Pediatric Uveitis

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UT Southwestern offers leading-edge care for children with pediatric uveitis, a rare but serious inflammatory eye condition. Our pediatric ophthalmologists use the latest diagnostics and treatments to help control inflammation and protect vision before long-term damage occurs.

What Is Pediatric Uveitis?

Pediatric uveitis is a group of inflammatory eye conditions that affect the middle layer of the eye, called the uvea. This inflammation can also affect nearby structures such as the retina (the part of the eye that senses light), the lens (which helps focus vision), or the optic nerve (which sends visual signals to the brain).

Although uveitis is rare in children, it can be especially serious when it occurs. Uveitis can lead to complications such as glaucoma, cataracts, and vision loss if it’s not treated early and carefully monitored.

Why Choose UT Southwestern for Pediatric Uveitis Care?

We offer one of the nation’s most advanced programs for pediatric uveitis, led by uveitis fellowship-trained ophthalmologists:

UT Southwestern is one of the few centers that offers consolidated care. This means that patients can receive ophthalmology evaluation and have their immunomodulatory therapy prescribed and managed in the same visit. For those who live outside the area and/or who have complex systemic diseases, our combined pediatric rheumatology-uveitis multidisciplinary clinic offers consolidated and coordinated care between the uveitis specialist and pediatric rheumatology team.

Families in nearby states – including Louisiana, Arkansas, Oklahoma, and New Mexico – often turn to UT Southwestern for the specialized care their child can’t find closer to home.

What Causes Pediatric Uveitis?

Most uveitis cases are idiopathic, meaning a cause is not identified. In other cases, it may be linked to the following conditions:

Infections: Viruses (herpes, COVID-19), bacteria (Lyme disease, tuberculosis), parasites (toxoplasmosis, toxocariasis), and fungi can all trigger inflammation.
Autoimmune diseases:
- One of the most common diseases associated with pediatric uveitis is juvenile idiopathic arthritis (JIA), the most common type of arthritis in children under 16.
- Other systemic conditions associated with uveitis include inflammatory bowel diseases (such as Crohn’s disease), ankylosing spondylitis, and sarcoidosis. These diseases cause the immune system to mistakenly attack healthy tissue, including the eyes.
Genetic predisposition: Some children carry risk genes, such as HLA-B27, that increase their chance of developing uveitis.
Eye trauma: Injury to the eye, or even to the opposite eye, can trigger inflammation.

What Are the Types of Pediatric Uveitis?

Pediatric uveitis types are based on which area of the eye is inflamed:

Anterior uveitis (iritis) is the most common type of uveitis in children. It involves the front part of the eye, including the iris and the fluid between the iris and cornea. It can occur suddenly or become chronic over time.
Intermediate uveitis (pars planitis) affects the middle part of the eye, especially the clear gel (vitreous). It often occurs in otherwise healthy children, and the cause may be unknown.
Posterior uveitis (choroiditis) involves the back of the eye, including the retina and the choroid (the layer between the retina and the outer white layer). It may progress slowly and last for years.
Panuveitis involves all layers of the eye. This type of uveitis may cause more severe symptoms and complications if left untreated.

Each type is evaluated according to timing (acute, recurrent, or chronic) and severity.

Female optician monitoring young boy in eye clinic

What Are the Symptoms of Pediatric Uveitis?

Symptoms vary depending on the type of uveitis and the child’s age. Many children, especially those with JIA, may show no outward signs at first. In other cases, symptoms may include:

Eye redness
Eye pain
Sensitivity to light (photophobia)
Blurred or cloudy vision
Floaters (black spots in vision)

Younger children may not complain of symptoms because they cannot describe what they’re seeing. Some adjust to the reduced vision and may not notice problems in one eye. That’s why at-risk children, such as those with JIA, need routine screening by an ophthalmologist, even when no symptoms are reported.

How Is Pediatric Uveitis Diagnosed?

At UT Southwestern, our pediatric ophthalmologists begin with a detailed eye exam. Because uveitis can be difficult to detect, especially in young or asymptomatic children, we use specialized tools and tests, including:

Slit-lamp exam: This uses a microscope that gives a magnified view of eye structures to detect inflammation.
Eye dilation: Eye drops can be used to widen the patient’s pupil so we can see the back of their eye more clearly. Dilation may cause temporary blurred vision and light sensitivity.
Lab tests: Blood work and sometimes X-rays or urine tests may be used to check for infections or autoimmune disease.

Our pediatric eye specialists may order imaging tests, such as:

Optical coherence tomography (OCT), which shows cross-sections of the retina to detect swelling or damage to it.
Ultrasound (B-scan) to measure the thickness of the retina and optic nerve as well as help detect the presence of a retinal detachment when the view into the back of the eye is decreased due to complications from uveitis.
Fluorescein angiography, which highlights blood vessels to identify inflammation.

Male ophthalmologist examining a girl with slit lamp

Pediatric Uveitis Screening for JIA Patients

Children with JIA have a higher risk of developing pediatric uveitis. Without regular screening, uveitis can go unnoticed until it causes permanent vision damage.

Most children with JIA-associated pediatric uveitis don’t report pain, redness, or changes in vision at first. That’s why routine eye exams are essential.

The frequency of eye exams depends on a child’s risk level. Key risk factors include:

A positive antinuclear antibody (ANA) test, which checks for immune system activity linked to autoimmune disease.
Younger age at arthritis onset (especially under age 6).
Arthritis that affects two to four joints (oligoarticular arthritis) or five or more joints (polyarticular arthritis).
Short time since diagnosis.

Children at highest risk may need to be screened every three months. Others may be checked every six to 12 months, depending on their history, age, and lab results.

Our team of pediatric ophthalmologists is highly experienced in screening children with JIA for uveitis, and we use the latest guidelines to help ensure early, accurate detection.

How Is Pediatric Uveitis Treated?

Our pediatric ophthalmologists work with families to create treatment plans tailored to the cause and severity of the inflammation. Our main goals are to:

Reduce inflammation
Control symptoms
Prevent complications
Protect vision

Initial treatments may include:

Steroid eye drops – often the first treatment recommended – which can reduce inflammation and relieve discomfort.
Pupil-dilating drops, which are used to help reduce pain and prevent scarring by keeping the pupil from sticking to the lens.

Extended steroid use (including steroid eye drops) can place children at high risk of long-term complications, including cataracts and glaucoma. Therefore, when uveitis is chronic (lasting more than three months) and/or recurrent, long-term steroid-sparing immunomodulatory therapy may be recommended.

Here at UT Southwestern, we are active in the frontiers of uveitis care, offering groundbreaking therapies, including the newest immunomodulatory therapies and biologics that allow for minimal dependency on corticosteroids.

Immunomodulatory therapy: Drugs such as methotrexate, mycophenolate, or adalimumab can help control long-term inflammation, especially in children with JIA or other autoimmune conditions.
Biologic therapies: If inflammation continues or returns despite other treatments, targeted immunotherapy, such as adalimumab or infliximab (anti-TNF agents), may be recommended to block the immune system’s overactive response.

Surgery for Pediatric Uveitis

In severe cases, surgery may be needed to manage complications caused by long-term inflammation, such as cataracts, glaucoma, or serious damage to the retina. Surgery is usually considered when other treatments are not enough to protect the child’s vision.

Surgical procedures include:

Cataract surgery: Removes the eye’s cloudy lens and may include placing an artificial lens to restore clearer vision
Glaucoma surgery: Helps lower high pressure inside the eye to prevent damage to the optic nerve
Steroid implants: Tiny devices placed in the eye that slowly release anti-inflammatory medication over time
Cryotherapy: A freezing treatment used to stop inflamed areas of the retina from worsening or spreading
Retinal surgery (vitrectomy): Removes the vitreous to improve vision and reduce inflammation