# Childhood Uveitic Glaucoma: Complex Management in a Fragile Population
## 2 Classification and Clinical Features of UG in Childhood  
The Standardization of Uveitis Nomenclature (SUN) system [12] classifies uveitis according to the anatomic location of inflammation into anterior (iris and the anterior ciliary body), intermediate (posterior ciliary body and vitreous), posterior (retina and/or choroid), and panveitis (all structures are affected). In addition, this classification provides information about the disease, such as onset (sudden or insidious), duration [limited (\(\leq\)3 months) or persistent (>3 months)], and course (acute, recurrent, or chronic). Here we report the features of pediatric diseases and infections which are more frequently related to uveitis glaucoma, according to the SUN system. Among the anterior uveitis, we reported the Juvenile Idiopathic Arthritis JIA-associated uveitis, the herpetic anterior uveitis and tubulointerstitial Nephritis and Uveitis (TINU). Juvenile Idiopathic Arthritis (JIA) is now defined as arthritis starting before the age of 16 years and lasting for 6 weeks or more. The disease activity reduces around 9 years of age and peaks around puberty. [13,14]. JIA-associated uveitis is a chronic non-granulomatous anterior uveitis, and in 3-7% of cases, it can precede the diagnosis of arthritis [15]. Unlike other forms of anterior uveitis, JIA-associated uveitis has an insidious onset, either unilateral or, more often, bilateral, and it is usually asymptomatic until sight-threatening complications arise. About three-quarters develop chronic inflammation with a high incidence of complications, such as cataracts, glaucoma, band keratopathy, and persistent cystoid macular edema [16]. The severity and chronicity of JIA-associated uveitis vary markedly. Young age at onset of uveitis, male genders, presence of synechiae at presentation and uveitis occurring before arthritis appear to be the most significant risk factors for a severe course of uveitis and developing complications [5]. A minority have mild, self-limiting uveitis, requiring only short-term topical steroids [17]. Herpetic anterior uveitis is another form potentially responsible for secondary glaucoma in children. Infectious etiologies constitute 13% of all pediatric uveitis [18]. Virusesimplicated are Herpes Simplex Virus (HSV) type 1 and type 2, Varicella Zoster Virus (VZV), and Cytomegalovirusovirus (CMV). They can cause acute unilateral non-granulomatous anterior uveitis, often associated with increased intraocular pressure, but they can also cause granulomatous anterior uveitis in chronic stages. Although rare in children, when the infection involves the retina, Acute Retinal Necrosis (ARN) may occur, causing a devastating reduction in visual acuity. Tubulointerstitial Nephritis and Uveitis (TINU) is a multisystemic autoimmune disease involving uvea and renal tubules and may be triggered by various factors, such as drugs or infections. Its incidence is highest at 15 years of age, but all age groups can be affected. In TINU, the uveitis is anterior and usually involves both eyes \(r\); however, posterior or intermediate uveitis can occur as well. Among the intermediate uveitis in childhood, pars planitis (PP), early-onset sarcoidosis (Blau syndrome), and juvenile multiple sclerosis (MS) are worth mentioning [19; 20; 21]. PP is an idiopathic type of intermediate uveitis accounting for 5-26.7% of all pediatric uveitis and is a diagnosis of exclusion [21]. Blau Syndrome is a systemic inflammatory granulomatousous disease that occurs in children under 5 years. It is characterized by uveitis, arthritis (mostly involving the knee and the wrist), and skin lesions, such as erythema nodosum, skin rash, vasculitis etc. Juvenile multiple sclerosis (MS) is rare in children, with an incidence in the literature ranging from 2.7% to 10.5% of the general MS group [22]. Posterior uveitis includes inflammation of the choroid with or without retinal involvement. In children, as in adults, the most common cause is toxoplasmosis [23; 24].