eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Uveitis, Anterior, Childhood: Follow-up

Author: R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
Contributor Information and Disclosures

Updated: Jan 5, 2008

Follow-up

Further Outpatient Care

  • Follow-up care is on a case-by-case basis and depends on the cause of the uveitis, the severity of the uveitis, and the medications used in treatment.
    • In the short term, adequate control of the inflammation must be assessed and monitored. Intraocular pressure must be monitored as elevations may result from inflammation, corticosteroid treatment, or both.
    • Longer term follow-up care additionally focuses on the formation of cataracts, cystoid macular edema, angle-closure glaucoma, and band keratopathy, in addition to the previously mentioned areas.
    • General medical evaluations are required for those patients on systemic immunosuppressants, such as prednisone and methotrexate.
  • The German Uveitis in Children Study Group recommends screening examinations for children with JIA as outlined below.
    • Children with JIA and no previous history of uveitis
      • Oligoarthritis, RF-negative polyarthritis, or early childhood psoriatic arthritis: Screening examinations should be conducted at 6-week intervals for 2 years, then every 3 months for the next 5 years.
      • Systemic arthritis or RF-positive polyarthritis: Screening examinations should be conducted every 3 months for 7 years.
      • Enthesitis-associated arthritis or late onset psoriatic arthritis: Screening examinations should be conducted every 6 months.
    • Children with JIA and a history of uveitis: The intervals of screening examinations should be adjusted based upon the activity and the treatment of the uveitis.

Inpatient & Outpatient Medications

Complications

  • Band keratopathy
  • Cataract
  • Glaucoma
  • Synechiae
  • Cystoid macular edema
  • Amblyopia
  • Hypotony
  • Phthisis

Prognosis

  • Prognosis in juvenile anterior uveitis varies greatly for the different causes. Systemic infections and Kawasaki disease have relatively benign courses. Uveitis associated with inflammatory bowel disease may be very mild or recurrent and of moderate severity. Reactive arthritis and AS may cause severe recurrent episodes of fibrinous inflammation.
  • Prognosis in sarcoid uveitis may vary widely; intractable cases leading to blindness do occur.
  • Uveitis related to JIA requires aggressive and careful follow-up, as it continues to be a blinding condition. Aggressive and persistent treatment of uveitis is required to avoid the severe complications, which may evolve insidiously.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • One common pitfall in the diagnosis of anterior uveitis in childhood and adolescence is concluding that an instance of uveitis is related to an early form of JIA, before excluding spondyloarthropathies, such as reactive arthritis, AS, and inflammatory bowel disease. However, the most common systemic association indeed is JIA.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Peter H Spiegel, MD, to the development and writing of this article.



More on Uveitis, Anterior, Childhood

Overview: Uveitis, Anterior, Childhood
Differential Diagnoses & Workup: Uveitis, Anterior, Childhood
Treatment & Medication: Uveitis, Anterior, Childhood
Follow-up: Uveitis, Anterior, Childhood
References
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Further Reading

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Keywords

anterior uveitis, juvenile idiopathic arthritis, JIA, juvenile rheumatoid arthritis, JRA, ankylosing spondylitis, AS, reactive arthritis, Reiter syndrome, inflammatory bowel disease, IBD, sarcoidosis

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Contributor Information and Disclosures

Author

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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