjunctivitis
- There is no direct evidence in the provided studies to assist in answering questions about conjunctivitis.
Glaucoma
- There is no direct evidence in the provided studies to assist in answering questions about glaucoma.
Cataract
- Cataract is a potential side effect of corticosteroid treatment for uveitis 2.
- There is no direct evidence in the provided studies to assist in answering questions about the treatment or management of cataract.
Comparison of Uveitis, Conjunctivitis, Glaucoma, and Cataract
- Uveitis is a potentially blinding disease that can affect both adults and children, and is associated with possible severe complications leading to visual impairment and blindness 3, 4.
- Inflammatory eye diseases, including uveitis, are responsible for a significant proportion of presentations to ophthalmic emergency facilities, and knowledge of how to differentiate between broad categories of disease and refer accordingly is important for the practising physician 5.
- There is no direct evidence in the provided studies to assist in comparing the treatment or management of uveitis, conjunctivitis, glaucoma, and cataract.