From the Guidelines
The etiology of uveitis is primarily determined by its anatomical location within the eye, with anterior uveitis commonly associated with HLA-B27-related conditions, intermediate uveitis frequently idiopathic, and posterior uveitis often caused by infectious agents or autoimmune conditions, as supported by recent guidelines and studies 1.
Uveitis Etiology Based on Location
The location of uveitis within the eye plays a crucial role in determining its etiology.
- Anterior uveitis, affecting the iris and ciliary body, is commonly associated with:
- HLA-B27-related conditions like ankylosing spondylitis, reactive arthritis, and inflammatory bowel disease
- Infections such as herpes simplex, herpes zoster, and syphilis
- Idiopathic causes
- Intermediate uveitis, involving the vitreous and peripheral retina, is frequently:
- Idiopathic (pars planitis)
- Linked to multiple sclerosis, sarcoidosis, and tuberculosis
- Posterior uveitis, affecting the choroid and retina, is often caused by:
- Infectious agents including toxoplasmosis, tuberculosis, syphilis, and cytomegalovirus, particularly in immunocompromised patients
- Autoimmune conditions like Behçet's disease, Vogt-Koyanagi-Harada syndrome, and sarcoidosis
- Panuveitis, which involves all layers of the uvea, is commonly associated with systemic disorders such as:
- Sarcoidosis
- Behçet's disease
- Vogt-Koyanagi-Harada syndrome
- Sympathetic ophthalmia
Importance of Location-Specific Etiology
Understanding the location-specific etiology of uveitis is crucial for proper diagnosis and management, as treatment approaches differ significantly depending on whether the cause is infectious, autoimmune, or idiopathic, as highlighted in recent studies and guidelines 1.
Recent Guidelines and Recommendations
Recent guidelines, such as the 2019 American College of Rheumatology/American Academy of Ophthalmology guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis, emphasize the importance of early detection and timely treatment to improve visual outcomes and prevent complications 1.
Treatment Approaches
Treatment approaches for uveitis vary depending on the underlying cause and location, with topical glucocorticoids being the initial treatment for anterior uveitis, and systemic immunosuppressive therapy, including biologic agents, being used for more severe or refractory cases, as recommended by recent studies and guidelines 1.
From the Research
Etiology of Uveitis Based on Location
The etiology of uveitis can be understood by examining its various forms, which are classified based on the location of the inflammation within the eye. This classification includes:
- Anterior uveitis: Involves the front part of the eye, including the iris and ciliary body.
- Posterior uveitis: Affects the back part of the eye, including the choroid and retina.
- Intermediate uveitis: Involves the middle part of the eye, including the vitreous and peripheral retina.
- Panuveitis: Inflammation that affects all parts of the uvea.
Causes of Uveitis
The causes of uveitis can be diverse and include:
- Autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis 2.
- Infectious diseases, such as toxoplasmosis and herpes zoster 3, 4.
- Trauma to the eye.
- Cancer, including lymphoma 5.
Specific Forms of Uveitis and Their Etiologies
Some specific forms of uveitis and their etiologies include:
- Acute anterior uveitis, which can be associated with HLA-B27 and conditions like ankylosing spondylitis 3, 2.
- Posterior uveitis, which can be caused by infections like toxoplasmosis or autoimmune conditions like sarcoidosis 3, 4.
- Behçet's disease, a form of uveitis that can cause significant vision loss if not adequately treated, and has been shown to respond well to biological therapy with TNF-α 5.
Classification and Diagnosis
The classification and diagnosis of uveitis are crucial for determining its etiology and guiding treatment. According to 3, about 70% of uveitis cases can be given a specific diagnosis based on clinical presentation and diagnostic tests. The anatomical classification of uveitis (anterior, posterior, intermediate, panuveitis) helps in understanding the potential causes and in planning the management strategy 3, 6.