Investigation and management of uveitis

Uveitis is estimated to account for 10% of blindness in people of working age in the Western world.1 A retrospective review of patients attending a uveitis clinic in the United Kingdom found that 70% of patients had visual impairment (visual acuity 6/18 or worse) and half of these patients had bilateral visual impairment.2 Acute anterior uveitis, which is the most common form of uveitis in the UK, usually has a good visual outcome, but other forms of uveitis have a poorer visual prognosis.

Uveitis is associated with many systemic diseases, including sarcoidosis, juvenile idiopathic arthritis, Behçet’s syndrome, and infectious diseases such as tuberculosis. For patients with systemic disease a management approach that involves collaboration with other specialties is important. In about half of cases, no systemic association is found and uveitis is presumed to be autoimmune.3 The introduction of biological treatments for many autoimmune conditions, and intravitreal injection of drugs for some eye diseases, has led to several of these treatments being used in patients with uveitis, despite limited evidence from randomised trials to support their use. This review discusses recent advances in the diagnosis of uveitis, ocular imaging, and treatments. It does not cover uveitis induced by ocular surgery.