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
  • 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

References

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