Panuveitis - Revision history

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2025-04-04T01:48:13Z

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			{{Infobox medical condition
			\| name = Panuveitis
			\| synonyms = Diffuse uveitis
			\| field = [[Ophthalmology]]
			\| symptoms = [[Eye pain]], [[redness]], [[blurred vision]], [[photophobia]], [[floaters]]
			\| complications = [[Cataract]], [[glaucoma]], [[macular edema]], [[retinal detachment]]
			\| onset = Any age
			\| duration = Variable
			\| causes = [[Autoimmune disease]], [[infection]], [[trauma]], [[idiopathic]]
			\| risks = [[Genetic predisposition]], [[systemic inflammatory diseases]]
			\| diagnosis = [[Clinical examination]], [[ophthalmoscopy]], [[imaging studies]], [[laboratory tests]]
			\| differential = [[Anterior uveitis]], [[intermediate uveitis]], [[posterior uveitis]], [[endophthalmitis]]
			\| treatment = [[Corticosteroids]], [[immunosuppressive drugs]], [[antibiotics]] (if infectious), [[surgery]]
			\| prognosis = Variable, depends on cause and treatment
			\| frequency = Rare
			}}
	'''Other Names: '''		'''Other Names: '''
	Inflammation of the whole uveal tract; Total uveitis; Diffuse uveitis		Inflammation of the whole uveal tract; Total uveitis; Diffuse uveitis
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	The condition can also affect the [[lens]], [[retina]], [[optic nerve]], and [[vitreous]], causing reduced vision or blindness.		The condition can also affect the [[lens]], [[retina]], [[optic nerve]], and [[vitreous]], causing reduced vision or blindness.
	It can last for a short time or can occur chronically. Severe cases may recur many times.		It can last for a short time or can occur chronically. Severe cases may recur many times.


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	== '''Cause''' ==		== '''Cause''' ==
	Panuveitis can be associated with an underlying condition, or it may occur by itself without the cause being known (idiopathic). Possible causes may include an attack from the body's own [[immune system]] (autoimmunity); an infection or [[tumor]] within the eye or in another part of the body; injury to the eye; and toxins that may penetrate the eye. Specific conditions that have been associated with panuveitis include tuberculosis; [[Vogt-Koyanagi-Harada syndrome]]; sympathetic [[ophthalmia]]; [[Behcet's disease]]; and [[sarcoidosis]].		Panuveitis can be associated with an underlying condition, or it may occur by itself without the cause being known (idiopathic). Possible causes may include an attack from the body's own [[immune system]] (autoimmunity); an infection or [[tumor]] within the eye or in another part of the body; injury to the eye; and toxins that may penetrate the eye. Specific conditions that have been associated with panuveitis include tuberculosis; [[Vogt-Koyanagi-Harada syndrome]]; sympathetic [[ophthalmia]]; [[Behcet's disease]]; and [[sarcoidosis]].

	== '''Inheritance''' ==		== '''Inheritance''' ==
	Panuveitis is not thought to be an inherited condition. While familial cases of uveitis have been reported, it is very rare. The few cases that have been reported may represent the familial occurrence of underlying conditions that are associated with uveitis (e.g. sarcoidosis, ankylosing spondylitis). We are not aware of reports of familial cases of panuveitis specifically, and to our knowledge, no gene responsible for the condition has been identified.		Panuveitis is not thought to be an inherited condition. While familial cases of uveitis have been reported, it is very rare. The few cases that have been reported may represent the familial occurrence of underlying conditions that are associated with uveitis (e.g. sarcoidosis, ankylosing spondylitis). We are not aware of reports of familial cases of panuveitis specifically, and to our knowledge, no gene responsible for the condition has been identified.

	== '''Symptoms''' ==		== '''Symptoms''' ==
	Signs and symptoms of panuveitis can develop suddenly and may affect one or both eyes. They may include blurred vision; seeing dark, floating spots ("floaters"); eye pain; redness of the eye; and sensitivity to light ([[photophobia]]). There may also be a whitish area (called a [[hypopyon]]) obscuring the lower part of the [[iris]].		Signs and symptoms of panuveitis can develop suddenly and may affect one or both eyes. They may include blurred vision; seeing dark, floating spots ("floaters"); eye pain; redness of the eye; and sensitivity to light ([[photophobia]]). There may also be a whitish area (called a [[hypopyon]]) obscuring the lower part of the [[iris]].
	Signs and symptoms may include eye redness and pain; blurring; light sensitivity; decreased vision; and seeing [[floaters]].		Signs and symptoms may include eye redness and pain; blurring; light sensitivity; decreased vision; and seeing [[floaters]].

	== '''Diagnosis''' ==		== '''Diagnosis''' ==
	Diagnosis of panuveitis is established in the presence of the following clinical signs:		Diagnosis of panuveitis is established in the presence of the following clinical signs:
	Evidence of choroidal or retinal inflammation such as [[choroiditis]] (focal, multifocal or serpiginous), choroidal [[granuloma]], retinochoroiditis, retinal [[vasculitis]], subretinal abscess, necrotizing [[retinitis]] or neuroretinitis; with evidence of vitreous inflammation (vitreous cells or vitritis); and presence of signs of anterior uveitis (cells and flare in the anterior chamber, keratic precipitates or posterior synechiae).		Evidence of choroidal or retinal inflammation such as [[choroiditis]] (focal, multifocal or serpiginous), choroidal [[granuloma]], retinochoroiditis, retinal [[vasculitis]], subretinal abscess, necrotizing [[retinitis]] or neuroretinitis; with evidence of vitreous inflammation (vitreous cells or vitritis); and presence of signs of anterior uveitis (cells and flare in the anterior chamber, keratic precipitates or posterior synechiae).

	'''Laboratory tests'''		'''Laboratory tests'''
	Whereas anterior segment inflammations involving the iris are routinely picked up by [[slit-lamp]] examination, ciliary body involvement can best be confirmed by [[ultrasound biomicroscopy]] (UBM). Baseline color fundus photography serves as an extremely good clinical reference when monitoring the fundus changes during follow-up periods.		Whereas anterior segment inflammations involving the iris are routinely picked up by [[slit-lamp]] examination, ciliary body involvement can best be confirmed by [[ultrasound biomicroscopy]] (UBM). Baseline color fundus photography serves as an extremely good clinical reference when monitoring the fundus changes during follow-up periods.

	[[Digital color fundus photography]] allows easy storage and retrieval of fundus images. A composite montage of the retina can be made to document better the lesions in the peripheral fundus		[[Digital color fundus photography]] allows easy storage and retrieval of fundus images. A composite montage of the retina can be made to document better the lesions in the peripheral fundus
	[[Fundus fluorescein angiography]] (FA) is mandatory for retinal and choroidal lesions.		[[Fundus fluorescein angiography]] (FA) is mandatory for retinal and choroidal lesions.
	[[Indocyanine green angiography]] (ICGA) is the technique of choice for imaging the choroid.		[[Indocyanine green angiography]] (ICGA) is the technique of choice for imaging the choroid.

	[[Ultrasound]] is a safe, noninvasive, dynamic tool for the evaluation of the posterior segment when direct visualization of the fundus is obscured due to severe [[inflammation]] or its complications.		[[Ultrasound]] is a safe, noninvasive, dynamic tool for the evaluation of the posterior segment when direct visualization of the fundus is obscured due to severe [[inflammation]] or its complications.

	[[Optical coherence tomography]] (OCT) is a noncontact and noninvasive imaging tool.		[[Optical coherence tomography]] (OCT) is a noncontact and noninvasive imaging tool.

	[[PCR]] has been used to diagnose uveitis, including viral uveitis, mycobacterial intraocular infections, infectious [[endophthalmitis]], and protozoal eye diseases. PCR is a powerful molecular technique for evaluation of very small amounts of Deoxyribonucleic acid and Ribonucleic acid. It can be a simple, rapid, sensitive, and specific tool for the diagnosis of infection, autoimmunity, and masquerade syndromes in the eye.		[[PCR]] has been used to diagnose uveitis, including viral uveitis, mycobacterial intraocular infections, infectious [[endophthalmitis]], and protozoal eye diseases. PCR is a powerful molecular technique for evaluation of very small amounts of Deoxyribonucleic acid and Ribonucleic acid. It can be a simple, rapid, sensitive, and specific tool for the diagnosis of infection, autoimmunity, and masquerade syndromes in the eye.

	== '''Treatment''' ==		== '''Treatment''' ==
	Panuveitis may be treated in several ways, including injections around the eye, oral medications, and eye drops.		Panuveitis may be treated in several ways, including injections around the eye, oral medications, and eye drops.

	[[Corticosteroids]] are the treatment of choice for most types of uveitis, including panuveitis. Depending on the severity of the disease, oral [[prednisolone]] is typically started in a larger dose, and then is tapered off a few weeks after starting therapy as inflammation improves. A maintenance dose is typically used thereafter.		[[Corticosteroids]] are the treatment of choice for most types of uveitis, including panuveitis. Depending on the severity of the disease, oral [[prednisolone]] is typically started in a larger dose, and then is tapered off a few weeks after starting therapy as inflammation improves. A maintenance dose is typically used thereafter.

	[[Immunomodulating drugs]] (drugs that alter the body's immune response) are needed if the inflammation cannot be controlled with corticosteroids or if active inflammation interferes with activities of daily living. [[Cycloplegics]] (eye drops that temporarily paralyze the ciliary body) are used to help with pain due to ciliary spasms.		[[Immunomodulating drugs]] (drugs that alter the body's immune response) are needed if the inflammation cannot be controlled with corticosteroids or if active inflammation interferes with activities of daily living. [[Cycloplegics]] (eye drops that temporarily paralyze the ciliary body) are used to help with pain due to ciliary spasms.

	Forms of uveitis due to infectious agents are treated by specific antimicrobial therapy ([[antibiotics]], [[antiparasitics]] or [[antivirals]]), with or without [[corticosteroids]].		Forms of uveitis due to infectious agents are treated by specific antimicrobial therapy ([[antibiotics]], [[antiparasitics]] or [[antivirals]]), with or without [[corticosteroids]].
	The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.		The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.
	* '''[[Adalimumab]]''' (Brand name: Humira)received expanded approval for the treatment of non-infectious intermediate, posterior, and panuveitis to include pediatric patients 2 years of age and older. It was approved for use in adults with non-infectious intermediate, posterior, and panuveitis in June 2016.		* '''[[Adalimumab]]''' (Brand name: Humira)received expanded approval for the treatment of non-infectious intermediate, posterior, and panuveitis to include pediatric patients 2 years of age and older. It was approved for use in adults with non-infectious intermediate, posterior, and panuveitis in June 2016.
	* '''[[Dexamethasone]]''' Intravitreal Implant (Brand name: Ozurdex)For treating non-infectious ocular inflammation, or uveitis, affecting eye's posterior segment.		* '''[[Dexamethasone]]''' Intravitreal Implant (Brand name: Ozurdex)For treating non-infectious ocular inflammation, or uveitis, affecting eye's posterior segment.

	== '''Prognosis''' ==		== '''Prognosis''' ==
	The outlook (prognosis) for people with panuveitis somewhat varies depending upon the cause and severity. However, uveitis is one of the major causes of blindness in the world, and visual morbidity in panuveitis is poor. Profound and irreversible vision loss can occur, especially when the condition is unrecognized, inadequately treated, or both.		The outlook (prognosis) for people with panuveitis somewhat varies depending upon the cause and severity. However, uveitis is one of the major causes of blindness in the world, and visual morbidity in panuveitis is poor. Profound and irreversible vision loss can occur, especially when the condition is unrecognized, inadequately treated, or both.

	Uveitis can rapidly damage the eye and cause long-term, vision-threatening complications. The most frequent complications include:		Uveitis can rapidly damage the eye and cause long-term, vision-threatening complications. The most frequent complications include:
	* [[Cataract]]		* [[Cataract]]
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	* [[Neovascularization]] of the retina, optic nerve, or iris		* [[Neovascularization]] of the retina, optic nerve, or iris
	* Cystoid macular [[edema]] (the most common cause of decreased vision in patients with uveitis).		* Cystoid macular [[edema]] (the most common cause of decreased vision in patients with uveitis).

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Prab at 13:05, 18 March 2025

2025-03-18T13:05:03Z

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Deepika vegiraju at 03:03, 16 July 2020

2020-07-16T03:03:15Z

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'''Other Names: '''
Inflammation of the whole uveal tract; Total uveitis; Diffuse uveitis
Panuveitis is [[inflammation]] of all layers of the [[uvea]] of the eye, which includes the [[iris]], [[ciliary body]], and [[choroid]]. These make up the middle layer of the eye.
The condition can also affect the [[lens]], [[retina]], [[optic nerve]], and [[vitreous]], causing reduced vision or blindness.
It can last for a short time or can occur chronically. Severe cases may recur many times.

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== '''Cause''' ==
Panuveitis can be associated with an underlying condition, or it may occur by itself without the cause being known (idiopathic). Possible causes may include an attack from the body's own [[immune system]] (autoimmunity); an infection or [[tumor]] within the eye or in another part of the body; injury to the eye; and toxins that may penetrate the eye. Specific conditions that have been associated with panuveitis include tuberculosis; [[Vogt-Koyanagi-Harada syndrome]]; sympathetic [[ophthalmia]]; [[Behcet's disease]]; and [[sarcoidosis]].

== '''Inheritance''' ==
Panuveitis is not thought to be an inherited condition. While familial cases of uveitis have been reported, it is very rare. The few cases that have been reported may represent the familial occurrence of underlying conditions that are associated with uveitis (e.g. sarcoidosis, ankylosing spondylitis). We are not aware of reports of familial cases of panuveitis specifically, and to our knowledge, no gene responsible for the condition has been identified.

== '''Symptoms''' ==
Signs and symptoms of panuveitis can develop suddenly and may affect one or both eyes. They may include blurred vision; seeing dark, floating spots ("floaters"); eye pain; redness of the eye; and sensitivity to light ([[photophobia]]). There may also be a whitish area (called a [[hypopyon]]) obscuring the lower part of the [[iris]].
Signs and symptoms may include eye redness and pain; blurring; light sensitivity; decreased vision; and seeing [[floaters]].

== '''Diagnosis''' ==
Diagnosis of panuveitis is established in the presence of the following clinical signs:
Evidence of choroidal or retinal inflammation such as [[choroiditis]] (focal, multifocal or serpiginous), choroidal [[granuloma]], retinochoroiditis, retinal [[vasculitis]], subretinal abscess, necrotizing [[retinitis]] or neuroretinitis; with evidence of vitreous inflammation (vitreous cells or vitritis); and presence of signs of anterior uveitis (cells and flare in the anterior chamber, keratic precipitates or posterior synechiae).

'''Laboratory tests'''
Whereas anterior segment inflammations involving the iris are routinely picked up by [[slit-lamp]] examination, ciliary body involvement can best be confirmed by [[ultrasound biomicroscopy]] (UBM). Baseline color fundus photography serves as an extremely good clinical reference when monitoring the fundus changes during follow-up periods.

[[Digital color fundus photography]] allows easy storage and retrieval of fundus images. A composite montage of the retina can be made to document better the lesions in the peripheral fundus
[[Fundus fluorescein angiography]] (FA) is mandatory for retinal and choroidal lesions.
[[Indocyanine green angiography]] (ICGA) is the technique of choice for imaging the choroid.

[[Ultrasound]] is a safe, noninvasive, dynamic tool for the evaluation of the posterior segment when direct visualization of the fundus is obscured due to severe [[inflammation]] or its complications.

[[Optical coherence tomography]] (OCT) is a noncontact and noninvasive imaging tool.

[[PCR]] has been used to diagnose uveitis, including viral uveitis, mycobacterial intraocular infections, infectious [[endophthalmitis]], and protozoal eye diseases. PCR is a powerful molecular technique for evaluation of very small amounts of Deoxyribonucleic acid and Ribonucleic acid. It can be a simple, rapid, sensitive, and specific tool for the diagnosis of infection, autoimmunity, and masquerade syndromes in the eye.

== '''Treatment''' ==
Panuveitis may be treated in several ways, including injections around the eye, oral medications, and eye drops.

[[Corticosteroids]] are the treatment of choice for most types of uveitis, including panuveitis. Depending on the severity of the disease, oral [[prednisolone]] is typically started in a larger dose, and then is tapered off a few weeks after starting therapy as inflammation improves. A maintenance dose is typically used thereafter.

[[Immunomodulating drugs]] (drugs that alter the body's immune response) are needed if the inflammation cannot be controlled with corticosteroids or if active inflammation interferes with activities of daily living. [[Cycloplegics]] (eye drops that temporarily paralyze the ciliary body) are used to help with pain due to ciliary spasms.

Forms of uveitis due to infectious agents are treated by specific antimicrobial therapy ([[antibiotics]], [[antiparasitics]] or [[antivirals]]), with or without [[corticosteroids]].
The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.
* '''[[Adalimumab]]''' (Brand name: Humira)received expanded approval for the treatment of non-infectious intermediate, posterior, and panuveitis to include pediatric patients 2 years of age and older. It was approved for use in adults with non-infectious intermediate, posterior, and panuveitis in June 2016.
* '''[[Dexamethasone]]''' Intravitreal Implant (Brand name: Ozurdex)For treating non-infectious ocular inflammation, or uveitis, affecting eye's posterior segment.

== '''Prognosis''' ==
The outlook (prognosis) for people with panuveitis somewhat varies depending upon the cause and severity. However, uveitis is one of the major causes of blindness in the world, and visual morbidity in panuveitis is poor. Profound and irreversible vision loss can occur, especially when the condition is unrecognized, inadequately treated, or both.

Uveitis can rapidly damage the eye and cause long-term, vision-threatening complications. The most frequent complications include:
* [[Cataract]]
* [[Glaucoma]]
* Retinal detachment
* [[Neovascularization]] of the retina, optic nerve, or iris
* Cystoid macular [[edema]] (the most common cause of decreased vision in patients with uveitis).

{{rarediseases}}
{{stub}}