Uveitis

Uveitis encompasses inflammatory diseases affecting various structures of the eye, including the iris, ciliary bodies and choroid, and may affect one or both eyes. It may occur in isolation or be associated with a systemic, infectious or inflammatory disease. Its presentation and course are highly variable. Specialist care makes it possible to identify the form of uveitis, investigate its cause when necessary, and adapt follow-up and treatment in order to preserve vision and limit complications. The department also manages complex cases or situations requiring a multidisciplinary opinion.

Management is based on a comprehensive and standardised ophthalmological assessment, making it possible to characterise the inflammation according to its location, activity and complications. The team relies in particular on the SUN classification and monitoring criteria, as well as on international recommendations from scientific societies specialising in uveitis. The aetiological assessment is guided by the clinical context and may combine laboratory tests, imaging and specialist consultations. Treatment is individualised and may include topical or systemic corticosteroid therapy, immunomodulatory or immunosuppressive treatments, as well as treatments targeting ocular complications. Management of complex cases is based on close collaboration with the relevant specialists, particularly in internal medicine, rheumatology or infectious diseases. Follow-up is adapted to disease activity and the response to treatment.

Regular follow-up is important, even when symptoms are mild, because inflammation can sometimes progress without causing significant discomfort initially. It is recommended to comply with the treatment and follow-up appointments, and to report any decrease in visual acuity, significant eye pain, unusual redness, the appearance of floaters or marked photophobia. Rapid worsening of symptoms or a significant reduction in vision warrants prompt ophthalmological assessment. Treatments may be adjusted gradually according to the activity of the inflammation and their tolerability. If systemic treatment is used, follow-up may also require coordination with the relevant specialist.

Proposed care pathway for patients being followed for uveitis

1. Referral to a specialist consultation in cases of suspected or known uveitis.
2. Ophthalmological assessment and characterisation of the inflammation according to SUN criteria.
3. Investigation of an associated cause when clinically indicated, with targeted additional tests.
4. Multidisciplinary discussion when the uveitis is associated with a systemic, infectious or autoimmune disease, or in complex cases requiring corticosteroid-sparing treatment.
5. Initiation and adjustment of treatment, with monitoring of inflammatory activity, vision and complications.
6. Long-term follow-up and coordination between the various healthcare professionals involved. The care pathway may be adapted according to the patient’s age, aetiology, severity and disease progression.

The transition to adulthood relies on coordination between paediatric and adult teams to ensure continuity of ophthalmological care and, where necessary, systemic follow-up. Particular attention is paid to understanding the disease, the young patient’s autonomy in managing their treatment, and the gradual transfer of medical information. Links with the relevant adult specialists can be arranged according to the aetiology and the patient’s needs.

The centre is contributing to the development of a structured approach to quality of care and research in uveitis. A Belgian Uveitis Registry (BUR) is being developed, with a retrospective pilot phase conducted at Erasme involving several hundred patients (UVERA), and the aim of extending it nationwide via REDCap. This project aims, in particular, to standardise the collection of clinical data and patient follow-up. Patient care is based on the SUN criteria and international recommendations. The project is also part of an academic initiative to develop quality indicators for uveitis.