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Pediatric Anterior Uveitis

Causes

  • JRA-related iridocyclitis
  • Behçet syndrome
  • Fuchs heterochromic iridocyclitis
  • Glaucomacyclitic crisis (Posner Schlossman)
  • Herpetic iritis
  • Idiopathic
  • IOL- related iritis
  • Kawasaki syndrome
  • Lens related Uveitis
  • Low-grade infectious endophthalmitis (P. acnes)
  • Sarcoidosis
  • Seronegative spondyloarthropathies
  • Syphilis
  • Traumatic iritis

Work-up for cases without an obvious cause

  • Most patients with uveitis are worked up for sarcoidosis, syphilis, and tuberculosis. Other testing is based on history and exam; for example, a child with chronic bilateral anterior uveitis would have ANA testing because JIA is a likely diagnosis, and a teenager with severe acute anterior uveitis in 1 eye would be tested for HLA‑B27. Lyme testing is useful in a Lyme endemic area or following history of tick bite and characteristic rash.111 There is limited utility in a “shot gun” approach to uveitis testing, and the positive predictive value of every test must be considered. Testing for sarcoidosis includes a chest x‑ray and might include obtaining angiotensin-converting enzyme (ACE) serum and lysozyme levels.112 Although CT chest is often obtained looking for sarcoidosis in older patients,113 it should probably not be used as a screening tool in pediatric patients, because of the radiation dose.114 Testing for TB can be performed via skin testing (PPD) or serum interferon gamma assay such as the QuantiFERON Gold. Syphilis testing includes both nontreponemal testing such as RPR and VDRL and treponemal testing such as fluorescent treponemal antibody absorption test (FTA-ABS) or Treponema pallidum particle agglutination (TPPA). excerpt from AAO Pediatric Anterior Uveitis

References