Childhood uveitis

Pediatric uveitis embraces a group of inflammatory diseases affecting the vascular layer of the eye. Among the broad spectrum of possible etiologies, juvenile idiopathic arthritis stands for the most common cause of anterior chronic uveitis in Western countries. Despite being considered a rare disease, non-infectious chronic uveitis is a serious and disabling sight-threatening condition accounting for up to 10 % of pathologies leading to blindness. Visual complications arise as a consequence of persistent or recurrent ocular inflammation, but also as result of chronic steroid treatment. Targeted antimicrobial treatment is necessary for infectious uveitis. On the other hand, non-infectious uveitis is managed trough a “step-by-step” approach, in order to control local inflammation, achieve a corticosteroid-sparing effect and reduce the risk of visual complications. Therapeutic options include corticosteroids, conventional immune-modulatory therapy and tumor necrosis factor α [TNF-α] antagonists. Preliminary evidence suggests a possible role of non anti-TNF-α modifier immunosuppressive treatment for refractory cases, accounting for about 25 % of total patients. Given the high cost and the lack of long-term safety data, the experience with these agents is still limited to few cases managed in highly specialized centers.