Uveitis- a photoessay 

  John G. O'Shea MD,  David A. Infeld FRCSEd, Robert B. Harvey FRCSEd.

Uveitis can be defined as inflammation of the uvea, the middle, vascular coat of the eye (Greek uva- grape) The uvea consists of the iris, ciliary body and the choroid. The International Uveitis Study Group classification separates uveitis anatomically by location of observed disease according to visible signs- anterior posterior or intermediate. Iritis is a synonym for anterior uveitis. (1,2,3,4,5,6,7)

Additionally, uveitis is described in relation to specific disease syndromes, for example Fuchs Heterochromic Cyclitis or occurring in relation to systemic disease such as sarcoidosis or toxoplasmosis. (1,2,3,4,5,6,7)

Uveitis may affect not only the uvea but also the optic nerve retina and vitreous. Uveitis is a major cause of visual impairment and may account for 10-15% of blindness in the USA. Of people aged under 65 who are registered legally blind, 10% are visually compromised because of uveitis and its complications, very nearly the same number affected by diabetic retinopathy.  This paper will embrace uveitis and also other inflammatory ocular manifestations of systemic diseases commonly encountered by physicians. (1,2,3,4,5,6,7)

International  Classification of Uveitis


Table- International Classification of Uveitis


Temporal- Acute versus Chronic ( >3 months)

In acute uveitis symptoms and signs occur suddenly and typically lasts up to 6 weeks. In chronic uveitis the onset is usually  gradual and the inflammation lasts longer than three months.



  • Anterior Uveitis ( Iris and anterior ciliary body )
  • Intermediate Uveitis ( posterior ciliary body- pars plana )   
  • Posterior Uveitis ( predominantly choroid)   



The above classification attempts to characterize uveitis appropriately based upon anatomical description of the major clinical signs. Once the type of uveitis has been identified, the process of meshing can be used to determine the appropriate etiology or syndrome. Even if an etiology cannot be established, a prognosis and suitable treatment regimen can often be formulated.  (5,6,7)

Overview of the Investigation and Management of Uveitis

The management of the patient with uveitis may involve the following,

  •             History taking  (ocular and general) 
  •             Complete ocular examination
  •             General physical examination
  •             Investigations
  •             Specialist medical referral ( for further evaluation )

Following history-taking and examination a short differential diagnostic list is compiled, taking into consideration the clinical features and the causes of uveitis seen in the patientís age group. The most practical approach with regard to the type of investigations to be arranged is one which is tailored to the individual patient.   (1,2,3)

Epidemiology of uveitis in the United Kingdom

A uveitis register at the Leicester Royal Infirmary consisted of data collected on all uveitis patients except minor easily resolved, anterior uveitis cases. The diagnoses of these patients were classified by the aetiological method. A total of 712 patients was entered into the register over a period of 10 years starting from January 1985. In the study, 73.0% of the cases fit into named clinical syndromes while 27.0% of the cases were diagnosed as idiopathic or uncategorised. The commonest definable cause of anterior uveitis was HLA-B27-related acute anterior uveitis, comprising 15.2% of all uveitis cases ( in some series up to 50% of uveitis is related to HLA B27 antigen ). Intermediate uveitis accounted for 7.9% of all cases while the commonest definable cause of posterior uveitis was toxoplasmosis, forming 4.6% of all uveitis cases.  (8)

The annual incidence in Western countries is approximately 17/100,000 while the prevalence of uveitis is estimated as about 38/100,000.  (1,3)



Ethnicity affects uveitis, for example- HLAB27 antigen is the commonest factor responsible for uveitis in Caucasians, in the Afro-Caribbean community  sarcoid is common whist Bechetís disease affects those of Asian and Middle Eastern origins (HLA B5 ). (1,2,3,4,5,6,7)


Table- Aetiology of Anterior uveitis

  • HLA-B27 Positive or Seronegative Group
  • Ankylosing spondylitis
  • Reiterís syndrome
  • Inflammatory bowel disease (Ulcerative colitis, Crohnís disease)
  • Psoriatic arthritis
  • Intraocular lens related
  • Herpes simplex
  • Herpes zoster
  • Trauma
  • Juvenile rheumatoid arthritis
  • Fuchsí Heterochromic iridocyclitis
  • Behcetís disease
  • Sarcoidosis
  • Tuberculosis
  • Syphilis
  • Glaucomatocyclitic crisis
  • Lens-induced uveitis
  • Idiopathic

Intermediate uveitis

  •             Pars planitis


Aetiology of Posterior uveitis


  • Infection                       Toxoplasma
  •                                     Histoplasmosis
  •                                     Cytomegalovirus
  •                                     Toxocara                                
  • Herpes simplex
  • Syphilis
  • Tuberculosis
  • Candida           
  • Retinal vasculitis
  • Sarcoidosis
    Sympathetic ophthalmia
  • Behcetís disease
  • Idiopathic                                          (1,2,3,4,5,6,7)




Clinical features of Anterior Uveitis

In acute uveitis symptoms and signs occur suddenly and last up to 6 weeks. Typically the patient has pain, ocular redness, blurred vision, photophobia and epiphora. The redness tends to be perilimbal with a violaceous hue.


Keratic precipitates

Occasionally the eye may be white with minimal pain. Examination of  the anterior chamber with the slit lamp microscope reveals the presence of white cells and flare. There may be small collections of white cells on the corneal endothelium (keratic precipitates). Mononuclear cells may collect to form iris nodules. The pupil may be irregular due to the presence of adhesions between the pupil margin and the anterior lens surface (posterior synechiae). Cells in the vitreous and occasionally oedema of the central retina (i.e. macular oedema) may be noted. (1,2,3)


Keratic precipitates (retroilumination )


Clinical features of Intermediate and  Posterior Uveitis


Disturbance of the central retina (macula) may cause blurred or distorted vision.

Cellular debris in the vitreous may cause floaters. The retina may appear cloudy and  white from oedema. Choroidal or retinal lesions may appear yellow or white, sometimes with black pigmented borders. Neovascularisation of the retina or optic nerve may be seen. Occasionally there may be swelling or pallor of the optic nerve head  

Debris in vitreous

The retinal vessels may be cuffed with inflammatory exudate. (1,2,3)


Retinal scarring from past toxoplasma.

Histopathology of Uveitis


The time course and the anatomical site of the inflammation can be determined in almost every case. Thus, at least these two aspects can be considered for every patient with uveitis (e.g., chronic iridocyclitis, acute retinitis). Acute disease usually starts abruptly and lasts 2 to 6 weeks, while chronic disease begins insidiously and has no defined endpoint, often lasting longer than 6 weeks.


Ocular inflammation involves vessel dilatation and increased vessel permeability with fluid extravasation and leucocyte migration. The ocular inflammation has acute and chronic phases. During the acute phase chemical mediators are elaborated, including prostaglandinís, histamine, serotonin, kinins, complement and leukotriene.


The chronic inflammatory phase can be granulomatous or non-granulomatous. Granulomatous inflammation  is characterized by infiltration with epithelioid cells, giant cells, plasma cells and lymphocytes. In non-granulomatous inflammation there is infiltration mainly with plasma cells and lymphocytes. Protein may leak from inflamed blood vessels and leucocytes may migrate from inflamed vessels, giving rise to so-called aqueous flare and cells. (1,2,3)


Investigations and Differential Diagnosis


The most practical approach is one which is tailored to the individual patient. and determine an appropriate management scheme can be aided by this system. It is not possible to review the many investigations routinely ordered for ocular inflammation individually but the following are worth stressing.



HLA-B27 Antigen


The test can be useful in cases of recurrent anterior uveitis. HLA-B27 denotes a genotype located on chromosome 6. It is present in 4% of the general population and up to 50% of patients with acute iritis. Many  patients with acute iritis therefore have a genetic predisposition. Factors which may trigger the occurrence of acute iritis are often unknown. In general, the importance of tissue tying for HLA B27 is under appreciated, the investigation has a high yield, is inexpensive, and gives patients an explanation of an often recurrent problem. (9)


Ankylosing spondylitis, Reiterís syndrome, psoriatic arthritis and inflammatory bowel disease are all associated with iritis, spondylitis and the presence of HLA-B27 positivity.         





Differential Diagnosis Of Uveitis- It is of paramount importance to note that uveitis can be caused or mimicked by the following-


ďMasquerade SyndromesĒ- neoplasms mimicking uveitis

Ocular malignant melanoma


Reticulum Cell Sarcoma ( Primary Intraocular Lymphoma )



Ocular Metastasis




Retinal detachment

Intraocular foreign body






Table Uveitis - Investigations


General Investigations


ESR / Plasma Viscosity/ C Reactive Protein



Syphilis Serology- TPHA, VDRL

Urine analysis ( Diabetes Mellitus )


Specific Investigations


HLA B27 Ag;   HLA B29 ( birdshot retinochoroidopathy )

Angiotensin Converting Enzyme

Rheumatoid Factor , Lupus Group Autoantibodies including anti-neutrophil cytopasmic antibody ( Wegenerís Granulomatosis ) Anticardiolipin Antibody- ( the yield of these investigations is actually low except in children with Juvenile Chronic Arthritis )

Toxoplasma Serology / IgG antibodies ( if negative on undiluted serum to exclude congenital toxoplasmosis )

Toxocara ELISA


Pathergy Test

Mantoux Test, Sputum Acid Fast Bacilli

X Ray Hands and SI Joints

B Scan for Masquerade Leisions or Posterior Scleritis

Kveim Test

Immune Complexes -Polyethylene Glycol Method

DNA Polymerase Chain Reaction ( Herpes virus, Propionebacter )

CT scan of chest ( sarcoidosis)

MRI( non Hodgkins lymphoma, neurosarcoid, demyelination )

Choroidal biopsy ( Non Hodgkinís Lymphoma )



Physician Referral


Rheumatological Referral

Broncho-alveolar lavage ( Sarcoid)

CSF studies ( non Hodgkins lymphoma, neurosarcoid, VKH )

Venereological Referral   HIV, Reiter's, Syphilis


A recent retrospective review showed the following abnormal results, plasma viscosity/ esr 34.2%, VDRL/TPHA (4.3%) Angiotensin converting enzyme (10.8%) Chest X ray ( 14.6%)




 Some Systemic Diseases Commonly Associated with Uveitis


Ankylosing Spondylitis  

About 30% of patients with Ankylosing spondylitis develop iritis. The iritis may precede the onset of back stiffness and pain. Rarely there may be retinal vasculitis and vitritis. (9,10,11)


Table Ankylosing Spondylitis


30% of AS patients develop iritis, especially if male; iritis may precede arthritis

rarely retinal vasculitis / vitritis.

Acute anterior uveitis lasting 2-6 weeks, good prognosis


Investigations in suspected ankylosing spondylitis

X-ray sacroiliac joints ( 2 yearly Sacroiliac joint X rays in males if initial X ray normal.)


Rheumatoid factor

HLA B27 (positive in more than 90% )

Need 2 yearly Sacroiliac joint X rays in males if initial X ray normal  (9,10,11)


Arthritis associated with uveitis

 Reiter's syndrome

This syndrome is characterised by the triad of arthritis, urethritis and conjunctivitis or less commonly, iritis. ( Conjunctivitis and iritis affect 60% and 20% of patients respectively.)

There may be also be associated episcleritis and keratitis.



Table- Reiter's Syndrome

triad of:  arthritis (weight bearing joints, sacroiliitis),

conjunctivitis or  iritis

urethritis (cervicitis).                         (9,10,11)





Table- Associations of Reiter's Syndrome


Occurs if genetically predisposed (HLA B27);  60 - 90% association


Exposure to certain urethritis / dysentery organisms: e.g.

Chlamydia, Yersinia, Shigella, Salmonella, Campylobacter.

The order of manifestation is normally: Ć urethritis ć conjunctivitis é arthritis.


20% anterior uveitis,

60% conjunctivitis,

episcleritis, keratitis, post-uveitis.

Reiterís disease can sometimes result in hypopyon formation    (9,10,11)


Juvenile Chronic Arthritis  


In juvenile chronic arthritis, a seronegative inflammatory arthritis affecting children, the patient often suffers from chronic anterior uveitis. The uveitis is most commonly seen in girls who are ANF positive and have pauciarticular disease. The uveitis is usually bilateral and may be complicated by the development of cataract, band keratopathy and glaucoma.




Table- Juvenile Chronic Arthritis


Chronic AAU , usually bilateral Commoner in female patients, the young, ANF positive. Pauciarticular disease <5 joints.



Glaucoma (20%)

Cataract (40%)

Band Keratopathy (40%)      (12,13)


The anterior uveitis is typically initially asymptomatic; the eyes are white rather than red

The visual prognosis may be adversely affected by a delay in diagnosis. Screening of affected children is therefore regarded as mandatory


Table- Monitoring Children with Juvenile Chronic Arthritis


High Risk


Early Onset , < 6 years, Pauciarticular Disease , ANA Positive


3 months for first year , then 6 months for five years , then annually


Medium Risk


polyarticular disease ANA positive , pauciarticular -disease ANA negative


6 monthly intervals for 5 years then annually


Low Risk


Systemic JCA , B27 associated arthritis , disease starting after age 11




For ten years after onset of JCA or until age 12, whichever is shorter.


Source RCOphth (UK),  British Paediatric Association (1994) (12)



Treatment includes topical corticosteroids, mydriatics, NSAID's and oral prednisolone  Chlorambucil may occasionally be required in severe cases. Reading glasses may be helpful if mydriatics are being used for both eyes as accommodation is paralysed by cycloplegics. Surgical treatment of cataract, glaucoma and band keratopathy may also be required. (12,13)



Toxoplasmosis gondii is an obligate intracellular protozoa causing up to 50% of cases of posterior uveitis .Ocular infection is characterised by focal necrotising retinochoroiditis with vitritis.In congenital infection the eye may also be affected by cataract, microphthalmos, and optic atrophy. (1,2,3)


Table- Congenital Toxoplasmosis


Highest transmission occurs in the IIIrd trimester

90% of congenital infections have no clinical signs

Earlier infection occurs in pregnancy - worse potential outcome

Triad:-   convulsions,

cerebral calcification

and chorioretinitis

Eye - chorioretinitis, cataracts, microphthalmos, panuveitis, optic atrophy  (1,2,3)


Toxoplasma focus


Complications include direct involvement of the fovea, papillomacular bundle, or optic disc. Cystoid macular oedema, subretinal neovascular membrane formation, tractional and rhegmatogenous detachment and retinal neovascularisation may also occur.   (1,2,3)




Table- Investigation of Toxoplasmosis


ELISA IgM in neonates, rising IgG in adults (although not that helpful in adults).

Fluorescein angiography (hypofluorescence in the early stages and then progressive leakage).

Indocyanine angiography - multiple small dark spots may be seen around the visible lesions implying the affected retina is greater than apparent initially. This sign may be useful in assessing the effect of treatment.  (5,6,7)



Some authorities argue that any active chorio-retinal lesion should be treated in order to decrease the risk of  macular traction, secondary retinal detachment and cystoid macular oedema. Medications used for treatment include pyramethamine, clindamycin,  sulfadiazine and  prednisolone.  Rarely, vitrectomy may be indicated for the removal of vitreous opacities and  haemorrhage and for the release of vitreoretinal traction.



Table- Some indications for active treatment of toxoplasmosis


Lesions that involve  the macula, papillomacular bundle or optic disc

and large, active lesions should be treated.

Immunocompromised patients should be treated.    



Behcetís Disease


This idiopathic systemic disease consists of an obliterative vasculitis and usually effects young males of Japanese and eastern Mediterranean origin. The eye may be involved with conjunctivitis, episcleritis, keratitis and uveitis. The anterior uveitis is usually acute with recurrent episodes. Severe disease may be indicated by the presence of a hypopyon. The eye may be white. Chronic uveitis is less common.  (1,14,15)


Table - Behcetís Disease


Idiopathic, systemic disease consisting of an obliterative vasculitis possibly due to circulating immune complexes


Young males, Japanese and eastern Mediterranean, HLA-B5 associated



Oral ulceration-100%, may pre-date eye disease, painful, recurrent

Genital ulceration- 90%, may be asymptomatic in females

Skin- erythema nodosum, pustules, ulceration, cutaneous hypersensitivity

Arthritis- non-destructive, wrists and ankles

CNS- palsies, brainstem syndrome, meningoencephalitis, affects 25% and major cause of mortality        (1,14,15)



Posterior uveitis is  more common than anterior uveitis. There may be vitritis; this is usually associated with anterior uveitis. Diffuse vascular leakage may lead to retinal oedema, cystoid macular oedema and optic disc oedema. Retinal vasculitis, predominantly periphlebitis, can lead to branch retinal vein occlusion and retinal neovascularization. Retinitis may be manifest as transient white necrotic infiltrates and intraretinal haemorrhages.     (1,14,15)


Aphthous ulcers


Anterior uveitis is treated with topical corticosteroids and mydriatics. Posterior uveitis is treated with oral prednisolone, usually with immunosuppression suc as azothiaprine chlorambucil and cyclophosphamide. The visual prognosis is often  poor.  (16)




This chronic non-caseating granulomatous systemic disease of unknown aetiology affects women more commonly than men and is more common in individuals of Afro-Caribbean ethnicity. (16,17,18)


Ocular Manifestations


About 30% of patients with sarcoidosis have ocular involvement.

Iritis  may be acute or chronic; it may be unilateral or bilateral. Patients with posterior uveitis usually have anterior uveitis as well. Vitritis is also common and tends to occur in older patients.


"Mutton fat" KPs

There may be retinal periphlebitis; the vessels may display an exudative cuff

(so called Ďcandle wax drippingsí). Inflammation of the retina may lead to macular oedema, retinal granuloma, preretinal nodules and retinal haemorrhage. Inflammation of the optic nerve may cause optic disc oedema, granuloma and neovascularization.


Branch retinal vein occlusion and retinal neovascularisation are uncommon. (16,17,18)



Table- Sarciodosis - Investigations


Chest X-ray


Serum ACE (angiotensin converting enzyme)- this is elevated in active disease

urine and serum calcium levels- hypercalciuria is common; hypercalcaemia is less common


Conjunctival biopsy may show granulomata


Broncho-Alveolar Lavage       (7,8,19)





Anterior uveitis is treated with topical corticosteroids and mydriatics. Orbital floor steroids, such as Depomedrone,  dexamethasone 40mg, can be given for unilateral posterior uveitis. Oral prednisolone may be given for bilateral posterior uveitis. Some patients may require immuno-suppression. (1,20,21,22,23)


Tuberculosis ( Ocular Manifestations )


The eyelids may be affected by lupus vulgaris with skin nodules surrounded by erythema.The orbit may be affected by cellulitis, dacryoadenitis, dacryocystitis, osteomyelitis and abscess formation.There may be  chronic conjunctivitis, episcleritis or scleritis.The cornea may be affected by keratoconjunctivitis or interstitial keratitis.

TB Vasculitis


Uveitis is the most common ocular manifestation. There may be chronic granulomatous anterior uveitis, multifocal choroiditis, exudative retinitis, vasculitis and optic nerve oedema.  Anti-tuberculous medications -isoniazid, ethambutol and rifampicin are given for at least 6 months. The use of prednisolone in ocular disease  is controversial. (16,17,18)



Table- Ocular Manifestations of Tuberculosis


Affects 2% of sufferers of active tuberculosis , uveitis is commonest manifestation.  Systemic disease is often apparent.


Eyelids- lupus vulgaris (nodules surrounded by erythema)

Orbit- cellulitis, dacryoadenitis, dacryocystitis, osteomyelitis, abscess

Conjunctiva- rarely affected, chronic conjunctivitis

Cornea- phlyctenular keratoconjunctivitis, interstitial keratitis (unilateral, sectorial, superficial vascularisation)

Sclera- episcleritis, nodular scleritis

Uveitis- chronic granulomatous anterior uveitis, multifocal choroiditis, exudative retinitis, vasculitis, optic nerve oedema, papilloedema       (16,17,18)




Herpes Zoster Ophthalmicus   

Herpes Zoster Ophthalmicus is commonly seen in the elderly. A vesicular rash is seen affecting the ophthalmic trigeminal distribution. The presence of vesicles on side of tip of nose (Hutchinsonís sign) indicates involvement of  the external nasal branch of nasociliary nerve and is associated with a high rate of ocular disease. Immunosuppression is  a risk factor for development of the disease.


There is often chronic anterior uveitis. Complications include sectoral iris atrophy, glaucoma, cataract, hypotony and phthisis bulbi. Posterior segment inflammation is seen including vitritis, retinal vasculitis and optic neuritis.


Therapy includes the following. Acyclovir ointment  (5 X day) is given. Topical corticosteroids  and mydriatrics are given for anterior uveitis. Anti-glaucoma medications are required occasionally. Prednisolone may be given if neurological, orbital or optic nerve involvement occurs. (1,2,3)



Table- Herpes Zoster Ophthalmicus


50% of varicella infected patients will develop zoster by 80yrs

15% trigeminal, 50% thoracic

Age is the most common predisposing factor, immunosuppression occurs in 1-2 % only.


Pathology is related to ischaemic vasculitis caused by viral invasion.


#10% will have ophthalmic involvement and of these 50% will develop complications

3-5 days of pain in trigeminal distribution maculopapular rash - vesicular (may not develop rash - zoster sine herpete)


Hutchinsonís sign- involvement of external nasal branch of nasociliary nerve - vesicles on side of tip of nose ř 93% will develop ocular disease

Lid margin vesicles ř 100% ocular involvement)



Ocular Manifestations Of  Acquired Syphilis

Uveitis may be acute or chronic, unilateral or bilateral. Interstitial keratitis affects a small percentage of acquired cases and is often unilateral. Chorioretinitis is bilateral in 50% of cases; multifocal or diffuse yellow exudate is seen.  (25,26)


The chorioretinitis may resolve, leaving extensive bone spicule pigmentation. The appearance may resemble retinitis pigmentosa. There may be retinal oedema, haemorrhages, exudates, cotton wool spots and vascular sheathing. Optic disc oedema may also be seen.


Investigations for suspected syphilitic uveitis include VDRL and FTA-ABS tests.

The VDRL test is useful for screening; false positive results may occur. The FTA-ABS test remains positive for life, even after treatment. (7,8)


Treatment- Syphilitic may be cured with treatment, in other types of uveitis, the condition is usually suppressed  by topical steroids.  Medications that may be considered include penicillin, erythromycin, doxycycline and ceftriaxone. (25,26)


Guidelines for the Treatment of Uveitis


The exact nature of the clinical features, their severity and their time course will vary between individual patients. Appropriate treatment requires knowledge of the patientís type of uveitis and awareness of the details of the individualís clinical features. In addition, the risks and benefits of various treatment options need to be considered.

The nature of the uveitis and any limitations of treatment should be outlined to the patient. (1,3)


Table Treatment of Uveitis


Specific vs. Nonspecific

Local Ocular vs. Systemic

Medical vs. Surgical

Specialist referral, for example to a rheumatologist, paediatrician or infectious disease specialist, may be helpful in many cases. A useful specialist report is more likely to be obtained if one indicates to the specialist the diagnostic possibilities that are being considered (e.g. juvenile rheumatoid arthritis, sarcoidosis).          (27)



Specific treatment, such as antimicrobial medication for infectious uveitis, should be given when appropriate. Examples include uveitis due to toxoplasma, syphilis or tuberculosis.


Ocular medication (such as eye drops or subconjunctival injection) is generally preferred to systemic medication (such as oral or intravenous therapy) in view of the much lower incidence of systemic side effects from ocular medication. (1,2,3)



Routes of administration of corticosteroid for uveitis include eye drops, ointment, periocular injection, oral and intravenous. The initial dose should be proportional to the severity of the inflammation. The dose is tapered gradually in order to minimize the risk of recurrence; the dose is correlated with the severity of the inflammation. Systemic corticosteroids can be given for certain types of posterior uveitis and for severe anterior uveitis unresponsive to intensive topical therapy. Eye drops are effective for anterior segment inflammation. Various strengths are available (table 3). Possible side effects from topical therapy are glaucoma, posterior subcapsular cataract and exacerbation of infection (particularly herpes simplex).  (1,3)



Table Corticosteroid eye drops  (in order of decreasing strength)




Fluorometholone   (1,3)


Mydriatic eye drops

Mydriatic eye drops (see table 4) produce pupil dilatation (mydriasis) and paralysis of the ciliary body (cycloplegia). It is important for mydriatic eye drops to be used in anterior uveitis as they provide pain relief, prevent posterior synechiae formation and also break any posterior synechiae that have already formed. Posterior synechiae can cause permanent pupil irregularity and can, if extensive, cause glaucoma. Short acting mydriatic eye drops allow the dilated pupil to remain mobile and possibly less likely to develop posterior synechiae if the inflammation is mild.



Table             Mydriatic eye drops (in decreasing order of  strength)




Atropine                               (2)



Cytotoxic medication and Immunosupression


These medications are commonly used as steroid sparing agents, patients will usually not be able to tolerate doses of prednisolone above 20 milligrams per day for long periods. Cytotoxic medication can cause serious side effects, such as bone marrow suppression, and is therefore reserved for patients with potentially blinding uveitis in whom the use of corticosteroid therapy is effective, poorly tolerated or contraindicated. Cyclosporin, an anti-T-cell immunosupressive agent, is occasionally used in severe uveitis when corticosteroids and cytotoxic medication are ineffective. (1)


Table             Cytotoxic and Immunosuppressive medication used in Uveitis Therapy

Cyclosporin- selectively depresses CD4+ lymphocytes

Azathioprine-  interferes with purine synthesis

Chlorambucil- alklating agent, used for Bechetís Diease 

Cyclophosphamide- alkylating agent used for uveitis in combination with life threatening systemic disease such as Wegenerís Granulomoatosis

Methotrexate  (seldom used) folic acid antagonist

FK 506 ( Tacrolimus), Rapamycin- alkylating agents, originally derived from streptococcus species     (1)



Uveitis may be an important consequence of systemic disease with profound implications for patient morbidity and quality of life. In many cases the morphology of ocular inflammation may be an important guide to the nature of the underlying disease under investigation. (1,3,23) The review encompasses  common types of uveitis encountered  in assocation with systemic disease in clinical practice and has outlined practical clinical approaches to investigate and treat uveitis .




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