Classification by Clinical Features
When uveitis symptoms begin quickly, the onset is termed sudden; when gradual, the onset is termed insidious. The clinical course of uveitis may be acute, chronic, or recurrent. Acute uveitis describes episodes of sudden onset and limited duration that usually resolve within 3 months or less. Chronic uveitis is persistent, with relapse occurring in less than 3 months after discontinuing treatment. Recurrent uveitis involves repeated episodes separated by periods of inactivity without treatment that last 3 months or longer.
Table 5-5 Diseases With Retinal Vasculitis
The severity of the inflammation can influence categorization and prognosis. The inflammatory process may occur in one or both eyes, or it may alternate between them. The distribution of ocular involvement—focal, multifocal, or diffuse—is also helpful to note when classifying uveitis.
The classification of uveitis as either granulomatous or nongranulomatous is still in use. However, the clinical appearance of uveitis as granulomatous or nongranulomatous may not necessarily correlate with the histologic description and can instead be related to the disease stage, the amount of antigen at presentation, or the patient’s state of immunocompromise (eg, a patient being treated with corticosteroids). Nongranulomatous inflammation typically has a lymphocytic and plasma cell infiltrate; clinically, cellular deposits (keratic precipitates) tend to be finer and distributed diffusely. Granulomatous inflammation also includes epithelioid and giant cells; clinically, cellular deposits with large, clumped, or greasy appearance are predominantly located in a gravity-dependent position on the inferior cornea. Discrete granulomas are characteristic of sarcoidosis and tuberculosis; diffuse granulomatous inflammation appears in Vogt-Koyanagi-Harada syndrome and sympathetic ophthalmia. Zonal granulomatous disease can be observed in lens-induced uveitis.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.