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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
    • Juvenile Idiopathic Arthritis
    • Behçet syndrome
    • 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) and serum 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/IgM * VZV IgG/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

  • Arthritis
    • ANA
  • Joint pain with chronic diarrhea and abdominal pain
    • HLA-B27
  • Rash
    • Psoriasis
      • rash areas are red, pink, or purple, dry, itchy, and scaly
      • associated with arthritis
    • Lyme
      • erythema migrans
        • red, blue or pink circular or oval with clear center, expands over several days, may reach up to 12 inches and have a raised border
      • Travel to endemic areas, exposure to ticks
  • Fever, Weight loss, fatigue, malaise, abdominal pain
    • urinary β2 microglobulin, BUN, Creatinine, UA
  • Previous Strep throat (group A strep infection suspected
    • Antistreptolysin O titers

Masquerades of Anterior Uveitis

References

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