Uveitis screening for juvenile idiopathic arthritis (JIA)

This resource is intended to explain the importance of attending eye screening appointments following a diagnosis of juvenile idiopathic arthritis (JIA).

Why do we offer eye screening to children with a diagnosis of JIA?

Some children with JIA will also get inflammation in their eyes. Unfortunately, uveitis may not cause any symptoms in the early stages and if undiagnosed and untreated uveitis may cause damage to the eyes which can threaten sight.

For this reason, the British Society for Rheumatology and the Royal College of Ophthalmologists have jointly produced a nationally recommended screening programme guideline.

What is uveitis?

The ‘uve’ in uveitis describes the uveal tract, which includes:

• the iris (the coloured part of the eye at the front of the eye)
• the ciliary body (the ring of muscle behind the iris)
• the choroid (the layer of tissue lining the inside of the eye behind the retina)

The word ‘itis’ means inflammation. Uveitis is a condition to describe inflammation inside the eyeball.

The ‘vitreous’ is the name of the jelly like substance in the middle of the eye.

Untreated, uveitis can cause:

• cataracts (opacity of the lens)
• glaucoma (high pressure inside the eye)
• macular oedema (swelling of the back of the eye)

Left untreated this can result in permanent damage and vision loss or visual impairment.

How do we detect uveitis?

Uveitis can be detected and treated early with regular specialist examinations.

A uveitis screening appointment will be offered to you within 6 weeks of the initial diagnosis of juvenile idiopathic arthritis (JIA) and on a regular basis thereafter.

It is essential that your child attends all their eye screening appointments because:

• Your child may not have any symptoms of uveitis
• If uveitis occurs we need to recognise and treat it early

If you are unable to attend, it is important that you contact the eye secretaries on the following phone numbers, ensuring that you have an alternative appointment.

Ophthalmology secretaries
Sarah Hayes 0114 2717468

Rheumatology secretaries
Paula Sharrock 0114 2717726

What are the symptoms?

Symptoms (if any) that may be experienced are:

• redness of the eye
• pain
• sensitivity to light (photophobia)
• blurred or cloudy vision
• loss or reduction of vision
• loss or reduction of peripheral vision (the ability to see objects at the side of your field of vision)
• floaters (debris in the vitreous jelly appear as dots in your vision)
• synec
• hiae (irregular shaped pupil) caused by inflammation in the anterior chamber of the eye.

How is uveitis treated?

Uveitis can be treated with anti-inflammatory (steroid) eye drops.

For some people a dilating drop to open up the pupil is necessary as well.

Sometimes drops are not enough to treat the uveitis. If this is the case, you may need stronger medication. This may be taken by mouth or by injection. You will have a lot of support with this from the nurse specialists, who will be more than happy to advise you.

What will happen in the future?

The outlook for people with uveitis varies greatly, but, with regular checks and medication management, uveitis can be well managed and controlled with good visual outcomes.

This does however require good compliance with medication and hospital appointments.