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Uveitis

Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye. more...

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Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. Uveitis requires a thorough examination by an ophthalmologist.

Types

Uveitis is usually categorized anatomically into anterior, intermediate, posterior and panuveitic forms.

  • Anywhere from two-thirds to 90% of uveitis cases are anterior in location (anterior uveitis), frequently termed iritis - or inflammation of the iris and anterior chamber. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Symptoms include red eye, injected conjunctiva, pain and decreased vision. Signs include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates ("KP") on the posterior surface of the cornea.
  • Intermediate uveitis consists of vitritis - inflammatory cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana.
  • Posterior uveitis is the inflammation of the retina and choroid.
  • Pan-uveitis is the inflammation of all the layers of the uvea.

Causes

A myriad of conditions can lead to the development of uveitis, including systemic diseases as well as syndromes confined to the eye. In anterior uveitis, no specific diagnosis is made in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27.

Systemic disorders causing uveitis

Systemic disorders that can cause uveitis include:

  • Acute posterior multifocal placoid pigment epitheliopathy
  • Ankylosing spondylitis
  • Behçet's disease
  • Birdshot retinochoroidopathy
  • Brucellosis
  • Herpes simplex
  • Herpes zoster
  • Inflammatory bowel disease
  • Juvenile rheumatoid arthritis
  • Kawasaki's disease
  • Leptospirosis
  • Lyme disease
  • Multiple sclerosis
  • Presumed ocular histoplasmosis syndrome
  • Psoriatic arthritis
  • Reiter's syndrome
  • Sarcoidosis
  • Syphilis
  • Systemic lupus erythematosus
  • Toxocariasis
  • Toxoplasmosis
  • Tuberculosis
  • Vogt-Koyanagi-Harada syndrome

Masquerade syndromes

Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:

  • Anterior segment
  • Intraocular foreign body
  • Juvenile xanthogranuloma
  • Leukemia
  • Malignant melanoma
  • Retinoblastoma
  • Retinal detachment
  • Posterior segment
  • Lymphoma
  • Malignant melanoma
  • Multiple sclerosis
  • Reticulum cell sarcoma
  • Retinitis pigmentosa
  • Retinoblastoma

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Uveitis associated with rifabutin therapy
From Morbidity and Mortality Weekly Report, 9/9/94

In 1993, the Public Health Service Task Force recommended use of Mycobutin(*) (rifabutin) at a daily dose of 300 mg for prophylaxis for disseminated Mycobacterium avium complex (MAC) infection in patients with human immunodeficiency virus (HIV) infection and <100 CD4+ T-Iymphocytes/[micor]L (1). However, uveitis (an inflammatory eye condition characterized by pain, redness, and possible temporary or permanent loss of vision) has been associated with rifabutin therapy.

Uveitis has occurred among participants in several trials for treatment and prophylaxis of MAC in which rifabutin was administered at daily doses of 300-900 mg per day in combination with other agents, particularly clarithromycin and/or fluconazole [2-4; C. Benson, Rush-Presbyterian St. Luke's hospital, Chicago, personal communication, 1994). Patients who developed uveitis have had mild to severe symptoms that resolved after treatment with corticosteroid and/or mydriatic eye drops; in some severe cases, however, resolution of symptoms occurred after several weeks. Uveitis occurred an average of 2-4 months after initiation of treatment for MAC (2).

Uveitis is rare when rifabutin is used as a single agent at 300 mg/day for prophylaxis of MAC in HIV-infected persons, even with the concomitant use of fluconazole or macrolide antibiotics. However, if higher doses of rifabutin are administered in combination with these agents, clinicians should be alert to the possibility of uveitis. Patients should be instructed to report symptoms of uveitis (i.e., pain, redness, and loss of vision) to their physician.

For patients with uveitis, temporary discontinuation of rifabutin and ophthalmologic evaluation are recommended. In most mild cases, using rifabutin again is acceptable; however, if signs or symptoms recur, use of rifabutin should be discontinued.

Physicians are encouraged to report cases of uveitis to the Food and Drug Administration's MedWatch Program, telephone (800) 332-1088 ([301] 738-7553).

Reported by: Div of Antiviral Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, Maryland. Div of HIV/AIDS, National Center for Infectious Diseases, CDC.

References

(1.)CDC. Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus. MMWR 1993; 42(no. RR-9):14-20.

(2.)Shafran S, Deschenes J. Miller M, et al. Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. N Engl J Med 1994; 330:438-9.

(3.)Trapnell CB, Narang PK, Li R, et al. Fluconazole increases rifabutin absorption in HIV positive patients on stable zidovudine therapy [Abstract no. PO B31-2212]. Vol. 1 IX International Conference on AIDS/HIV STD World Congress, Berlin, 1993.

(4.)Siegal F, Eilbott D, Burger H, et al. Dose-limiting toxicity of rifabutin in AIDS-related complex: syndrome of arthralgia/arthritis. AIDS 1990; 4:433-41.

(*)Use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

COPYRIGHT 1994 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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