Iritis and Uveitis Follow-up

Author: Keith Tsang, MD; Chief Editor: Rick Kulkarni, MD more...

Updated: May 4, 2011

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Further Outpatient Care
Complications
Prognosis
Patient Education
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Further Outpatient Care

Follow-up care with an ophthalmologist within 24 hours is imperative.

In the acute phase, cases of uveitis are followed every 1-7 days with slit-lamp examination and intraocular pressure measurements.

The ophthalmologist tapers steroids and cycloplegics.^[8]

When the condition is stable, patients are monitored every 1-6 months.

A fluocinolone acetonide intravitreal implant, available from Bausch & Lomb, provides continuous therapy for approximately 30 months.^{[9, 10]}

Complications

An acute rise in intraocular pressure secondary to pupillary block (posterior synechiae), inflammation or topical corticosteroid use is the single most important complication.

Examine all patients presenting with a red eye with a slit lamp to detect the presence of cells or flare.

Consider all other causes of a red eye^[11]before uveitis is diagnosed.

An acute rise in intraocular pressure can lead to optic nerve atrophy and permanent vision loss.

Prognosis

Generally, the prognosis for iritis and uveitis is good with appropriate treatment.

Patient Education

For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education articles Anatomy of the Eye and Iritis.

Contributor Information and Disclosures

Author

Keith Tsang, MD Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital

Keith Tsang, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas Lavenburg, MD Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kilbourn Gordon III, MD, to the development and writing of this article.

References

Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. Sept 2005;140:509-16. [Medline].
Yanoff and Duker. Uveitis and other intraocular inflammations. In: Ophthalmology. 3^rd ed. Mosby; 2008.
McCannel CA, Holland GN, Helm CJ, Cornell PJ, Winston JV, Rimmer TG. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol. Jan 1996;121(1):35-46. [Medline].
Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ, et al. Referral patterns of uveitis in a tertiary eye care center. Arch Ophthalmol. May 1996;114(5):593-9. [Medline].
[Best Evidence] Islam N, Pavesio C. Uveitis (acute anterior). Clin Evid (Online). November 2009;04:705.
Wills Eye Hospital. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5^th ed. Philadelphia, Pa: Lippincott; 2008.
Abad S, Seve P, Dhote R, Brezin AP. [Guidelines for the management of uveitis in internal medicine]. Rev Med Interne. Jun 2009;30(6):492-500. [Medline].
Lyon F, Gale RP, Lightman S. Recent developments in the treatment of uveitis: an update. Expert Opin Investig Drugs. May 2009;18(5):609-16. [Medline].
Lim LL, Smith JR, Rosenbaum JT. Retisert (Bausch & Lomb/Control Delivery Systems). Curr Opin Investig Drugs. Nov 2005;6(11):1159-67. [Medline].
Mohammad DA, Sweet BV, Elner SG. Retisert: is the new advance in treatment of uveitis a good one?. Ann Pharmacother. Mar 2007;41(3):449-54. [Medline].
Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Apr 2006;119(4):302-6. [Medline].
Dunne JA, Travers JP. Topical steroids in anterior uveitis. Trans Opthalmol soc UK. 1979;99(4):481-4. [Medline].
Foster CS, Alter G, DeBarge LR, Raizman MB, Crabb JL, Santos CI, et al. Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis. Am J Ophthalmol. Aug 1996;122(2):171-82. [Medline].
Merck Manuals: Uveitis. Available at http://www.merck.com/mmhe/sec20/ch232/ch232a.html.
Nishimoto JY. Iritis. How to recognize and manage a potentially sight-threatening disease. Postgrad Med. Feb 1996;99(2):255-7, 261-2. [Medline].
Nussenblatt R, Whitcup S, Palestine A. Uveitis: Fundamentals and Clinical Practice. 2^nd ed. St. Louis, Mo: Mosby; 1996.
Tessler H. Classification and symptoms and signs of uveitis. In: Duane T, ed. Clinical Ophthalmology. New York, NY: Harper and Row; 1987:1-10.

Anatomy of the eye.

Small stellate keratic precipitates with fine filaments in a patient with Fuchs heterochromic iridocyclitis.

Table 1. Classification of Uveitis

Table 1. Classification of Uveitis

Type	Primary Site of Inflammation	Includes
Anterior uveitis	Anterior chamber	Iritis/iridocyclitis/anterior cyclitis
Intermediate uveitis	Vitreous	Pars planitis/posterior cyclitis/hyalitis
Posterior uveitis	Choroid	Focal, multifocal, or diffuse choroiditis/chorioretinitis/retinochoroiditis/retinitis/Neuroretinitis
Panuveitis	Anterior chamber, vitreous, and/or choroid

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