eMedicine Specialties > Emergency Medicine > Ophthalmology

Iritis and Uveitis: Follow-up

Author: Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Contributor Information and Disclosures

Updated: Aug 13, 2009

Follow-up

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 exam and intraocular pressure measurements.
  • The ophthalmologist tapers steroids and cycloplegics.3
  • 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.4,5

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 eye6 before uveitis is diagnosed.
  • An acute rise in intraocular pressure can lead to optic nerve atrophy and permanent vision loss.

Prognosis

  • Generally, the prognosis is good with appropriate treatment.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose uveitis correctly may lead to permanent vision loss.
    • Uveitis is a diagnosis of exclusion; consider all other causes of a red eye first.
    • Use the slit lamp to examine all red eyes.
    • ED physicians must be trained in the proper use of slit lamps to detect cells and flare.
  • Prescription of topical corticosteroid medication in the ED is problematic.
    • Accurate intraocular pressure must be obtained, and herpes keratitis must be ruled out before considering topical steroid application.
    • Steroid treatment usually is initiated only in consultation with an ophthalmologist.
 


More on Iritis and Uveitis

Overview: Iritis and Uveitis
Differential Diagnoses & Workup: Iritis and Uveitis
Treatment & Medication: Iritis and Uveitis
Follow-up: Iritis and Uveitis
References
Further Reading
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References

  1. Wills Eye Hospital. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5th ed. Philadelphia, Pa: Lippincott; 2008.

  2. 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].

  3. 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].

  4. Lim LL, Smith JR, Rosenbaum JT. Retisert (Bausch & Lomb/Control Delivery Systems). Curr Opin Investig Drugs. Nov 2005;6(11):1159-67. [Medline].

  5. 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].

  6. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Apr 2006;119(4):302-6. [Medline].

  7. Nishimoto JY. Iritis. How to recognize and manage a potentially sight-threatening disease. Postgrad Med. Feb 1996;99(2):255-7, 261-2. [Medline].

  8. Nussenblatt R, Whitcup S, Palestine A. Uveitis: Fundamentals and Clinical Practice. 2nd ed. St. Louis, Mo: Mosby; 1996.

  9. Tessler H. Classification and symptoms and signs of uveitis. In: Duane T, ed. Clinical Ophthalmology. New York, NY: Harper and Row; 1987:1-10.

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Keywords

iritis, uveitis, inflammation of the uveal tract, inflammation of the iris, inflammation of the ciliary body, inflammation of the choroid, iridocyclitis, anterior uveitis, posterior uveitis, choroiditis, chorioretinitis, retinitis

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Contributor Information and Disclosures

Author

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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