Uveitis with MS typically presents with intermediate uveitis

This large retrospective study of patients with uveitis and multiple sclerosis (MS) found that the visual prognosis is favorable, with patients typically presenting with intermediate uveitis and a minority presenting with anterior uveitis. Patients with uveitis and MS are significantly older and more likely to be women than patients with idiopathic intermediate uveitis.

The paper highlights two important clinical points:

(1) While the majority of patient with uveitis and MS will have intermediate uveitis, 20% will have other manifestations, including granulomatous anterior uveitis. 

(2) Patients with idiopathic uveitis should undergo a complete review of systems on a regular basis. Ocular inflammation can precede the neurological manifestation of MS, and ophthalmologists are often involved in making the correct diagnosis.

The authors retrospectively reviewed the charts of 113 patients with uveitis and multiple sclerosis. Seventy-three percent of patients were women. The average age at uveitis diagnosis was 33.3 years, which was a year younger than the average age at diagnosis of MS. The majority of patients were diagnosed with both MS and uveitis within five years of each other.

Inflammation was bilateral in 73% of patients. Intermediate uveitis was diagnosed in 80% of eyes, with the remaining eyes categorized as anterior uveitis (15%), posterior uveitis (3%) or panuveitis (2%). Granulomatous anterior uveitis was documented in 8% of eyes and a history of optic neuritis in 35%. 

With an average median follow-up of 3.2 years, visual acuity was maintained in 35% of eyes, improved in 37% of eyes and decreased in 28% of eyes. Visual improvement was faster in eyes with anterior uveitis compared to anterior and intermediate uveitis.