Overview
HAU is an inflammatory condition thought to be related to lymphocyte-driven inflammation mediated by infected CD4+ T cells in the aqueous humour of the eye.
Incidence
There is insufficient evidence to comment on the incidence of HAU in people with HTLV-1 infection or on the predictors of disease development either internationally or in Australia. The age of onset ranges from teens to over 60 years of age.
Morbidity
Prognosis is generally favourable however recurrence is common. Sight-threatening complications include retinochoroidal degeneration and glaucoma. Corticosteroid-induced cataracts can occur. Vision loss in the untreated also can occur. Due to recurrence rates (up to 52% in one study) follow up with optometry and ophthalmology services is recommended.
Symptoms
Symptoms include blurred vision, floaters, decline in vision, eye redness, eye pain and photophobia. This can occur suddenly in both eyes or in one eye. The main clinicopathological features are vitreous opacity and retinal vasculitis.
Diagnosis
The gold standard for diagnosis is detection of HTLV-1 proviral DNA or anti-HTLV-1 antibodies in aqueous humour. This is infrequently done, and diagnosis is usually made by exclusion of other causes of uveitis and the presence of HTLV-1 infection.
Treatment
Treatment involves either topical and/or systemic corticosteroids.
Management and Care
Management and care should be initiated by the ophthalmology service. Education should be provided to the patient to be aware of early presentation if vision changes or new visual symptoms develop after the acute episode has been treated.
