A clinical study of uveitis in children and adolescents

INTRODUCTION: Uveitis refers to the inflammation of the middle vascular tunic of the eye of called uvea. The terminology uvea is derived from the latin word uva or grape and consists of the iris, ciliary body and the choroid. The frequency of uveitis in children under the age of 18, is relatively low, the approximate incidence of 8-10% of the over all uveitis cases from different world literature. Unlike adults, the identification, history and symptoms, of uveitis in a child is a diagnostic challenge, the complications are severe leading to vision threatening problems, and the peculiar problem of development of amblyopia in children. AIM: The aim is to analyse uveitis in children and adolescents with reference to age, sex, laterality, chronicity, severity, etiology, clinical presentation, complications and the various treatment modalities employed and the final visual outcome. MATERIALS AND METHODS: The study design was a prospective case study of 100 children and adolescents (<18 years) with uveitis presenting themselves in Stanley Medical College during the period of October 2003 to December 2005 for a period of 26 months. These patients were questioned for presenting complaints (if they were quite small and not reliable) history was taken from their parents. The duration of illness, the symptoms, (causative factor if any) associated symptoms esp. joint pain, loss of weight, appetite evidence of focal sepsis were enquired in detail. Contact history among the children were looked into. Any exposure history in parents were elicited. A thorough, systemic examination with special attention to musculo cutaneous, musculo skeletal, gastrointestinal, cardio pulmonary and neurological systems was made. Complete ocular examination was done with special attention to visual acuity, slit lamp examination, intraocular tension, direct and indirect ophthalmoscopy was performed. DISCUSSION: In our study of 100 paediatric and adolescent uveitis it was observed that uveitis is more common in the age group of 5-14 years, which forms nearly 80% of the cases. More than half the cases were of acute onset. Least number of cases were found in the age group of 0-4 years. On analyzing the aetiology of uveitis in our study the majority of cases were of unknown aetiology (36 cases), followed by juvenile spondyloarthropathies (13 cases), next comes toxoplasmosis (12 cases). Focal sepsis were also common manifesting about 15% of anterior uveitis. CONCLUSION: Uveitis beginning in childhood is a serious disease associated with sight threatening complications. Paediatric uveitis comprising of anterior uveitis is common in the age group between 5-15 years and posterior uveitis is common in children younger than ten years.