Diagnostic and Therapeutic Management of Papillitis in Patients With Uveitis

Abstract

Abstract: : Purpose: To study the frequency, clinical features, informative diagnostic tests and evolution of papillitis in patients with uveitis. Methods: Retrospective observational case series of patients referred for the first time to a tertiary eye care center for diagnostic and therapeutic management of uveitis during 2001. A review of clinical features, laboratory, angiographic and visual field findings, therapeutic management and evolution records was obtained. Isolated neuroophthalmological emergencies and demyelinating optic neuritis were excluded. Results: Among 671 patients referred for the first time, we found 106 presenting with papillitis (15.8%). Mean age was 45 years (4–91 years) and the F/M ratio was 1.3. Papillitis was mainly unilateral (n=70, 66%), associated with non granulomatous (n=90, 85%) uveitis. Initial visual acuity was < 20/100 in 27 patients (24.5%) and a cystoid macular edema was associated in 43.4% of cases (46 patients). Papillitis was related to an eye–limited disorder in 40% (n=42) of cases, to an infectious disease in 22% (n=24) of cases, to a systemic disease in 19% (n=20) of cases and to a presumed immune–mediated disorder in 8.5% of cases (n=9). Papillitis revealed a neurological condition associated with intraocular inflammation in 4.7% of cases (n=4) (cerebral thrombophlebitis, primary intraocular lymphoma). Anti inflammatory or specific drugs were used in 68.9% (n=73), including corticosteroids in 60.2% (n=44) of cases. Moreover a close follow–up was proposed to patients with normal visual field and visual acuity. The mean follow–up was 12 months (range 3 –24 m). During the follow–up, clinical evaluation has confirmed an improvement or stabilization in 64.5% of cases. Conclusions: Papillitis is commonly associated with intraocular inflammation. It should be taken into account for the final diagnosis and can also reveal a neurological condition. A standardized diagnostic and therapeutic strategy must be followed in the face of papillitis with visual acuity and/or visual field impairments.

Keywords: inflammation • neuro-ophthalmology: optic nerve • optic disc