Pediatric uveitis is estimated to represent about 5% to 10% of all uveitis cases. While the condition may be uncommon, Russell W. Read, MD, PhD, notes that prompt and skillful diagnosis and management are just as important as in adult patients. Children typically present much later in the disease course and with significant complications, Dr. Read said. In his on demand presentation for Uveitis Subspecialty Day, he offered a list of considerations for physicians managing childhood uveitis.
Don’t take shortcuts. Apply the same rigor to evaluation as you would with adult patients. This includes taking a careful history and performing a comprehensive ocular exam and directed testing. One thing to keep in mind: Children are often asymptomatic and are “poor historians.”
Do remember that kids are not just small adults. Although it may be challenging, most pediatric patients can be examined at the slit lamp. Dr. Read recommends examining the anterior chamber first, as it is arguably the most important area. Distractors—using a pediatric lane or playing videos near the physician’s ear—can often be helpful.
Don’t assume that all pediatric uveitis is juvenile idiopathic arthritis (JIA). Anterior uveitis remains the most common type in kids, followed by posterior, intermediate, and panuveitis. However, the epidemiology of the disease changes with age. JIA-associated disease is most common among patients younger than 5 years old. By contrast, pars planitis is most common in children 6 to 10 years, and toxoplasmosis should be a leading suspect for those aged 11 to 16.
Do control the inflammation. As in adults, inflammation should be addressed immediately. Corticosteroids are a typical starting point, but clinicians should consider transitioning to steroid-sparing therapy earlier with children than with adults, as growth retardation is one of the adverse effects of steroids. Consult with a pediatric rheumatologist as necessary.
Don’t fail to check IOP at every visit. Kids can be steroid responders, too! Although steroid therapy is typically safe to use for short periods, it can still carry the risk of increased IOP.
Do assume the child is listening. Be careful what you say to parents when the child is present. And make sure that the caregivers clearly understand the therapies you are prescribing.
Dr. Read concluded his presentation with a reminder to enjoy the experience of working with kids. “It is incredibly rewarding,” he said. —Keng Jin Lee.
Watch Uveitis Subspecialty Day. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; and click on the “Friday” tab.
Financial disclosures. Dr. Read: None.
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