Uveitis for Dermatologists: A Review

December 2020 | Volume 19 | Issue 12 | Original Article | 1192 | Copyright © December 2020


Published online November 28, 2020

Aaron Z. Priluck MDa, Bryn M Burkholder MDa, Dillon D Clarey MDb, Ryan M Trowbridge MDb

aJohns Hopkins University, Wilmer Eye Institute, Department of Ophthalmology, Baltimore, MD
bUniversity of Nebraska Medical Center, Department of Dermatology, Omaha, NE

Abstract
Certain dermatologic conditions and drugs used for their treatment are associated with uveitis, a vision-threatening group of inflammatory eye diseases. Dermatologists may therefore be the first healthcare providers to recognize the presence of uveitis in certain patients and can help ensure morbidity is minimized. Posterior uveitis in particular, which may manifest as insidious, painless vision loss, may first be identified by a careful review of systems by a dermatologist. Understanding uveitis and its associations with certain skin findings and drugs will help enable identification and triage of patients in need of ophthalmic care. An overview of uveitis is provided, including its epidemiology, etiologies, classification, presenting signs and symptoms, general management, and complications. Next, dermatologic diseases that may be associated with uveitis are reviewed with a focus on how uveitis is most likely to present. Lastly, drugs used by dermatologists and less common dermatologic diseases associated with uveitis are reviewed. Multidisciplinary management is necessary for patients with both skin disease and ocular complications such as uveitis. Dermatologists’ recognition of uveitis in patients may reduce time to referral and improve patient outcomes.

J Drugs Dermatol. 2020;19(12):1192-1198. doi:10.36849/JDD.2020.5165

INTRODUCTION

What is uveitis?
Uveitis refers to intraocular inflammation. This inflammation can involve the uvea, composed of the iris, ciliary body, and choroid, but can also involve the vitreous and/or retina (Figure 1). Thus, the term uveitis is somewhat of a misnomer as inflammation is not necessarily limited to uveal structures. Uveitis is classified as one of four categories based on where the inflammation is occurring: anterior uveitis refers to inflammation within the anterior chamber; intermediate uveitis refers to inflammation of the vitreous; posterior uveitis refers to inflammation of the retina, or choroid; and lastly, panuveitis occurs when inflammation is occurring in all areas simultaneously (Table 1). Uveitis is not a singular disease but a generic term encompassing a family of inflammatory diseases with different etiologies and treatment approaches.

How does uveitis clinically present?
Uveitis has a wide range of presentations even when associated with the same specific disease. Uveitis can present acutely with a painful, red, and photophobic eye with reduced visual acuity or chronically with more indolent worsening of visual acuity in an otherwise asymptomatic patient. While anterior uveitis commonly presents with eye pain and redness, these symptoms do not characterize every case of anterior uveitis, nor are they characteristic of anterior uveitis specifically. Similarly, intermediate, posterior, and panuveitis commonly present with decreased vision and floaters, but these symptoms are not universal. Of note, inflammation in the posterior segment of the eye is more likely to cause severe vision loss than anterior