Paediatric Uveitis
Dr. Rathinam Sivakumar
HOD - Uveitis Services
Dr. Radhika. T
Consultant, Uveitis Service
Dr. Vedhanayaki Rajesh
Consultant, Uveitis Service
Ocular History
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6 year old girl
redness and pain (OU) since 1 month
no H/O decreased vision
similar episodes in the past
General History
 anti-TB-treatment due to suspected
primary complex
 diagnosed outside to have juvenile
idiopathic arthritis
 adequate treatment
 Methotrexate 5mg OD
 Prednisolone 5mg 1-0-1
 Syp. Osteocalcin
First Presentation
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moderately built and nourished.
swelling of knee the small joints
OU: conjunctival granulomas
diffuse granulomatous KP's
AC - quiet
360º posterior synechiae
AVF – quiet; disc and vessels normal
 Conjuctival granulomas
 Granulomatous KPs
First Presentation
 Skin lesion
 flat-topped papules
on the face, trunk,
and extremities
Investigations
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TC : 8600 cells/cu.mm
N-54; L-44; E-02
ESR: 1h: 10mm
ACE: 73.2 IU (normal up to 53 IU)
Mantoux and ANA: negative
conjunctival biopsy: stratified squamous
epithelium with lymphocytic infiltration
suggestive of sarcoid
 chest X-ray: within normal limits.
Diagnosis
 Pediatric sarcoidosis induced uveitis
 Preschoolers present with the triad of
arthritis, uveitis, and a cutaneous
eruption of discrete small papules
 treated with steroid and resolved.
Differential Diagnosis
 JRA with uveitis ?
 Tuberculosis with uveitis ?
 Ocular sarcoidosis ?
Factors
JRA
B/L Granulomatous
uveitis
Against
Conj .Granuloma
TB
Sarcoid
Positive
Positive
_
_
Positive
Poly articular
involvement
Against
_
Positive
Negative ANA
Against
_
_
JRA
Elevated ACE
-
Negative Mantoux
_
Normal ESR
TB
SARCOID
_
Positive
Against
+/_
_
Against
+/_
Response to
steroids
Positive
Against
Positive
Treatment
 topical corticosteroids
 systemic corticosteroids
 methotrexate and folic acid
 she responded well to corticosteroids
 complete remission in 4 months
Conclusion
 Sarcoidosis is a multisystem granulomatous
disease
 ocular involvement in 26% to 50 %
 signs of ocular sarcoidosis
 conjunctival granuloma
 anterior uveitis: mutton fat KPs; iris nodules
Conclusion
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Vitritis, Panuveitis, Retinal vasculitis
Optic nerve involvement
Choroidal nodules, exudative retinal detachment
Cystoid macular edema
"Candle wax drippings", "punched-out" lesions
Lacrimal gland enlargement with Dry eye
NLD stenosis or total obstruction
Granuloma in soft tissues of orbit/extra ocular
muscles