1. Consultant, Uveitis Service
Paediatric Uveitis
Dr. Rathinam Sivakumar
HOD - Uveitis Services
Dr. Radhika. T
Consultant, Uveitis Service
Dr. Vedhanayaki Rajesh

2. Ocular History 6 year old girl redness and pain (OU) since 1 month
no H/O decreased vision
similar episodes in the past

3. General History anti-TB-treatment due to suspected primary complex
diagnosed outside to have juvenile idiopathic arthritis
adequate treatment
Methotrexate 5mg OD
Prednisolone 5mg 1-0-1
Syp. Osteocalcin

4. First Presentation moderately built and nourished.
swelling of knee the small joints
OU: conjunctival granulomas
diffuse granulomatous KP's
AC - quiet
360º posterior synechiae
AVF – quiet; disc and vessels normal

5. Conjuctival granulomas
Granulomatous KPs

6. First Presentation Skin lesion
flat-topped papules on the face, trunk, and extremities

7. Investigations TC : 8600 cells/cu.mm N-54; L-44; E-02 ESR: 1h: 10mm
ACE: IU (normal up to 53 IU)
Mantoux and ANA: negative
conjunctival biopsy: stratified squamous epithelium with lymphocytic infiltration suggestive of sarcoid
chest X-ray: within normal limits.

8. Diagnosis
Pediatric sarcoidosis induced uveitis
Preschoolers present with the triad of arthritis, uveitis, and a cutaneous eruption of discrete small papules
treated with steroid and resolved.

9. Differential Diagnosis
JRA with uveitis ?
Tuberculosis with uveitis ?
Ocular sarcoidosis ?

10. _
Against
Negative ANA
Positive
Poly articular involvement
Conj .Granuloma
B/L Granulomatous uveitis
Sarcoid TB
JRA
Factors

11. Elevated ACE Positive Against Response to steroids +/_ Normal ESR _
Negative Mantoux -
Elevated ACE
SARCOID TB
JRA

12. Treatment topical corticosteroids systemic corticosteroids
methotrexate and folic acid
she responded well to corticosteroids
complete remission in 4 months

13. Conclusion Sarcoidosis is a multisystem granulomatous disease
ocular involvement in 26% to 50 %
signs of ocular sarcoidosis
conjunctival granuloma
anterior uveitis: mutton fat KPs; iris nodules

14. Conclusion Vitritis, Panuveitis, Retinal vasculitis
Optic nerve involvement
Choroidal nodules, exudative retinal detachment
Cystoid macular edema
"Candle wax drippings", "punched-out" lesions
Lacrimal gland enlargement with Dry eye
NLD stenosis or total obstruction
Granuloma in soft tissues of orbit/extra ocular muscles