Diagnostic and therapeutic challenges in inflammatory eye diseases

Scleritis and uveitis are inflammatory eye-diseases which can threaten vision and can occur throughout life. The burden of visual loss, the uncertain prognosis of the eye-disease and its complications and the side-effects of treatment on daily life are profound. In general, inflammatory eye-diseases can be triggered by auto-immune disease, infections, masquerade syndromes presenting as inflammatory eye-disease, medication, trauma and repeated ocular surgery. The main goal of the treatment is to maintain visual function by reducing the inflammation and by adequate treatment of ocular complications. Next to maintaining and preserving vision, general wellbeing and level of functioning are important secondary goals. In the six studies presented in this thesis, challenges in both the diagnostic and therapeutic aspects in the treatment and counseling of patients with inflammatory eye disease are addressed. The first part of this thesis consists of three studies aimed at improving the diagnostic and therapeutic process in adult patients with inflammatory eye diseases of different etiology, prognosis and treatment. In the second part, three studies are presented that investigate challenges that are encountered in the treatment of inflammatory eye disease and its complications in children. The results presented in this thesis emphasize the need for a tailored and multidisciplinary treatment approach in inflammatory eye diseases. Ideally, treatment should be based upon disease mechanisms, location of the inflammation, treatment of ocular complications, presence of underlying systemic disease, effectiveness and side-effects of medication, effects on general well-being and functioning, judicious use of available financial resources and individual patient characteristics