Ebook Harley’s pediatric ophthalmology (6/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Harley’s pediatric ophthalmology (6/E): Part 2
Ebook Harley’s pediatric ophthalmology (6/E): Part 2
Pediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2ately 2% to 14% of patients seen in uveitis clinics arc children (1-3). Unique to the pediatric age group in the management and timely diagnosis of uveitis is the threat of amblyopia. In addition, the associated systemic disease profile is much different than that seen in adults. Children more often Ebook Harley’s pediatric ophthalmology (6/E): Part 2 (71%) have an associated systemic illness than adults (55%) (4). Although juvenile idiopathic arthritis (JIA) is the predominant cause of anterior uvEbook Harley’s pediatric ophthalmology (6/E): Part 2
eitis in children (5.6), it is important to recognize that uveitis in a child can be due to a wide range of etiologies, including serious life-threatePediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2isorder may even be entirely asymptomatic until irreversible ocular damage has been sustained (Fig. 13.1) The child may be unable to verbalize his/her symptoms, and can often function normally with visual acuity well below 20/20 for activities of daily living, especially when the disease is unilater Ebook Harley’s pediatric ophthalmology (6/E): Part 2al and the child is younger. The approach to pediatric uveitis requires the understanding that early recognition through screening, where appropriate,Ebook Harley’s pediatric ophthalmology (6/E): Part 2
can be of utmost importance.Table 13.1 summarizes the diagnostic approach to the child with pediatric uveitis.EPIDEMIOLOGYThe frequency and etiology Pediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2sis of worldwide studies showed that 7% of patients with uveitis are children. Parasitic anterior uveitis (49.3%) is the most common etiology globally, with idiopathic being the second most common (25.5%) (7). A group from Saudi Arabia reported idiopathic anterior non-granulomatous uveitis as the mo Ebook Harley’s pediatric ophthalmology (6/E): Part 2st common type of uveitis in children (26%) (8). A report from Israel found infectious diseases to be the primary etiology of uveitis in children andEbook Harley’s pediatric ophthalmology (6/E): Part 2
adolescents (31.2%) (1).To the contrary, a study from the US National Fye Institute found that idiopathic uveitis (28.8%) was the leading etiology in Pediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2 of 527 children in the United States with uveitis, found that 54% were female; 62% White. 15% Hispanic. 12% Black. 3% Asian, and 2% multiracial (9). The median age at diagnosis was 9.4 years.CLASSIFICATIONAlthough consortium-dnven classification systems have been proposed, they may be difficult to Ebook Harley’s pediatric ophthalmology (6/E): Part 2use in the clinical setting. The Standardization of Uveitis Nomenclature (SUN) criteria were developed for classification and description of uveitis bEbook Harley’s pediatric ophthalmology (6/E): Part 2
y anatomic location (Table 13.2). Specific grading criteria, such as quantitative grading of inflammation, were also elaborated (10). Morphologic clasPediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2eparate etiologies into exogenous, representing any external injury or invasion of microorganisms from outside the globe, versus endogenous, resulting from factors that originate within the patient.TREATMENT AND COMPLICATIONSTopical Medical Therapyliven with low-grade iritis, the goal is early, aggr Ebook Harley’s pediatric ophthalmology (6/E): Part 2essive treatment to suppress inflammation maximally, in hopes of preventing the development of vision-threatening complications (11-14). When inflammaEbook Harley’s pediatric ophthalmology (6/E): Part 2
tion IS more severe, topical corticosteroids may be indicated as frequently as every' 1 to 2 hours. Follow-up within 1 to 2 weeks after initiating trePediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2teroids. Although a fairly rapid taper may be appropriate on the first episode, any indication of intis recurrence during the taper should be met with a change to a slow taper. It may take weeks, months, or even283(c) 2015 Wolters Kluwer. All Rights Reserved.284 HARLEY'S PEDIATRIC OPHTHALMOLOGYFIGUR Ebook Harley’s pediatric ophthalmology (6/E): Part 2E 13.1. Child with asymptomatic oligoartlcular ịư.-eniie idiopathic arthritis who did not present until usual loss was noted ừ/ fthich time she had aEbook Harley’s pediatric ophthalmology (6/E): Part 2
dense white cataract multiple posterior synechiae, and actw anterior uveitis. Note the absence of conjunctival inflammation.years to accomplish a fullPediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2 treated uveitis IS even greater. Our experience with high dose and chronic topical steroid use actually shows a reduction in such complications and belter vision outcomes (15).Cycloplcgic agents arc also important, given the increased tendency of children to form synechiae Many different regimens h Ebook Harley’s pediatric ophthalmology (6/E): Part 2ave been suggested (16). We prefer a minimum of one dose of cyclopentolate 1% at bedtime It is also important to consider (and treat with glasses if nEbook Harley’s pediatric ophthalmology (6/E): Part 2
eeded) the blur induced by cycloplcgia, especially in school-aged children.A recent study specifically on the use of difluprcdnatc in pediatric uveitiPediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2mic immunomodulatory therapy, but it was not without risks (17). Glaucomaĩầblc 13.1EVALUATION AND TESTING FOR PEDIATRIC UVEITISHistory of Present IllnessMedical history:Systemic illnesses (e g . sarcoidosis. JIA. AIDS, I B)Social history:Sexual history (where appropnate based on age)BirthplaceTravel Ebook Harley’s pediatric ophthalmology (6/E): Part 2 (c.g., Ohio River Valley), camping/cnvironmcnt (exposure to ticks)Review of Systems:General: fever, weight loss, malaise, night sweats, weight loss,Ebook Harley’s pediatric ophthalmology (6/E): Part 2
lymphadenopathyEar. nose, throat hearing loss, tinnitusCardiac: murmurs (e g., mitral regurgitation in Kawasaki disease)Respiratory: shortness of breaPediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, Approxima Ebook Harley’s pediatric ophthalmology (6/E): Part 2Musculoskeletal: lower back pain, arthralgias, joint stiffness, myalgiaDermatologic rashes, desquamation, alopecia, vitiligo, lick and insect bitesPediatric UveitisGrace T. Liu • Alex V. LevinINTRODUCTIONUveitis in the pediatric population is a significant cause of ophthalmic morbidity, ApproximaGọi ngay
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