Uveitis in the elderly—is it easy to identify the masquerade?

Uveitis tends to occur in working age adults and is a major cause of visual loss in this age group.1 It does however occur both in childhood and in the elderly, and considerably less information is available regarding these two groups, particularly the latter. Regardless, in all age groups, it is necessary to accurately diagnose the form of uveitis, and to detect any underlying or associated systemic problems. Management is guided by the significant features of a patient’s history, the signs present within the eye, and the results of relevant investigations.2 While the causes of uveitis are legion, most are immune mediated, requiring the patient’s immune system to mount and perpetuate an immune response, irrespective of the initiating stimulus.3 It is known that the aging immune system is less able to respond to foreign antigens and that autoimmune antibody production rises. Overall, however, it is believed that the incidence of true immune mediated uveitis declines in the elderly. Infectious endophthalmitis, particularly that arising after surgery, and lymphoma both occur at higher frequency in the elderly. These constitute the masquerade syndromes.

In this review, information available on the types of uveitis found in the elderly is presented, along with data on the aging immune system. Specific information is given on the causes of the masquerade syndromes, and an approach to clinical management is suggested.