Regular review: Management of chronic uveitis

Abstract

To many, uveitis is an acute problem that resolves after treatment with topical corticosteroids. While this may be true of acute anterior uveitis, many forms of uveitis are chronic in nature and often require continuous treatment. The uveitis may be anterior, posterior, or both, and there can be considerable ocular morbidity. 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. 1 2 Given that uveitis is a much rarer disorder than diabetes (about 250 times less common), this gives some indication of the severity of the problems that can occur. This article describes the management of chronic uveitis, including its diagnosis and differential diagnosis, indications for and types of treatment, and the management of complications. #### Summary points Intraocular inflammation has various causes and can be acute or chronic In either case the inflammatory process can be apparently localised to the eye or be part of a systemic disease such as sarcoidosis or Beh¸et's disease The inflammation can occur in any part of the eye—anterior, posterior, or both—and visual loss can occur with any type Treatment depends on the location and severity of the inflammation, with systemic drugs being reserved for sight threatening posterior disease Complications are common and include cataract, glaucoma, macular oedema—all of which can reduce vision Chronic uveitis encompasses a heterogeneous group of diseases, many of which are idiopathic in origin.3 Systemic diseases, including sarcoidosis and Beh¸et's syndrome, can be associated with either acute or chronic uveitis. Chronic uveitis can be differentiated from acute recurrent anterior uveitis by its rate of progression4 and can usefully be defined as active uveitis that persists longer than three months. Chronic uveitis is associated with a high incidence of vision threatening complications such …