Uveitis in children

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Target exams

Red flags

• A child with juvenile idiopathic arthritis and a normal-looking eye can still have active chronic anterior uveitis — the disease is silent and detected only by slit-lamp screening, so never omit or delay surveillance slit-lamp examination in a child with JIA
• A small, irregular or poorly reactive pupil in a child with JIA suggests posterior synechiae from undiagnosed or inadequately treated chronic uveitis — urgent ophthalmology referral
• A white or grey plaque across the corneal surface in a child with JIA is band keratopathy from chronic anterior chamber inflammation — this is a late complication that signals months to years of undetected disease
• A red painful eye with photophobia in an adolescent may be acute anterior uveitis from HLA-B27-associated spondyloarthritis or inflammatory bowel disease — examine with slit-lamp and fluorescein before any topical steroid, because herpes simplex keratitis mimics this and is worsened by steroid
• A child presenting with visual impairment, leukocoria, squinting or behavioural visual change who has uveitis may already have cataract, glaucoma or amblyopia — ophthalmological emergency even if the eye is white and painless

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and Ophthalmology: uveitis in children — the silent chronic anterior uveitis of juvenile idiopathic arthritis, slit-lamp screening and the topical-to-biologic treatment ladder
• Rheumatology: the JIA-associated uveitis screening schedule by risk group, methotrexate and adalimumab systemic immunosuppression, and the joint paediatric-rheumatology and ophthalmology care model
• Renewed curriculum — Ophthalmology and rheumatology: the SUN anatomical classification, the 2019 ACR and Arthritis Foundation risk-stratified screening guideline, and the differential of non-infectious versus infectious uveitis
• Immunology and infectious diseases: T-cell mediated autoimmunity, ocular toxoplasmosis and toxocariasis, and TINU syndrome
• General Paediatrics: diagnosis and stepwise management of childhood uveitis, the JIA screening paradigm, and the red eye that is uveitis not conjunctivitis
• Systems of care: the coordination of paediatric, rheumatology and ophthalmology services for chronic uveitis surveillance and immunosuppression
• Long Case and Structured discussion: a child with juvenile idiopathic arthritis and uveitis — the screening schedule, the topical-to-biologic treatment ladder, the complications, and the transition to adult care
• Communication station: explaining to a family why a child with a normal-looking eye needs regular slit-lamp screening and immunosuppressive medication, and the safety-net for visual symptoms
• Level 2 and 3 — Ophthalmology and rheumatology: uveitis in childhood, the JIA association, the slit-lamp screening paradigm and the sight-threatening complications
• Chronic disease and long-term conditions: the joint care model, medication adherence, and the transition planning for chronic uveitis
• Foundation of Practice (FOP): the classification of uveitis, the silent presentation of JIA uveitis, and the infectious versus non-infectious differential
• Applied Knowledge in Practice (AKP): the risk-stratified screening schedule, the topical-to-biologic treatment ladder, and the complications of steroid therapy
• History-taking and management: the child with juvenile idiopathic arthritis and uveitis surveillance, and the acute red eye with photophobia
• Communication: explaining the rationale for slit-lamp screening and immunosuppression to a family, and the safety-net for visual deterioration
• General Pediatrics Content Outline — ophthalmology and rheumatology: uveitis in children, the JIA association, the SUN classification and the screening paradigm
• Rheumatology: the 2019 ACR and Arthritis Foundation risk-stratified uveitis screening guideline and the systemic immunosuppression ladder
• Patient Care: diagnosis and stepwise management of childhood uveitis from topical corticosteroid to biologic therapy, with ophthalmology and rheumatology co-management
• Systems-Based Practice and Population Health: the screening programme for JIA-associated uveitis, the barriers to surveillance in rural and remote settings, and the transition to adult care
• Medical Knowledge: the T-cell mediated autoimmune pathophysiology, the SUN classification, and the SYCAMORE trial evidence for adalimumab
• Medical Expert: uveitis in children — classification, the JIA screening paradigm, the treatment ladder and the complications, including the infectious posterior uveitides
• Health Advocate and Collaborator: screening adherence and equitable access to slit-lamp surveillance for Indigenous and remote-community children, and the joint care model
• Communicator: explaining the silent nature of JIA uveitis, the need for chronic immunosuppression, and the safety-net for visual symptoms