A Glimpse into Uveitis in the Aging Eye: Pathophysiology, Clinical Presentation and Treatment Considerations

Abstract

Uveitis describes a group of inflammatory conditions of the eye that have various underlying causes and clinical presentations. Susceptibilities to uveitis in the elderly may be attributed to age-related risk factors such as immunosenescence, increased immunological inflammatory mediators, and autoimmunity. Overall, anterior uveitis is more common than posterior and panuveitis in the general population and also in the elderly. Some causes of uveitis in the elderly are herpes simplex virus, ocular ischemic syndrome, sarcoidosis, and central nervous system lymphoma, and these will be discussed in detail herein. Eye care professionals need to consider the wide differential for uveitis, obtain the appropriate history, conduct a detailed clinical examination, and tailor management to the clinical presentation and underlying cause of disease. The challenges of polypharmacy and nonadherence in the elderly impact patient outcomes and must be taken into consideration when considering treatment.

Figure 1

Slit lamp photograph depicting iris atrophy in an individual with herpes simplex virus associated chronic iritis.

Figure 2

Fundus photograph depicting mid-peripheral hemorrhages and narrowed arteries in an individual with ocular ischemic syndrome.

Figure 3

Fundus photograph depicting (A) vitreous haze (arrow) in the setting of vitritis in an individual with sarcoidosis and (B) punched out peripheral choroidal lesions representing inactive disease.

Figure 4

Fundus photograph depicting multifocal, creamy, sub-retinal lesions (arrow) in an individual with primary central nervous system lymphoma.