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Key Features

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Essentials of Diagnosis
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  • Iridocyclitis associated with juvenile idiopathic arthritis

    • May be asymptomatic despite severe ocular inflammation

    • Occurs most often in girls with oligoarticular arthritis and a positive antinuclear antibody test

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General Considerations
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  • Other causes

    • Syphilis

    • Tuberculosis

    • Sarcoidosis

    • Relapsing fever (borreliosis)

    • Lyme disease

  • Juvenile spondyloarthropathies, including ankylosing spondylitis, reactive arthritis (Reiter syndrome), and psoriatic arthritis, are associated with anterior uveitis

  • A substantial percentage of cases are of unknown origin

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Clinical Findings

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Symptoms and Signs
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  • Injection, photophobia, pain, and blurred vision usually accompany iritis (anterior uveitis or iridocyclitis)

  • Other ocular findings of the anterior segment include conjunctivitis, episcleritis, and sterile corneal infiltrates

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Differential Diagnosis
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  • Iridocyclitis due to autoimmune disorder

  • Trauma

  • Infection

  • Malignancy

  • Idiopathic etiology

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Diagnosis

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  • Slit-lamp examination reveals anterior chamber inflammation with inflammatory cells and protein flare

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Treatment

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  • Topical corticosteroid and a cycloplegic agent is aimed at quieting the inflammation and preventing or delaying the onset of cataract and glaucoma

  • Methotrexate and other systemic immunosuppressive agents can be used in refractory cases

  • Systemic antitumor necrosis factor agents such as etanercept, infliximab, and adalimumab show promise in treating refractory cases

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Outcome

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Complications
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  • Permanent decreased vision due to

    • Cataracts

    • Secondary glaucoma

    • Band keratopathy

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Prognosis
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  • Depends on the severity of ocular inflammation, development of cataracts, and secondary glaucoma

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Reference

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Tugal-Tutkun  I: Pediatric uveitis. J Ophthalmic Vis Res 2011;6(4):259–269
[PubMed: 22454749]

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