Uveitis in Children

Abstract

Uveitis in children is an important cause of ocular morbidity and severe vision loss. The diagnosis and the management are challenging in such population due to some unique presentations. Majority of the cases are idiopathic with infectious causes contributing to about one fifth of the cases. Various causes of infectious uveitis include tuberculosis, toxoplasmosis, toxocariasis. Anterior uveitis is the most common anatomical type of uveitis in children followed by almost equal incidence of posterior, intermediate and panuveitis. The examination is often difficult in children and diagnostic evaluation is challenging. The management requires multidisciplinary approach involving the rheumatologist and uveitis specialist. Exclusion of infectious and masquerade causes is of utmost importance before starting any immunomodulatory treatment. The primary aim of the treatment is to reduce the inflammation as early as possible to prevent complications. Corticosteroids are the main pillar stone for the management. The dosage and the route of the steroids should be optimized according to the growth and development of the child as it may have to be given for a longer duration. Steroid sparing agents such as methotrexate, cyclosporine, azathioprine and biologic agents are reserved for children refractory to treatment with steroids. Children tend to develop complications of uveitis more often than in adults, which include band keratopathy, cataract, glaucoma, cystoid macular edema, amblyopia and strabismus.