Uveitis and Contact Lens Complications: Clinical Management

Uveitis Signs and Symptoms

Anterior Uveitis

• Reduced visual acuity (VA)
• Ciliary injection/flush around the limbus
• Miosis due to pupillary sphincter spasm
• Formation of posterior synechiae
• Anterior chamber cells and flare
• 'Spillover' of cells into the vitreous
• Hypopyon (white blood cell collection)
• Keratic precipitates (large/greasy suggest systemic; small suggest AAU)

Intermediate Uveitis

• Cells and flare
• Scattered keratic precipitates
• Vitreous cell spillover
• Vitreous snowballs and snow banking (white cells seen on fundus)
• Neovascularization and cystoid macular edema (CMO)

Grading Systems

Cells (/1x1 mm)

• 0: <1 | 0.5+: 1–5 | 1+: 6–15 | 2+: 16–25 | 3+: 26–50 | 4+: >50

Flare

• 0: None | 1+: Faint | 2+: Moderate (iris/lens clear) | 3+: Marked (iris/lens hazy) | 4+: Intense (fibrin)

Anterior Uveitis Management

Administer Pred Forte (1%) hourly for 2 days, then taper: 2-hourly (2 days) → QID, then TID, BID, QD (1 week each). Add Atropine BID–TID until quiet. Monitor intraocular pressure (IOP). Review in 1 day; refer severe or recurrent cases and consult GP for HLA-B27 blood testing.

Contact Lens (CL) Diagnosis and Management

• CIE (General): Small peripheral white/grey stromal infiltrates, minimal staining, mild redness. Management: Cease CL, topical steroid ± prophylactic antibiotic, lubricants.
• CLAIK: Multiple tiny faint infiltrates + SPK, mild conjunctival redness. Management: Cease CL, topical steroid ± prophylactic antibiotic, lubricants.
• CLPU: Peripheral well-defined white infiltrate ± small epithelial defect/staining. Management: Cease CL, prophylactic antibiotic.
• Microbial Keratitis (MK): Dense central infiltrate with epithelial defect (ulcer), indistinct margins ± AC reaction. Management: Cease CL, urgent referral, intensive topical antibiotics.
• SICS: Central diffuse punctate staining shortly after insertion, often bilateral. Management: Cease CL, change solution/material.
• CLPC: Large papillae on upper tarsal conjunctiva, mucus, itch. Management: Cease/reduce CL, antihistamine/mast-cell stabilizer ± topical steroid.
• SEAL: Superior arcuate epithelial defect/staining parallel to limbus. Management: Cease CL, prophylactic antibiotic.