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Uveitis in children is one of the most challenging conditions in paediatric ophthalmology. Some children develop inflammation in both their joints and their eyes, a combination known as JIA-associated uveitis. Unlike uveitis in adults, childhood uveitis is frequently a silent disease: the eye looks normal, there is no redness or pain, and the child does not complain of any symptoms. Yet without regular specialist monitoring and prompt treatment, it can quietly cause progressive damage to the structures of the eye and lead to serious complications, including cataracts, glaucoma and vision loss. At Clinica London, Mr Harry Petrushkin provides dedicated specialist eye care for children with uveitis and JIA-associated eye disease, with the thorough monitoring, clear communication and genuine warmth with children that this complex condition demands.
In children, anterior uveitis associated with juvenile idiopathic arthritis (JIA) is the most common form, where there is inflammation in both the eyes and the joints. The uveitis is characteristically chronic, bilateral, often affecting both eyes asymmetrically, and crucially, asymptomatic in many children. The absence of symptoms is what makes it so dangerous: a child can have active intraocular inflammation causing progressive damage without any outward sign, and without any complaint of pain or visual disturbance.
Because childhood uveitis so often causes no symptoms, it cannot be relied upon to announce itself. Regular specialist slit lamp examination, not waiting for symptoms to appear, is the only reliable way to detect active inflammation before it causes lasting damage to the eye.
All children diagnosed with JIA should be under regular ophthalmology review regardless of whether they have any eye symptoms. The screening frequency depends on the JIA subtype, ANA status, age at diagnosis and disease duration. If your child has joint disease from JIA and has not had a recent eye examination, please contact us to arrange an appointment with Mr Petrushkin.
You can book a private consultation directly with Clinica London without a GP referral. If your child is covered by private medical insurance, your insurer may require a GP or rheumatology referral letter before authorising the consultation. We recommend checking your policy before booking. Our team is happy to assist with any queries.
Book a consultation with Mr Petrushkin →Uveitis is inflammation of the uvea, the middle layer of the eye that includes the iris, ciliary body and choroid. It is classified by anatomical location: anterior uveitis affects the front of the eye, the iris and ciliary body; intermediate uveitis affects the vitreous and peripheral retina; posterior uveitis affects the retina and choroid; and panuveitis involves all layers.
Mr Harry Petrushkin is known for his warm, patient approach with children and his ability to put both children and parents at ease during what can be a daunting specialist appointment. He takes time to explain findings clearly, to answer questions fully, and to ensure that families leave with a thorough understanding of their child's condition and the plan going forward.
Mr Petrushkin takes a careful history including the JIA subtype and disease activity, current medications for both joints and eyes, any previous uveitis episodes and treatments, and any symptoms or concerns since the last appointment. For new patients, a full background history is taken.
Visual acuity is measured in each eye and intraocular pressure is checked. A detailed slit lamp examination assesses anterior chamber cells and flare, the lens, cornea and iris for complications, graded using standardised criteria and recorded against previous results to track progress.
OCT imaging of the macula checks for cystoid macular oedema. SLO imaging provides a detailed record of the fundus. Both scans are non-invasive and well tolerated by children, with results compared against previous scans to detect any change.
Following dilation with eye drops, Mr Petrushkin examines the vitreous, retina, macula and optic disc. Dilation takes 20 to 30 minutes to work and will leave the child's vision blurred and light-sensitive for a few hours, up to 24 hours in some children. It is worth bringing sunglasses.
Mr Petrushkin explains his findings clearly, including the current level of inflammation relative to the treatment target of zero cells, any changes in imaging, and any complications detected. The management plan is reviewed and any changes to treatment are discussed and agreed with the family.
A written summary is provided for the family, and sent where appropriate to the child's rheumatologist and GP. The next monitoring appointment is scheduled according to the level of disease activity, and Mr Petrushkin is available for queries between appointments where needed.
Children with uveitis and JIA-associated eye disease at Clinica London are seen by Mr Harry Petrushkin, a consultant ophthalmologist who specialises in uveitis and medical retina.
Mr Petrushkin has a particular interest in and commitment to the care of children with JIA-associated uveitis and the full range of paediatric uveitis presentations. He is known for the thoroughness of his monitoring, his expertise in managing complex and treatment-refractory cases, and for the care and warmth with which he works with children and their families. OCT and SLO imaging are integral to his monitoring approach.
Coordinated care with rheumatology: children with JIA-associated uveitis need coordinated care between their ophthalmologist and rheumatologist. At Clinica London, Mr Petrushkin works closely with paediatric rheumatology teams to ensure that systemic treatment is optimised for both joint and eye disease, and that any changes in therapy are communicated clearly between teams. We are happy to liaise directly with your child's rheumatologist.
Expert, thorough and caring specialist monitoring for children with uveitis and JIA-associated eye disease.
Book a consultation with Mr PetrushkinAll fees are for private appointments at 140 Harley Street. Prescription costs for systemic treatments are additional.
| Appointment / Assessment | Fee |
|---|---|
| New patient consultation with Mr Harry Petrushkin | £450 |
| Uveitis monitoring follow-up | £350 |
| OCT imaging | £350 |
| SLO fundus imaging | £185 |
| Visual field assessment (where indicated) | £275 |
Blood tests: your consultant may recommend blood tests. These are not required for every patient, but if clinically indicated they are an additional cost, typically ranging from £100 to £375, payable directly to the laboratory.
Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic joint disease, and uveitis is its most significant non-articular complication. The risk of uveitis is highest in children with oligoarticular JIA, affecting four or fewer joints, who are antinuclear antibody (ANA) positive, particularly girls under the age of seven at disease onset. In this group, the cumulative risk of uveitis over time is high, and regular screening is essential regardless of whether the child has any eye symptoms.
JIA-associated uveitis is typically anterior, chronic and non-granulomatous. It affects the front of the eye and causes inflammation of the aqueous humour, the fluid inside the front of the eye. On slit lamp examination, inflammatory cells and flare are visible in the anterior chamber. The child usually has no symptoms unless complications have already developed.
The goal of treatment is to achieve complete suppression of eye inflammation, protecting the eye from these complications over the long term.
Not all childhood uveitis is JIA-associated. Other causes include infectious uveitis, due to toxoplasmosis, herpes viruses, toxocara and other organisms, sarcoidosis, which can cause a granulomatous uveitis in older children and teenagers, tubulointerstitial nephritis and uveitis (TINU syndrome), and idiopathic anterior, intermediate or posterior uveitis. Less commonly, Behçet's disease, Vogt-Koyanagi-Harada syndrome and other systemic inflammatory conditions can present with uveitis.
Intermediate uveitis in children, presenting with floaters and blurred vision, is often idiopathic or may carry a risk of association with multiple sclerosis in older children, and requires careful investigation. Posterior uveitis in children always warrants thorough investigation for an infectious or systemic cause. Mr Petrushkin is experienced in the full range of paediatric uveitis presentations and in the investigations needed to establish the underlying cause.
Because childhood uveitis is frequently asymptomatic, regular specialist monitoring is the cornerstone of management. At Clinica London, children with uveitis receive thorough assessment at every appointment, using the best available imaging technology to detect disease activity and complications at the earliest possible stage.
The slit lamp is the primary tool for assessing uveitis activity. At each visit, Mr Petrushkin examines the anterior chamber carefully to grade the level of cells and flare, the two principal markers of active anterior inflammation, using standardised grading criteria that allow accurate tracking of disease activity over time. He also assesses for posterior synechiae, checks the lens for early cataract formation, and measures intraocular pressure to detect glaucoma.
The frequency of slit lamp monitoring is determined by the activity of the uveitis and the risk category of the child's JIA subtype. During active inflammation or following treatment changes, appointments may be as frequent as every four to six weeks. In stable remission, every three to four months is typical.
OCT provides detailed cross-sectional images of the retina and macula, allowing detection of cystoid macular oedema (CMO), the most common sight-threatening complication of chronic uveitis in children. CMO can be present without any symptoms and without any reduction in visual acuity at an early stage, making OCT imaging essential for its detection.
Serial OCT imaging allows accurate tracking of macular thickness over time, enabling early detection of CMO and prompt adjustment of treatment before significant damage occurs. It is a non-contact, non-invasive scan taking only a few minutes, and children generally find it straightforward to tolerate.
SLO provides high-resolution imaging of the fundus, the back of the eye, including the retina, optic disc and blood vessels. In children with uveitis, SLO imaging is used to assess for posterior segment involvement, optic disc changes, retinal vasculitis and other complications that may not be visible on standard fundus examination alone.
SLO imaging allows Mr Petrushkin to build a detailed longitudinal record of each child's fundus appearance over time, making subtle changes in disease activity or emerging complications detectable at the earliest possible stage.
The goal of treatment in childhood uveitis is complete suppression of inflammation to protect the eye from long-term complications. Treatment is escalated in a stepwise fashion, from topical therapy through to systemic and biologic agents, aiming to achieve and maintain zero cells in the anterior chamber at the minimum necessary level of treatment.
Topical corticosteroid eye drops are the first-line treatment for active anterior uveitis, with the frequency titrated to the level of inflammation and reduced as it is controlled. Mydriatic drops may be used alongside steroids to prevent posterior synechiae formation by keeping the pupil mobile.
Topical steroids are effective for acute flares, but long-term use carries risks including raised intraocular pressure and cataract. For children with chronic uveitis, topical steroids alone are rarely sufficient as a long-term strategy, and systemic treatment is usually needed to achieve adequate control.
Methotrexate is the standard second-line treatment for JIA-associated uveitis, recommended when topical treatment alone is not achieving adequate control. It is given once weekly, either orally or by subcutaneous injection, and takes several months to reach its full effect, with regular blood monitoring required.
Mr Petrushkin works in close coordination with the child's rheumatologist, who may already have prescribed methotrexate for the arthritis, to ensure systemic treatment is optimised for both joint and eye disease.
For children whose uveitis does not respond adequately to methotrexate, or where the disease is particularly severe at presentation, biologic therapy is the next step. Adalimumab, a TNF inhibitor given by subcutaneous injection every two weeks, is the most widely used and best-evidenced biologic for JIA-associated uveitis.
Other biologic agents, including abatacept and tocilizumab, may be used in children who do not respond to or cannot tolerate adalimumab. This decision is made in conjunction with the child's rheumatologist and, where appropriate, a paediatric uveitis multidisciplinary team.
Despite best treatment, some children with uveitis develop complications requiring additional management. Cataract surgery in uveitic eyes is more complex than in non-uveitic eyes, requiring careful timing, ideally when inflammation is well controlled, and specialist surgical expertise.
Raised intraocular pressure (uveitic glaucoma) may require topical anti-glaucoma drops, systemic treatment, laser or surgical intervention. Cystoid macular oedema may respond to intensification of systemic treatment, topical non-steroidal drops, periocular steroid injection or intravitreal treatment.
No GP referral needed. Speak to our team at 140 Harley Street.
Book a consultation with Mr Petrushkin
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