Uveitis

• Inflammation of the uveal tract (iris, ciliary body and choroid).
• Cause: infection (eg viral, bacterial, parasitic, fungal), trauma, lens damage, immune-mediated.
• Signs: severe pain, hyphemia, miosis, cloudy cornea, conjunctival hyperemia.
• Treatment: medical - many approaches.
• Prognosis: serious consequences if disease is uncontrolled.

• Ocular pain.
• Red eye (episcleral congestion).
• Lacrimation.

• Corneal edema.
• Cloudy eye.
• Iris color change.

• Common, although true incidence is unknown.
• Fungal and rickettsia diseases vary with location.

• If surgery or specialist referral required.

• Medical treatment only is usually sufficient.

• Often undetermined.
• Reflex uveitis Reflex uveitis.
• Systemic viral disease, eg infectious canine hepatitis Canine adenovirus type 1 disease with corneal opacity, very common.
• Systemic bacterial disease, eg leptospirosis Leptospirosis , brucellosis Brucellosis , Lyme disease Arthritis: borrelial , tuberculosis Pulmonary tuberculosis.
• Local bacterial disease, eg pasteurellosis, staphyloccocal infection (toxins).
• Septic bacterial focus, eg pyometra Pyometra.
• Parasitic, eg toxoplasmosis Toxoplasmosis , leishmaniasis Canine leishmaniosis (imported animals?).
• Mycotic infection, eg cryptococcosis , blastomycosis, histoplasmosis. Rare in temperate climate/country.
• Neoplasia - primary or secondary. Lymphoma is most common.
• Trauma, eg blunt or sharp injury or foreign bodies.
• Primary lens damage to expose lens proteins to aqueous.
• Diabetes.
• Lens-induced uveitis from cataract formation.
• Systemic hypertension.
• Auto-immune, eg uveodermatological syndrome. VKH syndrome.
• Rickettsial diseases, eg Ehlichiosis Ehrlichiosis , Rocky Mountain spotted fever.
• Immune-mediated.
• Hypermature cataracts cause lens proteins to elicit inflammation.

• Inflammation of uveal tract may involve iris (iritis), ciliary body (cyclitis), or choroid (choroiditis).
• More commonly involves all 3 (panuveitis).

• Breakdown of the blood-aqueous barrier causes anterior uveal tissue destruction.
• Increased vascular permeability is mediated by histamine, serotonin, prostaglandins and leukotrines, and causes extravasation of plasma proteins, cells and fluid.
• Iridal congestion, aqueous flare, hypopyon, keratitic precipitates and corneal edema develop along with cellular infiltration.
• Inflammation causes muscular spasm giving miosis and pain.

• Anterior uveitis therapy should last at least 2 months as the blood-aqueous barrier remains disrupted for about 8 weeks after insult.

• Red eye.
• Ocular pain.

• Ocular pain.

• Red eye.
• Lacrimation.
• Miosis.

• Signs related to systemic disease.
• Ocular opacity.

• Iris color change.

• Episcleral congestion.
• Ocular pain - blepharospasm, photophobia.
• Miosis.
• Swollen, dull iris with loss of fine detail.
• Iris color change.
• Conjunctival hyperemia.

• Sluggish pupillary movement.
• Aqueous flare (due to fibrin or cells in aqueous chamber).
• Decreased intraocular pressure.
• Corneal opacity .
• Synechiae .
• Hyphema .
• Deep corneal vascularization.
• Keratic precipitates on posterior surface of cornea.
• Foreign body in anterior chamber.
• Aqueous loss.

• Ophthalmoscopy:
  • Illumination anterior chamber from lateral to medial - for shallow anterior chamber due to swollen iris.
  • Retinal signs of systemic disease, chorioretinitis.

• Tonometry.
• Gonioscopy.

• For canine viral hepatitis, toxoplasmosis Toxoplasma antibody titer , Lyme disease, leptospirosis, mycoses.

• For neoplasia.

• To rule out systemic infectious focus, eg pyometra.

• See also Biochemistry Blood biochemistry: overview.

• The eye is inflamed with conjunctival hyperemia, episcleral congestion, corneal edema, aqueous flare and variable vision.

• Iris and ciliary body infiltrated with a mixture of inflammatory or neoplastic cell types, depending on the cause and chronicity of the disease.

• Glaucoma Glaucoma.

• Reflex uveitis Reflex uveitis.
• Other causes of red eye.
• Severe retinal dysplasia Retinal dysplasia.
• Collie eye anomaly Collie eye anomaly.
• Persistent hyperplastic primary vitreous.
• Glaucoma Glaucoma.
• Diabetic retinopathy Diabetic retinopathy.
• Other causes of hyphema.
• Systemic hypertension Hypertension.

• Removal of foreign body.
• Repair corneal tears.
  Consider referral to specialist if foreign body present.

• Topical corticosteroids:
  EitherPrednisolone acetate Prednisolone 1% - has best intraocular penetration.
  OrBetamethasone sodium phosphate Betamethasone 0.1%.
  OrDexamethasone Dexamethasone 0.1%.
• Topical mydriatics, eg atropine sulfate Atropine 1% - to decrease ciliary spasm → decreased pain: moderate pupil dilation → decreased synechiae formation.
• Ensure that pupil is opening during the first consultation.

  Treat for up to 10 days after resolution of uveitis

  Use mydratics with care if secondary glaucoma

• Systemic antibiotics and antifungals Therapeutics: antimicrobial drug.

• Systemic cytotoxic drugs, eg cyclophosphamide Cyclophosphamide , azathioprine Azathioprine if severe.
  Seek specialist advice before using.

• Treat any underlying disease.

• Patients with severe anterior uveitis should be hospitalized for intial diagnostic workup and medical management.

Monitoring

• Tonometry for elevated IOPor to assess improvement, ie reduced IOP in uveitis.
  Concurrent use of systemic corticosteroids and NSAIDs → risk of gastrointestinal side-effects.

• Variable depending on etiology.
• Early, aggresive medical therapy and a thorough diagnostic workup are required.

• Decreased ocular pain.
• Easily dilated pupil.
• Reduced flare and corneal edema.

• Complications, eg blindness, synechiae, hypopyon, hyphema, retinal detachment, secondary glaucoma, corneal edema, lens luxation, cataract formation, permanent vitreal opacities, iris bombe, optic neuritis/atrophy.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Michau T M, Breitschwerdt E B, Gilger B C et al (2003) Bartonella vinsonii subspecies berkhoffi as a possible cause of anterior uveitis and choroiditis in a dog. Vet Ophthalmol 6 (4), 299-304 PubMed.
• Sansom J (2000) Diseases involving the anterior chamber of the dog and cat. In Practice 22 (2), 58-70 VetMedResource.
• Huss B T, Collier L L, Collins B K et al (1994) Polyarthropathy and chonoretinitis with retinal detachment in a dog with systemic histoplasmosis. JAAHA 30 (3), 217-224 VetMedResource.
• Håkanson N & Forrester S D (1990) Uveitis in the dog and cat. Vet Clin North Am Small Anim Pract 20 (3), 715-35 PubMed.
• Crispin S M (1988) Uveitis in the dog and cat. JSAP 29 (7), 429-447 PubMed.