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Uveitis in children
1Ocular Immunovirology Service, University of Roma La Sapienza, Italy.
Insights
Pediatric uveitis, while less common than in adults, poses significant visual risks due to chronic inflammation and diagnostic challenges. Early identification of causes like juvenile rheumatoid arthritis and toxoplasmosis is crucial for better outcomes.
Area of Science:
- Ophthalmology
- Pediatrics
- Rheumatology
Background:
- Uveitis diagnosis is more frequent in adults, but pediatric cases present higher risks of chronic inflammation and poorer visual prognosis due to diagnostic delays.
- Childhood uveitis classification is more successful (71%) than in adults (55%), with distinct age-related etiologies influencing diagnosis and prognosis.
Purpose of the Study:
- To review the specific etiologies, diagnostic challenges, and prognostic factors of uveitis in the pediatric population.
- To highlight the importance of early diagnosis and surveillance for specific pediatric uveitis subtypes and associated conditions.
Main Methods:
- Literature review focusing on pediatric uveitis prevalence, causes, and clinical outcomes.
- Analysis of etiological classifications and diagnostic difficulties in childhood uveitis compared to adult cases.
Main Results:
- Juvenile rheumatoid arthritis is the leading cause of pediatric anterior uveitis (28%), necessitating surveillance, especially in ANA and HLA DR11 positive girls with pauciarticular disease.
- Intermediate uveitis is largely idiopathic (98%) and a major cause of vision loss via cystoid macular edema; toxoplasmosis is the most common posterior uveitis cause (43%).
- Diffuse uveitis forms are rare but severe, potentially indicating systemic diseases or masquerade syndromes like retinoblastoma or leukemia.
Conclusions:
- Effective management of pediatric uveitis requires understanding age-specific etiologies and implementing targeted ophthalmic surveillance protocols.
- Prompt diagnosis and management of pediatric uveitis, particularly infectious and autoimmune causes, are essential to prevent irreversible visual impairment.
Abstract:
Uveitis is diagnosed more often in adults than in children but in children the prevalence of chronic inflammation and the difficulty of an early diagnosis may worsen the visual prognosis. The different incidence of the presumed or defined etiologies in the various ages is probably responsible for the better classification of uveitis in childhood (71% versus 55% in adult patients). Juvenile rheumatoid arthritis is the most common identifiable etiology of pediatric anterior uveitis (28%). However, its long-term prognosis is not satisfactory and ophthalmic surveillance protocols are necessary especially for ANA and HLA DR11 positive girls with the pauci articular form of the disease. Intermediate uveitis is idiopathic in 98% of the cases and accounts for 20-26% of all pediatric uveitis; cystoid macular edema in these patients is the leading cause of visual impairment. Toxoplasmosis is the most frequent cause of posterior uveitis (43%) and of uveitis in childhood (12%); involvement is bilateral in 50-60% of cases. Diffuse uveitis forms are uncommon in children, but their course is particularly severe. They may either be the natural evolution of a posterior uveitis or the presenting sign of a systemic disease typical of the third decade of life, such as sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada's disease. Masquerade syndromes including retinoblastoma, leukemia and lymphoma, intraocular foreign body, retinitis pigmentosa may contribute to confusion in the differential diagnosis of inflammatory disease of the uveal tract in childhood.