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1024 Uveitis

Infectious canine hepatitis often (q 12-24h) for mild cases, more often (e.g., lens-induced uveitis), or is related to
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Borreliosis (q 6-8h) for severe cases chronic disease. The goal is to determine the
■ ■ Leishmaniasis • Ophthalmic steroids (prednisolone acetate or minimum effective drug doses to keep the
VetBooks.ir ○ Infection (cat) dexamethasone) should be used in moderate • If the eye returns to normal on the course of
eye clear and comfortable.
FeLV
to severe cases unless corneal ulceration is
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FIV
present.
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taper the topical antiinflammatories by
FIP • Ophthalmic nonsteroidal antiinflammato- antiinflammatories, the author will usually
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Toxoplasmosis ries (NSAIDs) can be used in mild cases, a drop per day q 2 weeks (e.g., q 8h→q
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Fungal (cryptococcosis, blastomycosis, if corneal disease precludes use of topical 12h × 2 weeks, q 12h→q24h × 2 weeks, q
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histoplasmosis, coccidioidomycosis) steroids, or in conjunction with steroids if 24h→q 48h × 2 weeks). Regular monitoring
• UVD syndrome uveitis is severe. should be performed during taper to check
• Hypertension • Oral steroids or oral NSAIDs can be used for flare-ups.
• Blood dyscrasias concurrently with topical steroids or topical
• Aberrant metazoan parasites: Dirofilaria NSAIDs. For example, it is safe to treat with Recommended Monitoring
immitis, ascarids, fly larvae topical prednisolone acetate and oral carprofen. First recheck is typically in 1 week, to assess
response and monitor for complications. If
DIAGNOSIS Acute General Treatment the eye is responding well, recheck times can
No corneal ulceration (no stain uptake): be done q 2-4 weeks until the eye is normal
Diagnostic Overview • Topical prednisolone acetate 1% q 6-12h or stable for at least 3-4 weeks. If the eye
Diagnostics should center on determining if or topical dexamethasone q 6-12h (alone or is responding poorly, consideration should
there is an ocular cause for the uveitis by a in combination with antibiotics: neomycin, be given to an alternative underlying cause.
complete ophthalmic exam and basic ophthalmic polymyxin B, or dexamethasone) Enucleation is considered if prognosis for
tests (Schirmer tear test [STT], fluorescein stain, Corneal ulceration (stain uptake) (p. 209): vision is poor and the eye remains painful.
tonometry). In the absence of a primary ocular • Topical flurbiprofen or diclofenac (topical
cause, it is important to consider an underlying NSAID) q 6-8h PROGNOSIS & OUTCOME
systemic illness. Client should be educated as to • Topical antibiotics given prophylactically or
the possible risks of a missed diagnosis. for active infection • Prognosis for vision corresponds to severity,
• Systemic antiinflammatories if uveitis second- chronicity, and cause of uveitis. The prognosis is
Differential Diagnosis ary to corneal disease is significant worse if the posterior segment is affected given
Other causes of a red eye: • Topical atropine q 12-24h if IOP is low or possible involvement of the retina. Secondary
• Primary glaucoma low-normal glaucoma is a negative prognostic factor because
• Conjunctivitis • Secondary glaucoma (IOP normal or it usually corresponds with severe uveitis or
• Episcleritis > 25 mm Hg) chronicity; glaucoma often permanently
• Keratitis ○ Topical dorzolamide-timolol q 8-12h damages the optic nerve and retina.
• Keratoconjunctivitis sicca Refractory to topical therapy alone or consid- • With prompt and aggressive treatment,
ered free of systemic disease: most immune-mediated or idiopathic uveitis
Initial Database • Prednisone 0.5-1 mg/kg/day PO responds well.
To rule in ocular causes of uveitis: • NSAIDS (e.g., carprofen, meloxicam) • If there is no improvement in the face of
• Complete ophthalmic exam of both eyes, Confirmed or suspected immune-mediated treatment, a new search for systemic disease
including a dilated fundic exam disease (e.g., UVD syndrome): should be undertaken. If the prognosis for
• STT, fluorescein stain, tonometry • Prednisone 1-2 mg/kg/day PO initially vision is poor, enucleation can relieve pain
To rule in/out systemic causes of uveitis: • Azathioprine or other immunosuppressive and provide diagnostic value with histopatho-
• Complete physical exam medications as needed long term logic exam and/or culture.
• CBC Confirmed or suspected infectious disease:
• Blood chemistry • Appropriate antimicrobial therapy PEARLS & CONSIDERATIONS
• Urinalysis
• Blood pressure Chronic Treatment Comments
• Infectious disease testing (retroviral testing • Chronic treatment may be required if cause • An important diagnostic goal for uveitis is to
for all cats; other testing based suspected remains undetermined, cannot be corrected determine whether there is a larger threat to
disease)
• Thoracic radiographs Lens
• Abdominal ultrasound
Advanced or Confirmatory Testing
• Lymph node aspirate Cornea
• Skin biopsy (UVD)
• Colonic scraping (protothecosis) Sclera
• Aqueocentesis, vitreocentesis (often referral
test but rarely necessary)
TREATMENT

Treatment Overview Retina Iris
• Empirical treatment regardless of underlying Ciliary body Uvea
cause is directed toward treating the eye and Choroid
secondary complications.
• Frequency of antiinflammatories should be UVEITIS Sagittal section of the globe shows the anatomic relationships of the uvea with the other parts of
proportional to the degree of uveitis: less the eye.

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