Uveitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

Overview

If left untreated, uveitis can progress to permanent vision loss. Complications of uveitis include cataracts, glaucoma, macular edema, and retinal detachment. With appropriate treatment, most attacks of anterior uveitis resolve within days to weeks, however, relapses are common. Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment.[1][2][3][4][5]

Natural History

If left untreated, uveitis can progress to permanent vision loss. Uveitis is estimated to be responsible for approximately 10% of the blindness in the western world.[3][4][5]

Complications

Possible complications of uveitis include:[6][7]

Prognosis

The prognosis of uveitis varies with the subtype, etiology, severity, duration and responsiveness to treatment.

  • The following are favorable prognostic factors:[8][9][10][11][12][13][14][15][16][17]
    • Rapid initiation of corticosteroid treatment
    • Good initial visual acuity
    • Good response to standard medical therapy
  • The following are poor prognostic factors:[8][9][10][11][12][13][14][15][16][17]
    • Chronic disease course
    • Posterior or intermediate uveitis
    • Lack of response to standard medical therapy
    • Complications of uveitis
    • Poor initial visual acuity
    • Isolated ocular uveitis (no underlying systemic disease)

With appropriate treatment, most attacks of anterior uveitis resolve within days to weeks, however, relapses are common. Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment.[1][2]

References

  1. 1.0 1.1 MedlinePlus Medical Encyclopedia Uveitis(2014)https://medlineplus.gov/ency/article/001005.htm
  2. 2.0 2.1 Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
  3. 3.0 3.1 McCluskey PJ, Towler HM, Lightman S (2000). "Management of chronic uveitis". BMJ. 320 (7234): 555–8. PMC 1117601. PMID 10688564.
  4. 4.0 4.1 Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A (1996). "Causes and frequency of blindness in patients with intraocular inflammatory disease". Br J Ophthalmol. 80 (4): 332–6. PMC 505460. PMID 8703885.
  5. 5.0 5.1 Nussenblatt RB (1990). "The natural history of uveitis". Int Ophthalmol. 14 (5–6): 303–8. PMID 2249907.
  6. Dick AD, Tundia N, Sorg R, Zhao C, Chao J, Joshi A; et al. (2016). "Risk of Ocular Complications in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis". Ophthalmology. 123 (3): 655–62. doi:10.1016/j.ophtha.2015.10.028. PMID 26712559.
  7. Maini R, O'Sullivan J, Reddy A, Watson S, Edelsten C (2004). "The risk of complications of uveitis in a district hospital cohort". Br J Ophthalmol. 88 (4): 512–7. PMC 1772087. PMID 15031168.
  8. 8.0 8.1 Chee SP, Jap A, Bacsal K (2009). "Prognostic factors of Vogt-Koyanagi-Harada disease in Singapore". Am J Ophthalmol. 147 (1): 154–161.e1. doi:10.1016/j.ajo.2008.07.044. PMID 18834575.
  9. 9.0 9.1 Sheu SJ, Kou HK, Chen JF (2003). "Prognostic factors for Vogt-Koyanagi-Harada disease". J Chin Med Assoc. 66 (3): 148–54. PMID 12779034.
  10. 10.0 10.1 Al-Kharashi AS, Aldibhi H, Al-Fraykh H, Kangave D, Abu El-Asrar AM (2007). "Prognostic factors in Vogt-Koyanagi-Harada disease". Int Ophthalmol. 27 (2–3): 201–10. doi:10.1007/s10792-007-9062-9. PMID 17435968.
  11. 11.0 11.1 Lobo A, Barton K, Minassian D, du Bois RM, Lightman S (2003). "Visual loss in sarcoid-related uveitis". Clin Experiment Ophthalmol. 31 (4): 310–6. PMID 12880455.
  12. 12.0 12.1 Maleki A, Cao JH, Silpa-Archa S, Foster CS (2016). "VISUAL OUTCOME AND POOR PROGNOSTIC FACTORS IN ISOLATED IDIOPATHIC RETINAL VASCULITIS". Retina. doi:10.1097/IAE.0000000000001019. PMID 26991648.
  13. 13.0 13.1 Bollemeijer JG, Wieringa WG, Missotten TO, Meenken I, ten Dam-van Loon NH, Rothova A; et al. (2016). "Clinical Manifestations and Outcome of Syphilitic Uveitis". Invest Ophthalmol Vis Sci. 57 (2): 404–11. doi:10.1167/iovs.15-17906. PMID 26848879.
  14. 14.0 14.1 Cheon JH, Kim WH (2015). "An update on the diagnosis, treatment, and prognosis of intestinal Behçet's disease". Curr Opin Rheumatol. 27 (1): 24–31. doi:10.1097/BOR.0000000000000125. PMID 25405821.
  15. 15.0 15.1 Abu El-Asrar AM, Al Tamimi M, Hemachandran S, Al-Mezaine HS, Al-Muammar A, Kangave D (2013). "Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids". Acta Ophthalmol. 91 (6): e486–93. doi:10.1111/aos.12127. PMID 23575246.
  16. 16.0 16.1 Wolf MD, Lichter PR, Ragsdale CG (1987). "Prognostic factors in the uveitis of juvenile rheumatoid arthritis". Ophthalmology. 94 (10): 1242–8. PMID 3684202.
  17. 17.0 17.1 Al-Mansour YS, Al-Rajhi AA, Al-Dhibi H, Abu El-Asrar AM (2010). "Clinical features and prognostic factors in Fuchs' uveitis". Int Ophthalmol. 30 (5): 501–9. doi:10.1007/s10792-010-9379-7. PMID 20496098.

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