ICD-10: H44.133

Sympathetic uveitis, bilateral, is classified under the ICD-10 code H44.133. This condition is a type of uveitis, which refers to inflammation of the uvea, the middle layer of the eye. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Sympathetic Uveitis

Definition

Sympathetic uveitis is a rare but serious inflammatory condition that typically occurs following trauma or surgery to one eye, leading to inflammation in the fellow eye. The bilateral aspect indicates that both eyes are affected, which can complicate the clinical picture and management.

Etiology

The exact mechanism of sympathetic uveitis is not fully understood, but it is believed to be an autoimmune response triggered by antigens released from the injured eye. This condition can occur after various ocular injuries, including penetrating trauma, surgical procedures, or even after the removal of an eye (enucleation) due to trauma or disease.

Symptoms

Patients with bilateral sympathetic uveitis may present with a range of symptoms, including:
- Blurred vision: Due to inflammation affecting the clarity of the ocular media.
- Photophobia: Increased sensitivity to light, which can be quite uncomfortable.
- Redness: Inflammation can lead to conjunctival injection (redness of the eye).
- Pain: Patients may experience ocular pain, which can vary in intensity.
- Floaters: The presence of floaters in the visual field may occur due to inflammatory debris in the vitreous.

Diagnosis

Diagnosis of sympathetic uveitis involves a comprehensive eye examination, including:
- Slit-lamp examination: To assess the anterior segment for signs of inflammation.
- Fundoscopy: To evaluate the posterior segment for any retinal changes or complications.
- History taking: A thorough history of any recent eye trauma or surgery is crucial.

Treatment

Management of bilateral sympathetic uveitis typically involves:
- Corticosteroids: Systemic or topical corticosteroids are the mainstay of treatment to reduce inflammation.
- Immunosuppressive therapy: In cases where corticosteroids are insufficient, additional immunosuppressive agents may be used.
- Management of complications: Regular monitoring for complications such as cataracts, glaucoma, or retinal detachment is essential.

Prognosis

The prognosis for patients with sympathetic uveitis can vary. Early diagnosis and treatment are critical to prevent vision loss. If left untreated, the condition can lead to significant complications, including permanent vision impairment.

Conclusion

ICD-10 code H44.133 for bilateral sympathetic uveitis encompasses a complex interplay of ocular trauma and autoimmune response, necessitating prompt diagnosis and aggressive management to preserve vision. Understanding the clinical features, diagnostic approach, and treatment options is essential for healthcare providers dealing with this condition. Regular follow-up is crucial to monitor for potential complications and ensure optimal patient outcomes.

Sympathetic uveitis, bilateral, is a specific type of uveitis characterized by inflammation of the uveal tract in both eyes, typically following trauma or surgery to one eye. This condition is classified under the ICD-10-CM code H44.133. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Definition and Etiology

Sympathetic uveitis occurs as a response to an injury or surgical intervention in one eye, leading to inflammation in the fellow eye. This phenomenon is thought to be an autoimmune reaction where the immune system mistakenly targets the uveal tissue of the unaffected eye due to shared antigens between the two eyes[1].

Onset and Duration

The onset of sympathetic uveitis can vary, typically occurring weeks to months after the inciting event. The duration of symptoms can also vary, with some patients experiencing chronic inflammation if not adequately treated[1].

Signs and Symptoms

Common Symptoms

Patients with bilateral sympathetic uveitis may present with a range of symptoms, including:

• Blurred Vision: Patients often report a decrease in visual acuity due to inflammation affecting the retina and other ocular structures[1].
• Photophobia: Increased sensitivity to light is common, leading to discomfort in bright environments[1].
• Eye Pain: Patients may experience varying degrees of ocular pain, which can be mild to severe[1].
• Redness: Conjunctival injection (redness of the eye) is frequently observed due to inflammation[1].
• Tearing: Increased lacrimation may occur as a response to irritation and inflammation[1].

Physical Examination Findings

During a clinical examination, healthcare providers may observe:

• Anterior Chamber Reaction: Presence of cells and flare in the anterior chamber, indicating inflammation[1].
• Keratic Precipitates: Small white deposits on the corneal endothelium may be noted, which are indicative of uveitis[1].
• Intraocular Pressure Changes: Patients may exhibit elevated intraocular pressure due to inflammation or secondary glaucoma[1].

Patient Characteristics

Demographics

Sympathetic uveitis can affect individuals of any age, but it is more commonly seen in adults, particularly those who have experienced ocular trauma or surgery. The condition is more prevalent in males than females, likely due to higher rates of eye injuries in this demographic[1].

Risk Factors

Key risk factors for developing sympathetic uveitis include:

• Ocular Trauma: Injuries to one eye, such as penetrating injuries or blunt trauma, are significant triggers[1].
• Surgical Procedures: Eye surgeries, particularly those involving the anterior segment, can precipitate this condition[1].
• Previous Uveitis: A history of uveitis may increase susceptibility to sympathetic involvement[1].

Comorbid Conditions

Patients with autoimmune disorders or those with a history of inflammatory eye diseases may be at higher risk for developing sympathetic uveitis following an inciting event[1].

Conclusion

Sympathetic uveitis, bilateral (ICD-10 code H44.133), is a serious condition that requires prompt recognition and management. Understanding its clinical presentation, including the signs and symptoms, as well as the characteristics of affected patients, is essential for healthcare providers. Early intervention can help mitigate complications and preserve vision in affected individuals. If you suspect sympathetic uveitis in a patient, a thorough examination and timely referral to an ophthalmologist are recommended for appropriate management.

Sympathetic uveitis, bilateral, is classified under the ICD-10-CM code H44.133. This condition is characterized by inflammation of the uveal tract in both eyes, typically following trauma or surgery to one eye. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Here are some relevant terms associated with H44.133:

Alternative Names

1. Bilateral Sympathetic Ophthalmia: This term emphasizes the bilateral nature of the condition and its association with sympathetic ophthalmia, which is a rare inflammatory condition that can occur after trauma to one eye.
2. Bilateral Uveitis: While this term is broader, it can be used to describe the inflammation affecting both eyes, specifically within the uveal tract.
3. Bilateral Inflammatory Eye Disease: This is a more general term that encompasses various inflammatory conditions affecting both eyes, including sympathetic uveitis.

Related Terms

1. Sympathetic Ophthalmia: This term refers to the condition where inflammation occurs in the uninjured eye following trauma to the other eye. It is important to note that while H44.133 specifically refers to the bilateral form, sympathetic ophthalmia can also occur unilaterally.
2. Uveitis: A general term for inflammation of the uvea, which includes the iris, ciliary body, and choroid. Uveitis can be classified into various types based on the location and cause of inflammation.
3. Ocular Inflammation: This broader term encompasses any inflammatory condition affecting the eye, including uveitis and sympathetic uveitis.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when documenting patient conditions, coding for insurance purposes, and communicating effectively with colleagues. Accurate terminology ensures that the specific nature of the condition is conveyed, which is essential for appropriate treatment and management.

In summary, the ICD-10 code H44.133 for bilateral sympathetic uveitis is associated with several alternative names and related terms that reflect its clinical significance and implications in ophthalmology.

Sympathetic uveitis, specifically coded as H44.133 in the ICD-10-CM system, refers to a rare form of uveitis that occurs in one eye and subsequently affects the other eye, often following trauma or surgery. The diagnosis of bilateral sympathetic uveitis involves several criteria and considerations, which are outlined below.

Clinical Criteria for Diagnosis

1. History of Ocular Trauma or Surgery

• A significant aspect of diagnosing sympathetic uveitis is the patient's history of trauma or surgical intervention to one eye. This event typically precedes the onset of symptoms in the second eye, which is crucial for establishing the diagnosis.

2. Symptoms and Signs

• Patients may present with a variety of symptoms, including:
  • Photophobia: Increased sensitivity to light.
  • Blurred Vision: Visual disturbances in one or both eyes.
  • Redness: Conjunctival injection or redness in the affected eye(s).
  • Pain: Ocular pain that may be unilateral or bilateral.
• Clinical examination may reveal signs such as:
  • Anterior Uveitis: Inflammation of the anterior segment of the eye, including the iris and ciliary body.
  • Posterior Uveitis: Inflammation that may involve the retina and choroid.

3. Ocular Examination Findings

• Detailed ocular examination is essential, which may include:
  • Slit-Lamp Examination: To assess for signs of inflammation in the anterior chamber.
  • Fundoscopy: To evaluate the posterior segment for any signs of inflammation or damage.
  • B-scan Ultrasound: In cases where the view of the retina is obscured, this imaging can help assess for any abnormalities.

4. Exclusion of Other Causes

• It is critical to rule out other potential causes of uveitis, such as infectious, autoimmune, or systemic diseases. This may involve:
  • Laboratory Tests: Blood tests to check for underlying systemic conditions.
  • Imaging Studies: To assess for any other ocular or systemic issues that could mimic sympathetic uveitis.

5. Response to Treatment

• The response to corticosteroid therapy or other anti-inflammatory treatments can also support the diagnosis. Improvement in symptoms following treatment may indicate sympathetic uveitis.

Conclusion

The diagnosis of bilateral sympathetic uveitis (ICD-10 code H44.133) is multifaceted, requiring a thorough patient history, clinical examination, and exclusion of other conditions. The presence of ocular trauma or surgery in one eye, coupled with the characteristic symptoms and clinical findings in both eyes, is essential for accurate diagnosis. Proper identification and management are crucial to prevent complications and preserve vision.

Sympathetic uveitis, bilateral, classified under ICD-10 code H44.133, is a rare but serious condition characterized by inflammation of the uveal tract in both eyes, typically following trauma or surgery to one eye. The management of this condition involves a combination of pharmacological and non-pharmacological approaches aimed at reducing inflammation, alleviating symptoms, and preventing complications.

Standard Treatment Approaches

1. Corticosteroids

Corticosteroids are the cornerstone of treatment for sympathetic uveitis. They help to reduce inflammation and control the immune response. The administration can be systemic (oral or intravenous) or local (intravitreal injections). Commonly used corticosteroids include:

• Oral Prednisone: Often initiated at a high dose and then tapered based on the clinical response.
• Intravitreal Steroid Injections: Such as triamcinolone acetonide, may be used for localized inflammation.

2. Immunosuppressive Therapy

In cases where corticosteroids are insufficient or if long-term treatment is necessary, immunosuppressive agents may be introduced. These can include:

• Methotrexate: Often used in conjunction with corticosteroids to enhance efficacy and reduce steroid dosage.
• Azathioprine: Another option for long-term management, particularly in chronic cases.
• Biologics: Agents like infliximab may be considered, especially in refractory cases or when associated with systemic autoimmune diseases[1][2].

3. Topical Therapies

Topical corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage anterior segment inflammation and discomfort. These may include:

• Topical Steroid Drops: Such as prednisolone acetate, to reduce inflammation in the anterior chamber.
• NSAID Eye Drops: To help alleviate pain and inflammation.

4. Management of Complications

Patients with sympathetic uveitis are at risk for complications such as glaucoma, cataracts, and retinal detachment. Regular monitoring and management of these complications are crucial. Treatment may involve:

• Antiglaucoma Medications: To control intraocular pressure if glaucoma develops.
• Surgical Interventions: Such as cataract surgery or retinal repair, if necessary.

5. Supportive Care

Supportive measures, including pain management and patient education, are essential. Patients should be informed about the nature of their condition, potential complications, and the importance of adherence to treatment regimens.

Conclusion

The management of bilateral sympathetic uveitis (ICD-10 code H44.133) requires a comprehensive approach that includes corticosteroids, immunosuppressive therapy, topical treatments, and careful monitoring for complications. Early intervention and a tailored treatment plan are vital to preserving vision and improving patient outcomes. Regular follow-up with an ophthalmologist is essential to adjust treatment as needed and to monitor for any adverse effects or complications associated with the disease and its treatment[3][4].

References

1. Clinical Policy: Photodynamic and Intravitreal Therapies.
2. Billing and Coding: Ophthalmology: Posterior Segment.
3. Infliximab (Avsola®, Inflectra®, Remicade®, & Renflexis®).
4. Posterior Segment Imaging (Extended Ophthalmoscopy).