Remember that red eye with WARNING symptoms like loss of visual acuity, ophthalmoplegia, pupillary involvement, photophobia, diplopia, associated systemic symptoms
Signs and Symptoms of Uveitis
Exam: can see ciliary flush (circumcorneal injection), hypopyon (not specific, can be seen in many other eye conditions), redness at the limbus
Pupil: often constricted
Ocular pain: moderate to severe, deep aching pain
Vision: mild-moderately reduced
Cornea: often hazy in appearance
Etiology of Uveitis
–IDIOPATHIC (most common)
-Infectious (HSV, Zoster, Toxo, Syphillis, TUBERCULOSIS, West-Nile, cat-scratch disease)
AIN (Acute interstitial nephritis)
Keep AIN in your differential for new onset AKI, especially if on antibiotics or NSAIDS!
Etiologies of AIN
1)Drugs (LOTS of them, commonly cephalosporins, NSAIDS, but includes famotidine, omeprazole)
2)Infections (Leptospira, legionella, staph, strep, etc.)
Many other immune and neoplastic disorders!
TINU (Tubulointerstitial nephritis and uveitis)
–RARE disease, ~250 cases since 1976
-Pathogenesis thought to be due to auto-immune T cell mediated with common modified C-reactive protein in both the uvea and renal tubular cells
–Manifests as Uveitis and Interstitial Nephritis, however must RULE out other etiologies of uveitis and AIN, especially Sarcoidosis and Sjogren’s as can look very similar.
–Treatment: Steroids, usually 1 mg/kg/day (40-60 kg) for 3-6 months