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Uveitis in Children and Adolescents.

Margaret H Chang1, Jessica G Shantha2, Jacob J Fondriest3

  • 1Division of Immunology, Boston Children's Hospital, Harvard Medical School, Fegan 6, 300 Longwood Avenue, Boston, MA 02115, USA.

Rheumatic Diseases Clinics of North America
|October 12, 2021
PubMed
Summary

Childhood noninfectious uveitis can cause vision loss. Early detection and treatment, including immunosuppression for severe cases, are crucial for optimizing vision in affected children.

Keywords:
AutoimmuneOphthalmologyPediatricsRheumatologyUveitis

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Area of Science:

  • Ophthalmology
  • Immunology
  • Pediatrics

Background:

  • Childhood noninfectious uveitis presents significant risks for sight-threatening complications.
  • Idiopathic chronic anterior uveitis and juvenile idiopathic arthritis-associated uveitis are the most prevalent forms.
  • Ocular inflammation stems from an immune response targeting intraocular antigens.

Purpose of the Study:

  • To outline the diagnostic and therapeutic strategies for childhood noninfectious uveitis.
  • To emphasize the importance of early detection and intervention in managing pediatric uveitis.
  • To discuss the role of various treatments, including glucocorticoids and systemic immunosuppression.

Main Methods:

  • Ophthalmic work-up involves assessing anatomical involvement, disease activity, and complications.
  • Initial treatment strategies include local and/or systemic glucocorticoids.
  • Systemic immunosuppressive agents like methotrexate and anti-tumor necrosis factor (TNF) monoclonal antibodies (adalimumab, infliximab) are used for refractory cases.

Main Results:

  • Glucocorticoids are effective initial treatments but pose risks with long-term sole use.
  • Systemic immunosuppression is necessary for children with recurrent, refractory, or severe uveitis.
  • Timely and appropriate management is key to preventing vision loss.

Conclusions:

  • Optimizing vision in childhood uveitis necessitates early detection and comprehensive treatment.
  • A multi-faceted approach, balancing efficacy and toxicity, is essential for managing pediatric uveitis.
  • Systemic immunosuppressive therapies play a vital role in controlling severe or refractory cases.