Uvéite | Clinique Omicron Québec

Anatomical classification and main etiologies

Etiological assessment of uveitis

• Baseline Assessment (all uveitis): Chest X-ray (sarcoidosis + tuberculosis) + CBC + ESR + CRP + ACE (angiotensin-converting enzyme — sarcoidosis) + syphilis serology (VDRL + TPHA) + QuantiFERON-TB Gold + blood glucose + HLA-B27 (anterior uveitis)
• Targeted infectious disease assessment: Toxoplasmosis serology (IgG + IgM — posterior uveitis) + HSV PCR + VZV + CMV in aqueous or vitreous humor if doubt + Lyme serology if exposed in endemic area + HIV serology (atypical posterior uveitis)
• Extended autoimmune panel: ANA + anti-dsDNA (lupus) + ANCA (Wegener's) + HLA-B27 (if not done) + rheumatoid factor + anti-CCP antibodies + spondyloarthritis workup as indicated
• Imaging : Thoracic CT (occult sarcoidosis if X-ray normal) + brain MRI (multiple sclerosis if intermediate uveitis) + PET-CT if lymphoma suspected
• Aqueous humor or vitreous humor analysis (biopsy): PCR for infectious agents + cytology (malignant cells - lymphoma) + intraocular antibody assay (local/serum ratio) → for refractory or atypical uveitis

Treatment

• Non-infectious anterior uveitis — topical corticosteroids (1st line): dexamethasone ophthalmic solution 0.1% (%) (Maxidex®) + or prednisolone acetate 1% (%) → every hour during acute phase → gradual taper over 4-8 weeks depending on response + cycloplegic mydriatics (atropine 1% (%) + or cyclopentolate 1% (%)) → prevention of posterior synechiae (iris-lens adhesions) + analgesic + reduction of ciliary spasms + never topical corticosteroids without etiological workup and ophthalmological follow-up (risk of worsened herpetic keratitis)
• Posterior or intermediate uveitis — systemic corticosteroids: prednisone 1 mg/kg/day orally -> gradual taper based on response + periocular corticosteroids (subconjunctival or sub-Tenon's injection of triamcinolone) if localized form + intraocular implant of extended-release corticosteroids (fluocinolone - Iluvien®) for chronic recurrent posterior uveitis
• Infectious etiological treatment: toxoplasmosis: pyrimethamine + sulfadiazine + folinic acid × 6 weeks (+ corticosteroids if macular involvement) + herpes: acyclovir or valacyclovir + CMV: IV ganciclovir or valganciclovir + tuberculosis: four-drug antituberculosis therapy × 6–9 months + syphilis: IV penicillin G × 14 days
• Immunosuppressants (chronic, recurrent uveitis refractory to corticosteroids): methotrexate (sarcoid uveitis + JIA) + mycophenolate mofetil + azathioprine + cyclosporine + tacrolimus
• Biotherapies (severe refractory uveitis): anti-TNF (adalimumab — Humira® — only FDA + Health Canada approved biologic for non-infectious uveitis) + infliximab + rituximab (ocular lymphoma) + tocilizumab (JIA uveitis)
• Complications to treat: Secondary glaucoma (glaucoma eye drops + surgery) + secondary cataract (surgery once uveitis is controlled) + macular edema (intravitreal corticosteroid or anti-VEGF injections)

Consult at Clinique Omicron

Clinique Omicron's physicians and nurse practitioners (NPs) rapidly refer any suspected uveitis cases to ophthalmology, prescribe systemic etiological workups (HLA-B27 + ACE + QuantiFERON + syphilis serology + toxoplasmosis + chest X-ray), investigate associated systemic diseases (spondyloarthropathies + sarcoidosis + Behçet's disease + inflammatory bowel disease), and coordinate between the ophthalmologist and organ specialists based on the etiology. Consultations are available at several service locations in Quebec and via telemedicine. To make an appointment, visit cliniqueomicron.ca.

The content of this page is for informational purposes only and does not replace the advice of an ophthalmologist. Uveitis is an ophthalmological emergency — delayed treatment can lead to irreversible complications (synechiae + cataracts + glaucoma + blindness). Never prescribe or self-administer ocular corticosteroids without a prior ophthalmological examination — the risk of worsening herpetic keratitis is significant.