Ophthalmologist

All children with suspected Juvenile Idiopathic Arthritis (JIA) should have eye screening with a slit lamp examination. Other conditions may have intra-ocular involvement and ophthalmological assessment is often useful as part of a multisystem diagnostic approach. 

• Screening is required at regular intervals and often for several years as uveitis can occur at any time and be without symptoms (i.e., asymptomatic). Flares of uveitis may occur during changes or breaks in systemic treatment and can occur even though there is no active joint disease. Flares of uveitis can only be detected by a slit lamp examination which needs to be performed by an ophthalmologist although in some health care contexts this can be done by an experienced optician.
• Often those children with the more mild types of arthritis (e.g., oligo JIA) may have the most severe forms of uveitis. In such cases, the uveitis is often “silent” i.e., the (younger) child does not report symptoms (such as pain, blurring or floaters) so making the screening essential. 
• In other types of JIA, children with JIA who carry HLA B27 (such as in Enthesitis Related Arthritis [ERA]) may develop an acute uveitis which differs from the above with a painful red often photophobic eye - this is rather like acute anterior uveitis that develops in ankylosing spondylitis in adults. Children with HLA B27 and ERA do not need regular eye screening as they will present with acute uveitis flares. 

Nurses require expertise in supporting children attending for the eye examinations, emphasising the importance of attending regularly and to chase up when appointments are missed.

• Play preparation may be required by a hospital play therapist to reduce fear and increase compliance with appointments and cooperation with the actual examination.
• The use of eye drops can be uncomfortable; children and their parents may need further support in the clinic or if giving eye drop treatments at home.
• There are incidences where children have developed visual impairment and blindness due to poor adherence with eye screening appointments or treatment. Recurrent missed appointments or failure to comply with treatment can form safeguarding concerns by professionals.