Uveitis classification

Uveitis is best described using various, concurrent classification systems. Uveitis may be classified according to anatomical location into 4 subtypes, depending on which part of the uvea is primarily affected: anterior, intermediate, posterior, and panuveitis. Based on the duration of symptoms it may be further sub-classified as acute or chronic. Upon further investigation, uveitis may be classified according to histological features of the inflammation such as granulomatous or non-granulomatous. Additionally, uveitis may be described by the laterality of the condition (unilateral or bilateral). Finally, uveitis may be classified by general underlying systemic causes such as infectious, autoimmune, drug-induced, or idiopathic.^{[1][2][3][4][5]}

Uveitis can be described according to the following classifications:^[1][2][5]

• Classification by Anatomical Location
  • Anterior uveitis: Iritis, cyclitis or iridocyclitis (inflammation affecting the iris, the ciliary body, or both)
  • Intermediate uveitis: Viritis or pars planitis (inflammation of the the vitreous humor or the pars plana)
  • Posterior uveitis: Choroiditis, retinitis, or chorioretinitis (inflammation of the choroid, the retina, or both)
  • Panuveitis: Inflammation of the entire uvea
• Classification by Duration of Symptoms^[3]
  • Acute: Active uveitis for less than 3 months
  • Chronic: Active uveitis for more than 3 months
• Classification by type of inflammation^[4]
  • Granulomatous: showing granulomatous inflammation on slit lamp test
  • Non-granulomatous showing no granulomatous inflammation on slit lamp test
• Classification by Laterality
  • Unilateral: Single eye involvement
  • Bilateral: Both eyes involvement
• Classification by Etiology^[1][2]
  • Idiopathic: No known cause
  • Infectious: Bacterial, viral, fungal, or parasitic cause
  • Autoimmune/Inflammatory: Caused by a systemic non-infectious inflammatory condition commonly associated with uveitis
  • Drug-Induced: Iatrogenic cause by medications that are associated with incidence of uveitis
    

As uveitis manifests in a variety of clinical etiologies, differentiation must be established in accordance with the classification system for particular subtypes. Etiologies of acute anterior unilateral infectious uveitis must be differentiated from other subtypes that cause conjuctival injection, eye pain, and photophobia such as acute anterior bilateral non-infectious uveitis or chronic anterior uveitis. Diversely, posterior infectious uveitis must be differentiated from other subtypes that cause visual changes such as intermediate non-infectious uveitis and infectious panuveitis. Using the above model, the following is a classification of uveitis, which includes the most common subtypes:

Anterior uveitis can be classified according to the following presentation:^[5][6][7]

• Acute (>3 months of active symptoms)^[3]
  • Unilateral
    • Infectious: Cytomegalovirus, Herpes simplex, Varicella zoster, syphilis
    • Non-infectious: Seronegative spondyloarthropathy, relapsing polychondritis, systemic lupus erythematosus (SLE), Kawasaki disease
  • Bilateral
    • Infectious: Tuberculosis, syphilis
    • Non-infectious: tubulointerstitial nephritis with uveitis (TINU syndrome)
• Chronic (>3 months of active symptoms)^[3]
  • Infectious: Tuberculosis
  • Non-infectious: juvenile idiopathic arthritis, Sjorgen’s Syndrome, sarcoidosis

Intermediate may present with unilateral or bilateral involvement. It can be classified according to the following etiologies^[5][6][7]

• Infectious: Lyme disease, Whipple’s disease
• Non-infectious: multiple sclerosis, sarcoidosis, tubulointerstitial nephritis with uveitis (TINU syndrome), lymphoma

Posterior uveitis may present with unilateral or bilateral involvement. It can be classified according to the following most common etiologies:^[5][6][7]

• Infectious: Toxoplasmosis, Cytomegalovirus, Tuberculosis, Syphilis, Toxocariasis, Herpes simplex, Varicella zoster, cat scratch disease
• Non-infectious:Vogt-Koyanagi-Harada syndrome, systemic lupus erythematosus, granulomatosis with polyangitis, Behcet’s disease, birdshot chorioretinopathy, lymphoma

Panuveitis may present with unilateral or bilateral involvement. It can be classified according to the following most common etiologies:^[5][6][7]

• Infectious: Tuberculosis, syphilis
• Non-infectious: Juvenile idiopathic arthritis, Behcet’s disease, sarcoidosis, Vogt-Koyanagi-Harada syndrome, Sjorgen’s Syndrome

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