Uveitis in children

Uveitis - inflammation of the uveate tract. Inflammatory process can be localized in certain departments of the uveal tract, in connection with which it is expedient to subdivide the uveal process in its localization. The clinical course of uveitis is divided into acute, subacute and chronic.

Causes of acute anterior uveitis

• Injury.
• Infectious diseases:
  • exanthema;
  • brucellosis;
  • a disease from cat scratching;
  • herpes simplex;
  • Infectious mononucleosis;
  • Kawasaki disease (skin-mucous syndrome with lymph node involvement) - systemic vasculitis that occurs in childhood and manifests itself:
    • fever;
    • stomatitis;
    • erythema of the palms;
    • lymphadenopathy;
    • myocarditis;
    • bilateral conjunctivitis;
    • uveitis;
  • Lyme disease;
• spondyloarthropathy;
• ankylosing spondylitis;
• psoriatic arthritis;
• inflammatory bowel disease (Crohn's disease [Crohn's disease] and ulcerative colitis);
• Reiter syndrome (Reiter);
• Behcet's disease.

[1], [2], [3], [4], [5], [6],

Causes of chronic anterior uveitis

• Injury.
• Leprosy.
• Onchocerciasis.
• Juvenile rheumatoid arthritis (Still's disease):
  • the predominant cause of chronic anterior uveitis in childhood;
  • manifests, as a rule, in the second decade of life;
  • oligoartritic form with a lesion of not more than four joints during the first three months of the disease;
  • polyarthritic form with lesion of more than four joints during the first three months of the disease;
  • fever against worsening of well-being.

[7], [8], [9], [10]

Symptoms of uveitis

• The suspension of cellular elements in the moisture of the anterior chamber;
• Precipitates on the cornea.
• Reduced vision due to macular edema, increased intraocular pressure, blurred vision of the anterior chamber.
• Perhaps the deposition of cellular elements behind the lens.

Complaints

• Pain.
• Redness of the eyeball.
• Photophobia.

Iridocyclitis in juvenile rheumatoid arthritis

• It develops more often in patients with an oligoartritic form of juvenile rheumatoid arthritis, with antinuclear antibodies in the serum and the absence of rheumatoid factor and human leukocyte antigen (BWA) -B27.
• Girls are sick more often than boys.
• Debuts early, usually up to 10 years.

A timely treatment can prevent the occurrence of complications such as the formation of posterior synechia, the development of cataracts and glaucoma. Therefore, it is advisable to carry out screening to identify a risk group for the onset of the Still disease.

• At the system start - annually.
• In the case of polyarthritis, every 6 months.
• With oligoartritic form - every 3 months.
• With oligoartritic form and the presence of antinuclear antibodies in the serum, every 2 months for 7 years after the manifestation of the disease. Among patients with rapidly occurring remission, screening is performed at an earlier time.

Treatment of uveitis

1. Installation of the mydriatic. It is more expedient to prescribe short-term mydriatica to preserve the pupil's mobility. In the absence of posterior synechia, but high risk of their formation, for the night appoint midriatiki as short as possible to exclude the negative effects of concomitant cycloplegia.
2. Instillations of corticosteroids with the appearance of a suspension of exudate in the anterior chamber. Against the backdrop of a chronic inflammatory reaction, this therapeutic measure is usually ineffective. On the contrary, exacerbation of the process requires forced instillation of corticosteroids (hourly) and frequent examination of the patient.
3. When exacerbations of the process, injections of long-acting steroid preparations or soluble steroid products of short duration, starting with high doses and subsequent reduction thereof, are carried out. In severe chronic forms of the disease, the appointment of immunosuppressants is effective.
4. In the case of ribbon-like corneal dystrophy, removal of the excimer lesion by the laser is possible, keratectomy or the use of chelating agents EDTA.
5. Surgical intervention for cataracts. Possible complications in the form of severe postoperative uveitis with subsequent fibrotic changes of the vitreous. A pronounced uveal process is an indication for carrying out lensweetectomy. Only with a mild inflammatory process can the technique of aspirating cataracts with the preservation of the posterior capsule be used. In all cases of surgical intervention for cataracts in the background of chronic anterior uveitis, one or two large peripheral colophony of the iris should be formed. Operative treatment is carried out under the cover of local and general steroid therapy, prescribing appropriate medications in the form of preoperative preparation, and in the postoperative period.
6. If the process is complicated by secondary glaucoma, the following treatment measures are recommended:
   • iridectomy, in the presence of a pupillary block;
   • instillation of antihypertensive drugs;
   • reception of diacarbum;
   • trabeculodialysis;
   • trabeculectomy in combination with the use of cytostatic agents and the implantation of tubular drainage to improve the effectiveness of surgical intervention.
7. With concomitant edema of the macular area, the control over the course of the uveal process is strengthened and in some cases non-steroidal anti-inflammatory drugs are prescribed.

Forecast

In all cases, the forecast should be extremely restrained and cautious. At least 25% of patients with chronic uveitis with juvenile rheumatoid arthritis have an unfavorable visual prognosis.

[11], [12]