Uveíte: Etiologia, manifestações clínicas e diagnóstico

Abstract

Introduction: Uveitis, the process of intraocular inflammation, can result from many causes. It often occurs with infections and inflammatory diseases but can occur as an isolated process. Infectious causes include bacterial and spirochetal diseases, viral diseases, fungal and parasitic infections. From an immune-mediated perspective, it occurs as disorders of spondyloarthritis, sarcoidosis, and multiple sclerosis. It is rarely due to a drug hypersensitivity reaction. Referral to an ophthalmologist is indicated for the diagnosis and treatment of patients with symptoms suggesting inflammation of the uveal tract. Objectives: discuss clinical and diagnostic aspects of uveitis. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors "Uveitis", "Etiology", "Clinical Manifestations" AND "Diagnosis”. Articles from 2019-2024 (total 77) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: The symptoms of uveitis depend on the portion of the uveal tract affected. Anterior uveitis can produce pain and redness; posterior or intermediate uveitis is more likely to be painless but is often associated with floaters and/or some degree of visual loss. Visual loss can occur with anterior, intermediate, or posterior involvement. It can be associated with a variety of complications. Evaluation by an ophthalmologist is important in recognizing and managing possible complications of uveitis. Such complications may include: Band keratopathy (calcium deposition in the corneal epithelium); Posterior synechiae (adhesion of the iris to the lens that is posterior to it); Cataracts (resulting from inflammation in some patients or glucocorticoid treatment in others); Cystoid macular edema (accumulation of fluid in the area of ​​central vision); Intraocular hypertension and glaucoma. Slit lamp and funduscopic examination are necessary to establish the presence of uveitis. The examination should include scleral depression to assess inflammation just posterior to the lens. Referral to an ophthalmology specialist for slit lamp examination and a dilated fundus examination is necessary for the diagnosis of uveitis in patients suspected of uveal tract inflammation based on their symptoms and findings or in the presence of other diseases strongly associated with uveitis. uveitis. The RSVP mnemonic can be useful to guide when referring a patient to an ophthalmologist. R stands for redness, which for this purpose must be persistent, as redness is common and is often a manifestation of problems that are not generally vision-threatening, such as eye allergies, dry eye, or mild chemical irritation.  S stands for light sensitivity. Although this is not specific to acute anterior uveitis (it frequently occurs, for example, with migraine), it may indicate intraocular inflammation. V means visual change. Anyone complaining of vision loss or blurring needs an eye exam or sometimes a neurological exam. The P is for pain, which is prominent in acute anterior uveitis but usually absent in more common conditions such as dry eye or allergies. In general, symptoms that begin acutely require immediate ophthalmic evaluation, whereas there is less urgency in evaluating a chronic complaint. Conclusion:Uveitis often occurs in association with other systemic medical conditions, especially infections and inflammatory diseases, but can occur as an isolated process. A detailed medical history is the most important step in diagnosing an associated systemic disease. A chest x-ray and serologic test for syphilis should be performed in patients for whom there is no apparent cause. Other diagnostic tests may include a chest CT scan and evaluation to rule out other infections, systemic inflammatory diseases, or multiple sclerosis.