Tugal-Tutkun Ilknur
Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Ophthalmic Vis Res. 2011 Oct;6(4):259-69.
Uveitis is less common in children than in adults, and its diagnosis and management can be particularly challenging. Young children are often asymptomatic either because of inability to express complaints or because of the truly asymptomatic nature of their disease. Even in advanced cases, parents may not be aware of severe visual impairment until the development of externally visible changes such as band keratopathy, strabismus, or leukocoria. Therefore, the diagnosis is often delayed and severe complications may be seen at the time of initial visit. Young children may not be cooperative for a complete ocular examination and subtle findings of intraocular inflammation such as trace cells may be easily missed in the early stages of the disease. Children, in general, tend to have more severe and chronic intraocular inflammation that frequently results in ocular complications and visual loss. In children who present with amblyopia or strabismus, a careful examination is required to rule out uveitis as an underlying cause. Delayed and variable presentations cause a distinct challenge in the diagnosis of uveitis in children, furthermore differential diagnosis also requires awareness of etiologies which are different from adults. There are unique forms of uveitis and masquerade syndromes in this age group, while some entities commonly encountered in adults are rare in children.
葡萄膜炎在儿童中比在成人中少见，其诊断和管理可能特别具有挑战性。幼儿往往没有症状，要么是因为无法表达不适，要么是因为其疾病确实没有症状。即使在病情严重的情况下，在出现如带状角膜病变、斜视或白瞳症等外部可见变化之前，家长可能也没有意识到严重的视力损害。因此，诊断往往会延迟，在初次就诊时可能会出现严重并发症。幼儿可能不配合进行全面的眼部检查，在疾病早期可能很容易漏诊眼内炎症的细微表现，如微量细胞。一般来说，儿童往往有更严重和慢性的眼内炎症，常常导致眼部并发症和视力丧失。对于出现弱视或斜视的儿童，需要进行仔细检查以排除葡萄膜炎作为潜在病因。延迟和多变的表现给儿童葡萄膜炎的诊断带来了独特的挑战，此外，鉴别诊断还需要了解与成人不同的病因。这个年龄组有独特形式的葡萄膜炎和伪装综合征，而一些在成人中常见的疾病在儿童中很少见。
