Summary
The diagnosis and management of uveitis is complicated and challenging. The protean signs and symptoms seen in patients with uveitis may lead to a diagnostic dilemma. A carefully taken history with particular attention to demographic factors and meticulous physical examination are crucial to guiding diagnostic testing. Tailoring the diagnostic approach in patients with uveitis frequently yields useful data in contrast to blanketing every possible uveitic entity. It is also important to distinguish among various aetiologies, including infectious and neoplastic causes which may respond to specific therapy.
Medical treatment of noninfectious uveitis must have clear objectives including reduction of inflammation, relief of symptoms and restoration of visual functioning. Familiarity with possible symptoms and signs of adverse drug reactions is essential early in the course of treatment so that their effects may be minimised. Appropriate therapy of presumed autoimmune uveitis is based on disease severity, presence or absence of bilateral disease and the health status of the patient.
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References
Henderly DE, Haymind RS, Rao NA, et al. The significance of pars plana exudate in pars planitis. Am J Ophthalmol 1987; 103: 669–71.
Smith RE, Godfrey WA, Kimura SJ. Chronic cyclitis. Course and visual prognosis. Trans Am Acad Ophthalmol Otolaryngol 1973; 77: 760–8.
Ferris FL III, Kassiff A, Bresnick GH, et al. New visual acuity charts for clinical research. Am J Ophthalmol 1982; 94: 91–6.
Hakin KN, Watson PG. Systemic associations of scleritis. Int Ophthalmol Clin 1991; 31: 111–29.
Pouliquen Y, Haye C, Bisson J, et al. Ultrastructure de la keratopathie en bandelette. Arch Ophthal (Paris) 1967; 27: 149.
o’Connor GR. Calcific band keratopathy. Trans Am Opthalmol Soc 1972; 70: 58.
Nussenblatt RB, Palestine AG. Uveitis: fundamentals and clinical practice. Chicago: Year Book Medical Publishers, 1989.
Smith RE, Nozik NE. Uveitis: a clinical approach to diagnosis and management. Baltimore: Williams and Wilkins, 1989.
Rosenbaum JT. Systemic associations of anterior uveitis. Int Ophthalmol Clin 1991; 31: 131–42.
Hogan MJ, Kimura SJ, Thygeson P. Signs and symptoms of uveitis: I. anterior uveitis. Am J Ophthalmol 1959; 47: 155–70.
Schlaegel Jr TF. Essentials of uveitis. Boston: Little, Brown & Co., 1969.
Whitcup SM, Nussenblatt RN, de Smet MD, et al. The diagnosis and management of severe uveitis. Annual Meeting, American Academy of Ophthalmology. Chicago: Amercian Academy of Ophthalmology, 1993.
Oski FA, DeAngelis CD, Feigin RD, et al. Principles and practice of pediatrics. Philadelphia: Lippincott, 1990.
Uhlenhuth PT. Zur Lehre von der Unterscheidung verschiedener Eiweissarten mit Hilfe spezifixher Sera, in Fetschrift zum 60 Gerburstag von Robert Koch. Jena: Fischer, 1903: 49–74.
Wacker WB, Lipton MM. Experimental allergic uveitis: homologous retina as uveitogenic antigen. Nature 1965; 206: 253–8.
Wacker WB, Kaslow CM, Yankeelov JA, et al. Experimental allergic uveitis. Isolation, characterization, and localization of a soluble uveitogenic antigen from bovine retina. J Immunol 1977; 119: 1949–58.
Caspi RR, Roberge FG, Chan CC, et al. New model of autoimmune disease: experimental uveoretinitis induced in mice with two different retinal antigens. J Immunol 1988; 140: 1490–5.
Marak Jr GE. Recent Advances in sympathetic ophthalmia. Surv Ophthalmol 1979; 24: 141–56.
Chan CC, Palestine AG, Nussenblatt RB. Antiretinal Antibodies in Vogt-Koyanagi-Harada syndrome, Behçet’s disease, and sympathetic ophthalmia. Ophthalmology 1985; 92: 1025–98.
Chan CC, Ben Ezra D, Hsu SM. Granulomas in sympathetic ophthalmia and sarcoidosis: immunohistochemical study. Arch Ophthalmol 1985; 103: 198–202.
Chan CC, Ben Ezra D, Rodrigues MM, et al. Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia. Ophthalmology 1985; 92: 580–90.
Momoeda S. Lymphocyte transformation test in Vogt-Koyanagi-Harada syndrome. Nippon Ganka Gakkai Zasshi 1976; 80: 491–6.
Maezawa H, Yano A, Taniguchi M, et al. The role of cytotoxic T lymphocytes in the pathogenesis of Vogt-Koyanagi-Harada disease. Ophthalmologica 1982; 185: 179–86.
Nussenblatt RB, Gery I, Ballentine EJ, et al. Cellular immune responsiveness of uveitis patients to retinal S-antigen. Am J Ophthalmol 1980; 89: 173–9.
Forrester JV. Duke-Elder lecture: new concepts on the role of autoimmunity in the pathogenesis of uveitis. Eye 1992; 6: 433–46.
Deschennes J, Char DH, Kaliter S. Activated T lymphocytes in uveitis. Br J Ophthalmol 1988; 72: 83–7.
Dick A, Cheng AT, Purdie JM, et al. Immunocytochemical analysis of blood lymphocytes in uveitis. Eye 1992; 6: 643–7.
Fauci AS. Clinical aspects of immunosuppression: use of cytotoxic agents and corticosteroids. In: Ballanti JA, editor. Immunology II. Philadelphia: WB Saunders, 1978.
Gilman AG, Goodman LS, Rall TW, et al. The pharmacological basis of therapeutics. New York: Macmillan, 1985.
Elkington JR, Hunt Jr AD, Godfrey L. Effects of pituitary adrenocorticotropic hormone (ACTH) therapy. JAMA 1949; 141: 1273–9.
Gordon DM, McLean JM. Effects of pituitary adrenocorticotropic hormone (ACTH) therapy in ophthalmologic conditions. JAMA 1950; 142: 1271–5.
Olson JA, Steffensen EH, Margulis RW, et al. Effect of ACTH on certain inflammatory diseases of the eye. JAMA 1950; 142: 1276–81.
Gordon DM. Hydrocortisone in Ophthalmology. Am J Ophthalmol 1954; 37: 533–8.
Gordon DM. Prednisone and prednisolone in ocular disease. Am J Ophthalmol 1956; 41: 593–600.
Cook C, MacDonald RK. Effect of cortisone on the permeability of the blood-aqueous barrier to fluorescein. Br J Ophthalmol 1951; 35: 730–40.
Leibowitz HM, Kupferman A. Bioavailability and therapeutic effectiveness of topically administered corticosteroids. Trans Am Acad Ophthalmol Otolaryngol 1975; 79: 0P–78.
McCartney HJ, Drysdale IO, Gornall A, et al. An autoradiographic study of the penetration of subconjunctivally injected hydrocortisone into normal and inflammed eyes. Invest Ophthalmol 1965; 4: 297–301.
Freeman WR, Green RL, Smith RE. Ecographic localization of corticosteroids after periocular injection. Am J Ophthalmol 1987; 103: 281–8.
Beck RW, Cleary PA, Anderson Jr MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med 1992; 326: 581–8.
Corley CC, Lessner SE, Larsen WE. Azathioprine therapy of “autoimmune” diseases. Am J Med 1966; 41: 404–12.
Newell FW, Krill AE. Treatment of uveitis with azathioprine imuran. Trans Ophthalmol Soc 1967; 87: 499–511.
Andrasch RH, Pirofsky B, Burns RP. Immunosuppressive therapy for severe chronic uveitis. Arch Ophthalmol 1978; 96: 241–51.
Yazici H, Parzili H, Barnes CG, et al. A controlled trial of azathioprine in Behçet’s syndrome. N Engl J Med 1990; 322: 281–5.
Urowitz MB, Hunter T, Bookman AAM, et al. Azathioprine in rheumatoid arthritis: a double-blind study comparing full dose to half dose. J Rheumatol 1974; 1: 274–81.
Woodland J, Chaput-de-Saintonge DM, Evans SJ, et al. Azathioprine in rheumatoid arthritis: double-blind study of full versus half doses versus placebo. Ann Rheum Dis 1981; 40: 355–9.
Jolivet J, Cowan KH, Curt GA, et al. The pharmacology and clinical use of methotrexate. N Engl J Med 1983; 309: 1094–104.
Mitchell MS, Wade ME, DeConti RC, et al. Immunosuppressive effects of cytosine arabinoside and methotrexate in man. Ann Intern Med 1969; 70: 535–47.
Rothenberg SP, Iqbal MP, da Costa M. Effect of folate compounds on the accumulation of methotrexate and the activity of dihydrofolate reductase in liver, kidney, and small of the mouse. J Pharmacol Exp Ther 1982; 223: 631–4.
Wong VG, Hersh EM. Methotrexate in the therapy of cyclitis. Trans Am Acad Ophthalmol Otolaryngol 1965; 69: 279–93.
Lazar M, Weiner MJ, Leopold IH. Treatment of uveitis with methotrexate. Am J Ophthalmol 1969; 67: 383–7.
Shah SS, Lowder C, Schmitt MA, et al. Low-dose methotrexate therapy for ocular inflammatory disease. Ophthalmology 1992; 99: 1419–23.
Fauci AS, Haynes BF, Katz P, et al. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983; 98: 76–84.
Hoffman GS, Kerr RY, Leavitt CW, et al. Wegener’s granulamotosis: an analysis of 158 patients. Ann Intern Med 1992; 116: 488–98.
Oniki S, Kurakazu K, Kawata K. Immunosuppressive therapy of Behçet’s disease with cyclophosphamide. Jpn J Ophthalmol 1976; 20: 32–40.
Buckley CE III, Gills JP. Cyclophosphamide therapy of peripheral uveitis. Arch Intern Med 1969; 124: 29–35.
o’Duffy JDD, Robertson DM, Goldstein NP. Chlorambucil in the treatment of uveitis and meningoencephalitis of Behçet’s disease. Am J Med 1984; 76: 75–84.
Godfrey WA, Epstein WV, o’Connor GR, et al. The use of chlorambucil in intractable idiopathic uveitis. Am J Ophthalmol 1974; 78: 415–28.
Tricoulis D. Treatment of Behçet’s disease with chlorambucil. Br J Ophthalmol 1976; 60: 55–7.
Jennings T, Tessler HH. Twenty cases of sympathetic ophthalmia. Br J Ophthalmol 1989; 73: 140–5.
Nussenblatt RB, Palestine AG, Chan CC. Cyclosporin A therapy in the treatment of intraocular inflammatory disease resistant to systemic corticosteroids and cytotoxic agents. Am J Ophthalmol 1983; 96: 275–82.
Nussenblatt RB, Palestine AG, Rook AH, et al. Treatment of intraocular inflammatory disease with cyclosporine A. Lancet 1983; 2: 235–8.
Masuda K, Nakajima A. A double-masked study of cyclosporine in Behçet’s diseases. In: Schiinder R, editor. Cyclosporine treatment in Behçet’s disease. Berlin: Springer Verlag, 1985: 162–4.
Palestine AG, Austin HA, Balow JE, et al. Renal histopathological alterations in patients treated with cyclosporin for uveitis. N Engl J Med 1986; 314: 1293–8.
Diaz-Llopis M, Cervera M, Meneto JL. Cyclosporin therapy of Behçet’s disease: a long term study. Curr Eye Res 1990; 9 Suppl.: 17–23.
Towler HM A, Whiting PH, Forrester JV. Combination low dose cyclosporin A and steroid therapy in chronic intraocular inflammation. Eye 1990; 4: 514–20.
Bielory L, Holland C, Gascon P, et al. Uveitis, cutaneous, and neurosarcoid: treatment with low dose cyclosporin A. Transplant Proc 1988; 20 (Suppl. 4): 144–8.
Goto T, Kino T, Hatanaka H, et al. FK 506: historical perspectives. Transplant Proc 1991; 23: 2713–7.
Mochizuki M, Masuda K, Sakane T, et al. A multicenter clinical open trial of FK 506 in refractory uveitis including Behçet’s disease. Transplant Proc 1991; 23: 3343–6.
Dumont RJ, Staruch MF, Koprak SL, et al. Distinct mechanisms of suppression of murine T cell activation by the related macrolides FK 506 and rapamycin. J Immunol 1990; 144: 251–8.
Whiting PH, Woo J, Adam BJ, et al. Toxicity of rapamycin-a comparative and combination study with cyclosporine at immunotherapeutic dosage in the rat. Transplantation 1991; 52: 203–8.
Roberge FG, Chen H, Chan CC, et al. Rapamycin treatment of autoimmune uveoretinitis. Invest Ophthalmol Vis Sci 1992; 33: 933.
Eugui EM, Almquist SJ, Muller CD, et al. Lymphocyte-selective cytostatic and Immunosuppressive effects of mycophenolic acid in vitro: role of deoxyguanosine nucleotide depletion. Scand J Immunol 1991; 33: 161–74.
Gery I, Allison AC, Miller-Rivero N, et al. Inhibition of experimental autoimmune uveoretinitis (EAU) by mycophenolate mofetil (MM). Invest Ophthalmol Vis Sci 1993; 34: 1480.
Wells H. Studies of the chemistry of anaphyIaxis. III. Experiments with isolated proteins, especially those of hen’s egg. J Infect Dis 1911; 9: 147–71.
Bitar DM, Whitacre CC. Suppression of experimental autoimmune encephalomyelitis by oral administration of myelin basic protein. Cell Immunol 1988; 112: 364–70.
Nussenblatt RB, Caspi RR, Mahdi R, et al. Inhibition of Santigen induced experimental autoimmune uveoretinitis by oral induction of tolerance with S-antigen. J Immunol 1990; 144: 1689–95.
Thurau SR, Chan CC, Suh E, et al. Induction of oral tolerance to S-Ag induced experimental autoimmune uveitis by a uveitogenic 20mer peptide. J Autoimmun 1991; 4: 507–16.
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Anglade, E., Whitcup, S.M. The Diagnosis and Management of Uveitis. Drugs 49, 213–223 (1995). https://doi.org/10.2165/00003495-199549020-00006
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DOI: https://doi.org/10.2165/00003495-199549020-00006