Update on the management of uveitis in children: an overview for the clinician

ABSTRACT

Introduction: Pediatric uveitis comprises a range of ocular inflammatory diseases that may lead to vision impairment. The impact on visual functioning over the lifetime horizon can be substantial, underscoring the importance of appropriate ophthalmic evaluation, diagnostic testing and treatment. This review focuses on the anatomic classification, laboratory diagnosis, associated systemic diseases, and management of pediatric uveitis.

Areas covered: A review of the literature was performed to synthesize our current understanding of the anatomic classification of pediatric uveitis, disease epidemiology, and management principles. We also review important corticosteroid-sparing strategies including non-biologic and biologic agents given their key role in the treatment of pediatric uveitis. Recent advances in the assessment of vision-related quality-of-life using the Effects of Youngsters’ Eyesight on Quality of Life (EYE-Q) instrument are discussed.

Expert opinion: Pediatric uveitis can lead to long-term vision impairment if not appropriately screened and treated. While topical and systemic corticosteroids are useful for the acute treatment of uveitis, the disease chronicity of many pediatric uveitis syndromes often warrants early escalation of therapy to immunosuppressive medications. Future directions include an improved understanding of risk factors for uveitis and better metrics to evaluate the impact of disease on vision-related quality-of-life of pediatric uveitis patients.

KEYWORDS:

• Uveitis
• juvenile idiopathic arthritis
• pediatric uveitis
• immunosuppression
• EYE-Q
• vision-related quality-of-life

Article highlights

• Pediatric uveitis is an often insidious, potentially blinding, ocular disease that is not well understood.

• Uveitis in pediatric patients can often present asymptomatically and is commonly associated with systemic disease entities such as juvenile idiopathic arthritis (JIA).

• Treatment options include topical and systemic corticosteroids, conventional immunotherapy, and newer emerging biologic agents.

• Continued research is needed to further elucidate prognostic factors to identify pediatric patients at risk of developing uveitis and prevent vision-threatening complications in this vulnerable population.

Declaration of interest

S Yeh reports being a consultant for Santen, Inc. and Clearside Biomedical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This project was supported by an unrestricted grant from Research to Prevent Blindness (Emory Eye Center, Emory University School of Medicine), NIH/NEI core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), Building Interdisciplinary Careers in Women’s Health of the National Institutes of Health K12HD085850 (J Shantha). Research reported in this publication was supported by the National Eye Institute of the National Institutes of Health under Award Number K23EY030158 and RO1EY029594. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.