Uveitis is the third leading cause of blindness in America, with five to ten percent of uveitis cases occurring in children under the age of 16. Uveitis in children covers a wide range of inflammatory and infectious conditions, including isolated ocular disease or associated systemic disease. It poses unique challenges due to the difficulty in diagnosis and a possible need for aggressive treatment. Overall, the outcome is frequently worse compared to adults due to the delay in diagnosis and initiation of treatment. Unlike adults, children with uveitis may be asymptomatic despite having significant intraocular inflammation.
Common causes of noninfectious anterior uveitis in the pediatric population are juvenile idiopathic arthritis and HLA-B27-associated or panuveitis. Other important causes of uveitis in children include Lupus, Behcet’s, and infectious sources such as TORCH (toxoplamosis, rubella, cytomegalovirus, herpes), toxocariasis, and Lyme.
Inflammation in children should not be tolerated
As in the treatment of adult uveitis patients, a stepladder approach is utilized. The initial treatment of anterior uveitis is topical steroids. If the inflammation is not well controlled, oral or periocular corticosteroids may be added while the patient is considered for systemic immunomodulatory medications (steroid-sparing agents). With posterior segment disease, the initial treatment is periocular steroid injections or oral steroids followed by systemic immunomodulatory therapy. The timeliness of moving to steroid-sparing medications is important when treating children given the local ocular effects from the chronic use of steroids which includes the development of cataract and glaucoma, and the systemic effects of oral steroids.
Pediatric uveitis is a complex, chronic, and challenging condition for the patient, parent, and physician. The ultimate goal of medical therapy for noninfectious pediatric uveitis patients is to achieve complete and sustained inflammation control to reduce ocular complications and pre- vent permanent visual disabilities. Due to the indolence of ocular disease, patients diagnosed with juvenile idiopathic arthritis, HLA-B27, sarcoidosis, and other autoimmune/rheumatologic conditions should be screened for ocular inflammation.