Introduction

Childhood uveitis represents inflammation of the uveal tract in patients under 16 years. It poses unique diagnostic and therapeutic challenges due to its often asymptomatic presentation and potential for severe visual impairment.

Key Points:

• Affects approximately 30/100,000 children
• Accounts for 5-10% of all uveitis cases
• Often bilateral (70% cases)
• Can be sight-threatening if untreated
• Requires long-term monitoring

Classification

1. Anatomical Classification:

• Anterior Uveitis
  • Most common form (40-50%)
  • Involves iris and ciliary body
  • Often associated with JIA
• Intermediate Uveitis
  • Affects pars plana and peripheral retina
  • Second most common (20-30%)
  • Often idiopathic
• Posterior Uveitis
  • Affects choroid and retina
  • Often infectious etiology
  • More common in developing countries
• Panuveitis
  • Involves entire uveal tract
  • Most severe form
  • Often associated with systemic disease

2. Clinical Pattern:

• Acute vs Chronic
• Granulomatous vs Non-granulomatous
• Unilateral vs Bilateral

Etiology & Associations

1. Systemic Associations:

• Juvenile Idiopathic Arthritis (JIA)
  • Most common association
  • Oligoarticular type highest risk
  • ANA positive cases
• Other Rheumatologic Conditions
  • Juvenile Sarcoidosis
  • Behçet's Disease
  • Inflammatory Bowel Disease
  • TINU Syndrome

2. Infectious Causes:

• Viral
  • Herpes simplex
  • Varicella zoster
  • Cytomegalovirus
• Bacterial
  • Tuberculosis
  • Syphilis
  • Lyme disease
• Parasitic
  • Toxoplasmosis
  • Toxocariasis

3. Specific Syndromes:

• Vogt-Koyanagi-Harada syndrome
• Tubulointerstitial Nephritis and Uveitis (TINU)
• CINCA/NOMID syndrome

Clinical Features

1. Common Symptoms:

• Anterior Uveitis
  • Often asymptomatic (JIA-associated)
  • Red eye
  • Photophobia
  • Pain
• Intermediate Uveitis
  • Floaters
  • Blurred vision
  • Pain usually absent
• Posterior Uveitis
  • Vision loss
  • Visual field defects
  • Floaters

2. Clinical Signs:

• Anterior chamber cells and flare
• Keratic precipitates
• Synechiae
• Vitritis
• Snowballs/snowbanking
• Retinal vasculitis
• Chorioretinal lesions

Diagnosis

1. Ophthalmic Evaluation:

• Slit Lamp Examination
  • Cell and flare grading
  • Keratic precipitates
  • Synechiae evaluation
• Fundus Examination
  • Vitreous cells
  • Retinal lesions
  • Optic disc changes
• Imaging
  • Fundus photography
  • Fluorescein angiography
  • OCT/OCT-A
  • Ultrasound when needed

2. Laboratory Investigations:

• Basic Workup
  • CBC, ESR, CRP
  • ANA
  • RF factor
  • HLA-B27
• Infectious Workup
  • Tuberculin test
  • TORCH titers
  • Toxoplasma serology
  • Viral PCR if indicated

Management

1. Medical Treatment:

• Topical Therapy
  • Corticosteroids
  • Cycloplegics
  • Anti-glaucoma medications if needed
• Systemic Therapy
  • Corticosteroids
  • Immunomodulators
    • Methotrexate
    • Mycophenolate mofetil
    • Azathioprine
  • Biologics
    • Adalimumab
    • Infliximab

2. Monitoring:

• Regular slit lamp examination
• IOP monitoring
• Visual acuity assessment
• Drug toxicity monitoring
• Growth monitoring

Complications

1. Structural Complications:

• Band keratopathy
• Posterior synechiae
• Cataract
• Glaucoma
• Macular edema
• Retinal detachment

2. Visual Outcome:

• Risk Factors for Poor Prognosis
  • Delayed diagnosis
  • Poor compliance
  • Posterior segment involvement
  • Chronic inflammation
• Prevention Strategies
  • Regular screening
  • Early intervention
  • Aggressive treatment when needed
  • Regular monitoring