Uveitis in Children and Adolescents

Overview

How does the eye work?

The eye functions in the same way as the inner workings of a camera.

The front of the eye admits light rays through the cornea and the pupil (the middle of the iris that determines how much light enters the eye).

Next, the lens focuses that light through a clear gel-like substance—called the vitreous humor—onto the retina. The aqueous humor is in the front part of the eye in the anterior chamber. The retina is a thin layer of tissue that makes up the inner lining of the back of the eye.

The retina works like film in a camera, transforming light into images. It converts the light rays to impulses that travel along the optic nerve to the brain. The brain integrates the images sent from both eyes and interprets them as a single, three-dimensional image. This lets us perceive depth and distance.

If any of the parts of the eye become damaged, changes in eyesight can occur.

What is uveitis?

Uveitis is an inflammation of inner parts of the eye. The uvea consists of:

  • the iris (the colored portion of the eye)
  • the ciliary body (which produces fluid inside the eye and controls the movement of the lens)
  • the choroid (which lines the eyeball from the iris all the way around the eye)

Uveitis might also be known as iritis or iridocyclitis, depending on which part of the eye is affected by inflammation.

Symptoms and Causes

What causes uveitis in children and adolescents?

Uveitis can be caused by infection, injury or an autoimmune or inflammatory disease. However, many times an exact cause cannot be identified. This type is known as idiopathic, non-infectious uveitis.

What are the symptoms of uveitis in children and adolescents?

The symptoms of uveitis may not be obvious. Sometimes, children might complain of light bothering their eyes or blurred vision. Your child's eyes might look red or cloudy. However, these symptoms usually develop so slowly that permanent eye damage can occur before any visual difficulties are noticed.

In order to detect eye problems and prevent them from causing damage, your child needs frequent eye exams with a pediatric ophthalmologist.

Diagnosis and Tests

What is an ophthalmologist?

An ophthalmologist is a medical doctor who specializes in diagnosing and treating eye diseases. An ophthalmologist is different than an optometrist. In many states, optometrists do not prescribe treatments.

What happens during an ophthalmologist appointment for uveitis in children and adolescents?

The eye exam performed by the ophthalmologist is painless and lasts several minutes. Be sure to tell the ophthalmologist about the medicines your child is taking. (If your child sees a rheumatologist, he or she can tell you the names of the medicines, the dosages, and why they have been prescribed.)

Prior to the eye exam, the ophthalmologist will put drops in your child's eyes (which might burn a little) to make the pupils bigger (dilate). Dilating your child's eyes helps the doctor clearly view the inside of the eyes.

To detect eye inflammation, the ophthalmologist uses a special microscope called a slit lamp. The machine shines a thin beam of light into one eye at a time so the doctor can view the insides of the eyes.

A visual field exam might also be performed to detect vision changes.

What is the role of a rheumatologist in treating uveitis in children and adolescents?

Rheumatologists become involved in the care of patients with eye disease when the eye disease is difficult to control. Rheumatologists are able to diagnose autoimmune and inflammatory diseases. They can further evaluate the patient for systemic conditions that can be associated with eye inflammation. These doctors also know a great deal about the immunosuppressive medications that may be used to treat the disease and can monitor for potential side effects also. The role of the rheumatologist is important in the care of patients with eye inflammatory disease, so regular follow-up is necessary.

Management and Treatment

How is uveitis in children and adolescents treated?

If eye problems occur, your rheumatologist and ophthalmologist will discuss ways to treat them to prevent permanent eye damage.

If uveitis is diagnosed, different types of eye drops might be prescribed. Eye drops to dilate the eyes may be prescribed in order to keep the pupils open and help prevent scarring. Steroid drops might be prescribed to reduce swelling and decrease inflammation. However, long-term use of steroid eye drops can have significant side effects, such as glaucoma and cataracts.

If eye drops are not effective in decreasing the inflammation, oral steroids (taken by mouth) might be prescribed. Oral or injectable methotrexate is now often used to treat significant eye inflammation so the long-term side effects of steroids can be avoided. In cases of severe uveitis, new biologic medicines such as infliximab or adalimumab may be used.

What are complications of uveitis in children and adolescents?

If the inflammation is not detected and treated early, scarring and vision problems can occur. Glaucoma, cataracts, and permanent visual damage (including blindness) are all complications that could result from severe uveitis.

Prevention

How can further eye problems be prevented if my child has uveitis?

Carefully follow medicine guidelines and keep all scheduled appointments with your rheumatologist and ophthalmologist, even if you think your child’s eye problems are under control.

Living With

How often should my child with uveitis have eye examinations?

Ask your rheumatologist and ophthalmologist how often your child's eye exams should be scheduled and follow their recommendations. If eye problems are detected, more frequent examinations will be necessary.

Last reviewed by a Cleveland Clinic medical professional on 02/22/2019.

References

  • Expert knowledge and experience of healthcare providers at Cleveland Clinic
  • Angeles-Han ST, Rabinovich CE. Uveitis in children. Curr Opin Rheumatol. 2016;28(5):544-9.
  • American Academy of Ophthalmology. Pediatric Anterior Uveitis. (https://www.aao.org/disease-review/pediatric-anterior-uveitis) Accessed 3/1/2019.
  • Parker DM, Angeles-han ST, Stanton AL, Holland GN. Chronic Anterior Uveitis in Children: Psychosocial Challenges for Patients and Their Families. Am J Ophthalmol. 2018;191:xvi-xxiv.

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