Table of Contents

Pediatric Anterior Uveitis

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
- Tubulointerstitial 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 PCR
  - VZV PCR
- 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 DNA PCR or Lyme Disease AB Western Blot
- 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
  - Borrelia burgdorferi antibodies IgG, IgM
Fever, Weight loss, fatigue, malaise, abdominal pain
- urinary β2 microglobulin, BUN, Creatinine, UA. ANA, HLA-B27, CBC
Previous Strep throat (group A strep infection suspected
- Antistreptolysin O titers

Masquerades of Anterior Uveitis

Leukemia
Retinoblastoma
Juvenile Xanthogranuloma

References

AAO Pediatric Anterior Uveitis