eMedicine Specialties > Ophthalmology > Iris & Ciliary Body
Uveitis, Anterior, Childhood: Follow-up
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.
- Children with JIA and no previous history of uveitis
Inpatient & Outpatient Medications
- See Medication.
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
- For excellent patient education resources, visit eMedicine's Eye and Vision Center and Arthritis Center. Also, see eMedicine's patient education articles Anatomy of the Eye, Iritis, Juvenile Rheumatoid Arthritis, Psoriatic Arthritis, and Inflammatory Bowel Disease.
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.
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.
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References
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Further Reading
Keywords
anterior uveitis, juvenile idiopathic arthritis, JIA, juvenile rheumatoid arthritis, JRA, ankylosing spondylitis, AS, reactive arthritis, Reiter syndrome, inflammatory bowel disease, IBD, sarcoidosis
Follow-up: Uveitis, Anterior, Childhood