Uveitis in children

Uveitis is an inflammation of the uveal tract. The inflammatory process can be localized in certain parts of the uveal tract, in connection with which it is advisable to subdivide the uveal process by its localization. According to the clinical course, uveitis is divided into acute, subacute and chronic.

Causes of acute anterior uveitis

• Injury.
• Infectious diseases:
  • exanthema;
  • brucellosis;
  • cat scratch disease;
  • herpes simplex;
  • infectious mononucleosis;
  • Kawasaki disease (mucocutaneous syndrome with lymph node involvement) is a systemic vasculitis that occurs in childhood and is manifested by:
    • fever;
    • stomatitis;
    • erythema of the palms;
    • lymphadenopathy;
    • myocarditis;
    • bilateral conjunctivitis;
    • uveitis;
  • Lyme disease;
• spondyloarthropathy;
• ankylosing spondylitis;
• psoriatic arthritis;
• inflammatory bowel diseases (Crohn's disease and ulcerative colitis);
• Reiter's syndrome;
• Behcet's disease.

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Causes of Chronic Anterior Uveitis

• Injury.
• Leprosy.
• Onchocerciasis.
• Juvenile rheumatoid arthritis (Still's disease):
  • the predominant cause of chronic anterior uveitis in childhood;
  • manifests itself, as a rule, in the second decade of life;
  • oligoarthritic form with damage to no more than four joints during the first three months of the disease;
  • polyarthritic form with damage to more than four joints during the first three months of the disease;
  • fever with deteriorating health.

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Symptoms of Uveitis

• Suspension of cellular elements in the fluid of the anterior chamber;
• Precipitates on the cornea.
• Decreased vision caused by macular edema, increased intraocular pressure, and clouding of the anterior chamber fluid.
• Deposition of cellular elements behind the lens is possible.

Complaints

• Pain.
• Redness of the eyeball.
• Photophobia.

Iridocyclitis in juvenile rheumatoid arthritis

• It most often develops in patients with the oligoarthritic form of juvenile rheumatoid arthritis, in the presence of antinuclear antibodies in the blood serum and the absence of rheumatoid factor and human leukocyte antigen (HLA)-B27.
• Girls get sick more often than boys.
• Debuts early, usually before 10 years of age.

Timely treatment can prevent complications such as the formation of posterior synechiae, the development of cataracts and glaucoma. Therefore, it is advisable to conduct screening to identify the risk group for Still's disease.

• In case of a systemic start - annually.
• For the polyarthritic form - every 6 months.
• For the oligoarthritic form - every 3 months.
• In the oligoarthritic form and the presence of antinuclear antibodies in the blood serum - every 2 months for 7 years after the onset of the disease. Among patients with rapid remission, screening is performed at an earlier date.

Treatment of uveitis

1. Mydriatics instillations. It is more appropriate to prescribe short-acting mydriatics to maintain pupillary mobility. In the absence of posterior synechiae, but with a high risk of their formation, mydriatics of the shortest possible duration are prescribed at night to eliminate the negative impact of concomitant cycloplegia.
2. Instillation of corticosteroids when exudate suspension appears in the anterior chamber. Against the background of a chronic inflammatory reaction, this treatment is usually ineffective. On the contrary, an exacerbation of the process requires forced instillation of corticosteroids (hourly) and frequent examination of the patient.
3. In case of exacerbations of the process, injections of prolonged-action steroids or soluble short-acting steroids are administered, starting with high doses and then decreasing them. In severe chronic forms of the disease, immunosuppressants are effective.
4. In case of band-shaped corneal dystrophy, excimer laser removal of the affected area, keratectomy, or the use of ethylenediaminetetraacetic acid (EDTA) chelating agents may be possible.
5. Surgical intervention for cataract. Complications in the form of severe postoperative uveitis with subsequent fibrous changes in the vitreous body are possible. A pronounced uveal process is an indication for lensvitrectomy. Only in the case of a mild inflammatory process can the technique of cataract aspiration with preservation of the posterior capsule be used. In all cases of surgical intervention for cataract against the background of chronic anterior uveitis, one or two large peripheral colobomas of the iris should be formed. Surgical treatment is carried out under the cover of local and general steroid therapy, prescribing the appropriate drugs both as preoperative preparation and in the postoperative period.
6. If the process is complicated by secondary glaucoma, the following treatment measures are recommended:
   • iridectomy, in the presence of pupillary block;
   • instillation of antihypertensive drugs;
   • taking diacarb;
   • trabeculodialysis;
   • trabeculectomy in combination with the use of cytostatic agents and implantation of tubular drainage to increase the effectiveness of surgical intervention.
7. In case of concomitant macular edema, control over the course of the uveal process is increased and, in some cases, non-steroidal anti-inflammatory drugs are prescribed.

Forecast

In all cases, the prognosis should be extremely reserved and cautious. At least 25% of patients with chronic uveitis against the background of juvenile rheumatoid arthritis have an unfavorable visual prognosis.

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