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Care of children with anterior uveitis
Insights
Pediatric anterior uveitis, often chronic, presents unique challenges. Early recognition of systemic links and prompt treatment are key to managing this condition in children.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
Background:
- Anterior uveitis in children is frequently chronic.
- Specific pediatric entities include chronic iridocyclitis, heterochromic cyclitis, and pars planitis.
Purpose of the Study:
- To present the clinical features of 290 children diagnosed with anterior uveitis.
- To explore systemic associations and management strategies for pediatric anterior uveitis.
Main Methods:
- Retrospective review of clinical data from 290 pediatric patients.
- Analysis of specific uveitis entities and associated systemic conditions.
Main Results:
- The majority of cases exhibited chronic anterior uveitis.
- Systemic associations included sarcoidosis, Vogt-Harada-Koyanagi syndrome, and seronegative arthritides.
- Children with pauciarticular juvenile chronic arthritis and positive antinuclear antibody are at high risk.
Conclusions:
- Topical corticosteroids effectively manage most cases.
- Chlorambucil may be required for refractory cases.
- Secondary glaucoma is a severe complication with poor therapeutic response.
Abstract:
The clinical features of 290 children with anterior uveitis are presented. The vast majority suffered from chronic uveitis. Specific uveitis entities in children include the syndrome of 'chronic iridocyclitis' in girls, heterochromic cyclitis, and pars planitis. Systemic associations include sarcoidosis, the Vogt-Harada-Koyanagi syndrome, and the seronegative arthritides (juvenile chronic arthritis, juvenile ankylosing spondylitis, psoriatic arthritis, and rarely Reiter's and Beçet's syndromes). Children with a pauciarticular onset of juvenile chronic arthritis, especially when combined with positive findings for antinuclear antibody, are at particular risk of developing chronic anterior uveitis. Most cases of chronic anterior uveitis can be controlled with topical corticosteroids. Those that are resistant to both topical and systemic corticosteroids may have to be treated with chlorambucil. The operation of lensectomy is a great advance in the management of complicated cataract. Secondary glaucoma is the most devastating complication of chronic anterior uveitis in children and responds poorly to therapy.