A Review of Pediatric Uveitis: Part I. Infectious Causes and the Masquerade Syndromes

Abstract

Uveitis is a manifestation of complex processes that can represent an infectious or a purely immune system modulated condition and may have grave effects on the eye. Much of the morbidity in these conditions is the result of the immune response to these stimuli. These infectious diseases may be successfully treated by addressing the inciting organism with recognized interventions. Treatment of the immune response to the organism often must be pursued simultaneously to minimize long-term complications caused by structural changes within the eye. Assisting the individual's immune response to eliminate the organism while minimizing the immune response's damaging effects remains a unique challenge drawing on both the science and the art of medicine. Several non-infectious conditions that are not autoimmune diseases may commonly masquerade as uveitis, leading to delays in appropriate treatment.

Management of pediatric uveitis

“…These infectious diseases can be successfully treated with specific antimicrobial interventions, and thus careful and extensive systemic work up of these causes must be performed to rule out infections prior to the institution of treatment [10]. …”

Uveitis in Children

“…Herpes simplex virus (HSV) and varicella zoster virus (VZV) can cause unilateral acute granulomatous or nongranulomatous anterior uveitis in children. 12 Patchy or sectoral iris atrophy may occur. The intraocular pressure may be high in herpetic infections contrary to low intraocular pressure seen in non-infectious anterior uveitis.…”

“…The causes include tumors such as retinoblastoma, leukemia and juvenile xanthogranuloma, congenital abnormalities such as Coats disease, retained intraocular foreign bodies following trauma and endogenous endophthalmitis. 12,27…”

Pediatric uveitis

“…Infectious agents such as Toxoplasma, Toxocara, Bartonella, or those causing Lyme disease syphilis, or tuberculosis, and viruses can be common causes of pediatric uveitis [12], especially in developing countries, and should be ruled out. In developed countries, infectious uveitis constitutes 11–13% of all pediatric uveitides [13]. A growing body of evidence supports infection as the causative or triggering event in presumed idiopathic uveitis [14].…”