Emergency Department Care
The main goals in the emergency department are to correctly diagnose uveitis, to provide analgesia, and to refer the patient to an ophthalmologist [22] for possible initiation of topical steroids.
Although the patient's eye is erythematous and cells are present in the anterior chamber, antibiotics are not indicated.
Consultations
Patients with possible uveitis should be examined by an ophthalmologist within 24 hours.
Long-Term Monitoring
Follow-up care with an ophthalmologist within 24 hours is imperative.
In the acute phase, cases of uveitis are monitored every 1 to 7 days with slit-lamp examination and intraocular pressure measurements.
The ophthalmologist tapers steroids and cycloplegics. [23]
When the condition is stable, patients are monitored every 1 to 6 months.
Two sustained-release corticosteroid vitreous implants (fluocinolone acetonide [Retisert, Yutiq] and dexamethasone [Ozurdex]) have been approved by the FDA for the treatment of inflammation-induced cases of panuveitis, intermediate uveitis, and posterior uveitis. [1] These implants preclude risks associated with systemic steroids and reduce the need for immunosuppressive agents while providing continuous therapy (approximately 30-36 months). [24, 25] The installation and monitoring of these treatment modalities should be managed by an ophthalmologist.
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Anatomy of the eye.
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Small stellate keratic precipitates with fine filaments in a patient with Fuchs heterochromic iridocyclitis.
Tables
Type |
Primary Site of Inflammation |
Manifestation |
Anterior uveitis |
Anterior chamber |
Iritis/iridocyclitis/anterior cyclitis |
Intermediate uveitis |
Vitreous |
Vitreitis/hyalitis/pars planitis |
Posterior uveitis |
Choroid |
Choroiditis/chorioretinitis/retinochoroiditis/retinitis/neuroretinitis |
Panuveitis |
Anterior chamber, vitreous, and/or choroid |
All of the above |
