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Pediatric Anterior Uveitis
Causes
- Primarily Ocular
- Infectious
- post-surgical (P. Acnes)
- herpes viruses
- Post-traumatic iritis
- Fuchs heterochromic iridocyclitis
- Lens-related
- IOL related
- Glaucomacyclitic crisis (Posner Schlossman)
- Systemic Non-infectious Disease
- Tubular Interstitial Nephritis and Uveitis (TINU)
- Sarcoidosis
- Kawasaki syndrome
- Juvenile onset spondyloarthropathies (HLA-B27 associated)
- Juvenile Ankylosing spondilitis
- Reactive arthritis
- Inflammatory Bowel disease related
- Psoriatic arthritis
- Systemic Infectious Diseases
- Post Infectious Autoimmune uveitis (streptococcal pharyngitis)
- Herpes Viruses (VZV, HSV)
- Syphilis
- Tuberculosis
- Lyme
Work-up for cases without an obvious cause
- Consider working up for:
- Sarcoidosis
- angiotensin-converting enzyme (ACE) serum and lysozyme levels
- followed by chest x-ray
- followed by Chest CT
- Syphilis
- Non-treponemal testing
- RPR -or-
- VDRL
- Followed by treponemal testing
- fluorescent treponemal antibody absorption (FTA-ABS) -or-
- Treponema pallidum particle agglutination (TPPA)
- Tuberculosis
- Serum QuantiFERON Gold or PPD
- Herpes viruses
- HSV IgG and IgM
- VZV IgG and IgM
- JIA without significant arthritis (ANA)
- TINU
- urinary β2 microglobulin
- BUN, Creatinine
- urinalysis (looking for proteinuria, normoglycemic glycosuria, microheaturia, sterile pyuria)
- Lyme titers in endemic areas or travel to endemic areas
- Lyme IgG and IgM
- HLA-B27 in teenagers
- Mascarade diseases (leukemia, lymphoma)
- CBC
Work up based on history and exam findings
- Previous Strep throat (group A strep infection suspected
- Antistreptolysin O titers
Masquerades of Anterior Uveitis
- Leukemia
- Juvenile Xanthogranuloma