Objectives: 1.CHU St Pierre / 2.CHU Brugmann / 3.HUDERF: Université Libre de Bruxelles
Pediatric uveitis represents 5-10% of total uveitis (anterior 40%, posterior 20%, intermediate 35%, panuveitis 5%). Noninfectious and persistent forms are the most frequent; around 85% and 75%. Uveitis in children, in comparison to adults is slightly more (frequently) often bilateral (65%). Idiopathic uveitis is present in around 30% to 70%. The most frequent systemic causes of noninfectious uveitis are: Juvenile Idiopathic Arthritis (JIA), Tubulointerstitial Nephritis and Uveitis (TINU), juvenile sarcoidosis, Blau syndrome, Kawasaki disease, Vogt-Koyanagi-Harada disease and Behçet disease. JIA is the most common of them (20 %) and the most severe. JIA related uveitis is usually bilateral, anterior and insidious. Complications can occur before the first ocular examination. It is usually associated with oligoarticular arthritis and antinuclear antibodies (ANA) are present in about 75%. Since the uveitis is asymptomatic in 50% of cases, it is necessary to check regularly the eyes of all children with JIA, especially those with oligoarticular JIA. The first line therapy is topiczl corticosteroids, but it should not be applied for more that 3x daily for several months. It is important to measure the intraocular pressure regularly. If the inflammation is not controlled, oral corticosteroids can be initiated for a short period of time together with corticosteroid sparing agents like methotrexate. The use of biologics remains a second line treatment. Nevertheless, biologics, especially anti-TNFalpha, have dramatically improved the prognosis of pediatric noninfectious uveitis, in particular JIA. Infectious pediatric uveitis is often viral (RV,, HSV, VZV, CMV), parasitic (Toxoplasmosis, Toxocariasis), bacterial (Tuberculosis, Bartonella, Lyme, Syphilis), and post-Streptococcal. Their treatment is based on specific antimicrobial medication, often in association with short-term local and systemic corticosteroids. Masquerade syndromes include trauma, retinoblastoma, leukemia, congenital eye disorders such as Coats disease, and inherited retinal degenerations, are challenging cases and must be ruled out appropriately.
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