Pediatric Uveitis

What are the signs and symptoms of Pediatric Uveitis?

Children with uveitis may exhibit several symptoms, including:

• Eye redness
• Eye pain
• Blurry vision
• Sensitivity to light
• Black spots floating in the vision, also known as floaters

Some of these complaints may initially be mistaken for other conditions such as pink eye. The diagnosis of uveitis can only be made by an eye care specialist using specialized equipment and testing.

In some cases, children may have uveitis with no symptoms that they complain of or signs that their caregivers can see. Children are very adaptable when it comes to their vision and may not notice that vision is blurry in one eye or that floaters are normal. They may be too young to voice any symptoms, or simply may not have symptoms.

What tests do we use to diagnose pediatric uveitis? 

To make a uveitis diagnosis, your child’s ophthalmologist will perform a complete eye exam, check your child’s vision in an age-appropriate way, measure eye pressure and look inside the eye for signs of inflammation. Your child’s doctor may give them dilating eye drops to make the pupil large so that the back part of the eye can be examined easier.

Doctors often use eye imaging tests to help diagnose and treat uveitis, including:

• Slit lamp photos or fundus photos are detailed images of different parts of the eye.
• Ocular coherence tomography (OCT) can show whether inflammation has caused swelling of the retina, optic nerve or other structural damage.
• B scan ultrasound can show the thickness of the retina and optic nerve. It can also check for retinal detachment when the ophthalmologist can’t see through to the back of the eye because of cataracts or severe inflammation.
• Oral fluorescein angiography is a process using fluorescein dye to get clearer images of the blood vessels during the photo-taking process. This study provides a great deal of information about the level of inflammation in the eye and can help guide treatment. Many eye clinics perform this test by instilling the dye through an IV in the arm (requiring a needle poke), but at Children’s Hospital Colorado, we do this test by having the child drink an orange-colored version of the dye mixed with juice. This is much easier for younger children than a needle stick, while still allowing our uveitis specialists to get the vital information they need.

Once your child’s doctor has made a uveitis diagnosis, they might try to determine if there is an underlying condition since about half the cases are linked to an underlying cause. To do this, they may request your child to take laboratory tests such as blood work, urine tests, and in some cases, an X-ray.

Through these tests, certain infections can be identified or ruled out as a cause. They can also provide baseline status of your child’s liver and kidney function, which your doctor will need during uveitis treatment.

What can your child expect from eye imaging tests?

After eye dilation, your child may complain of blurry vision and light sensitivity. This is common and is usually only bothersome for an hour or two after the exam, although the pupils may stay large for several days. Your child’s ophthalmologist will provide them with sunglasses after a dilated visit and it’s a good idea to bring a hat for your child if it’s a sunny day. Your child may miss a day of school depending on how they react to the dilation. If it doesn’t bother them, they can return to regular activities after their eye exam and testing.

Our ophthalmologists are experts that safely and comfortably examine children for uveitis. Our team has experience putting children at ease so they can get the information they need from the eye exam. Rarely, when more detailed testing is required from a very young child or a child who cannot tolerate the exam, our providers may recommend an examination under anesthesia. This involves putting the child to sleep with anesthesia and then performing the eye exam and testing as we otherwise would in the clinic.

How do we treat pediatric uveitis?

Our treatment of pediatric uveitis uses a multifaceted approach. In some cases, inflammation can be so mild your child’s doctor may recommend observation to see if it goes down on its own. In other cases, your child’s doctor may recommend something to help reduce the inflammation to prevent complications like cataracts, glaucoma and retinal damage.

Your child’s doctor may recommend a steroid medication to treat the inflammation. These medicines work to damp down the immune system, and can be taken by mouth, in eyedrop form or injected around or in the eye. However, steroid medications can have complications if used over a long period — steroids around the eyes can cause the eye pressure to rise and may produce cataracts. Steroids taken by mouth can cause agitation, weight gain, and bone density loss. For these reasons, we often start with steroid medication to reduce inflammation quickly, but if the uveitis continues, we may recommend switching our approach for a long-term treatment.

If your child’s uveitis continues, we may transition to medicines other than steroids to manage the inflammation. These medications also suppress an overactive immune system but are much safer for long-term use. Some common examples include methotrexate, mycophenolate and adalimumab. These medications are usually managed by a rheumatologist, who specializes in medication that reduces inflammation. This is why we also have a combination Ophthalmology-Rheumatology Clinic, in which your child can be seen by rheumatologists and ophthalmologists in the same visit.

If the uveitis can’t be successfully treated with medication, some children may need pediatric uveitis surgery to help manage the condition.

Why choose us to treat pediatric uveitis?

We are the only multidisciplinary team to form an ophthalmology-rheumatology clinic in the Rocky Mountain region designed to treat pediatric uveitis. Our system provides streamlined care for our patients to see all the specialists in one place at one time, making your visit convenient and effective. Through our combined clinics, we offer thoughtful, unified medical decisions for patients and their families and we can adjust medications without delay.

We have a wide range of special instruments designed specifically for children that are needed to accurately diagnose uveitis and its complications. For example, fluorescein angiography is a test preformed to detect abnormalities in blood flow in the eye. While many places only offer intravenous administration of the dye to detect blood flow (requiring a needle stick), we offer an oral alternative of an orange-flavored dye so younger patients can avoid a needle stick.

Our doctors are experienced in managing the most complicated forms of uveitis and complications that may include medical or surgical treatments. And our specialized clinic brings together different specialists from around the hospital so your child can see every doctor they need to on the same day, in the same trip.

The Ocular Immunology and Uveitis Foundation is dedicated to finding a cure for ocular inflammatory diseases, to correct the worldwide deficit of properly trained ocular immunologists and to provide education and emotional support for patients afflicted with ocular inflammatory disease.

OliviasVision.org provides information, support and advice for anyone affected by uveitis. Olivia’s Vision also looks to the future by raising funds to train new uveitis experts, specialist pediatric nurses and research regarding potential new treatments, so that one day, avoidable vision loss from uveitis is eliminated.