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Anterior Uveitis (iritis)
Anatomy
• Uveitis = inflammation of the uvea
• Uvea = iris, cilliary body, choroid
• Anterior uveitis = inflammation of iris and anterior
chamber
• Intermediate uveitis = inflammation of middle part of the
uveal tract, mainly the vitreous humour. It can also affect
the underlying retina.
• Posterior uveitis = inflammation which affects the back
(posterior) part of the eye. It can affect the choroid, the
head of the optic nerve, and the retina (or any combination
of these structures). It includes chorioretinitis, retinitis and
neuroretinitis.
• Panuveitis = inflammation affecting the whole of the uveal
tract
WHO ?
• Most common in young/middle aged adults
20-59yrs
• Affects 17-52 people per 100,000 per yr
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Causes ?
50 % are idiopathic
50 % of those with anterior uveitis are HBLA27
+VE
May be secondary to corneal graft
Eye infections e.g. toxoplasmosis, herpes virus
keratitis
Other associations ..
• Autoimmune : HLAB27, Reiters syndrome,
Bechets
• Infectious : leptospirosis, lyme disease, syphilis,TB
• Systemic disease : IBD, MS, kawsaki’s, juvenile
arthritis, polyarteritis nodosa,psoriatic/reactive
arthritis, sarcoidosis, SLE
• Drugs : Rifabutin ( similar to rifampicin)
• Trauma
• Cancer : NHL, HL, Leukaemia, Melanoma
Presents ..
Symptoms
• Acute onset pain
• Photophobia
• Blurred vision
• Decreased visual acuity
• Headache
Signs
• Watering
• Circumcorneal redness
• Small or irregular pupil
• +/- hypophyon ( anterior chamber pus causing
white ‘fluid-level’ line)
• +/- keratitic precipitates on posterior surface
of cornea
• Cells in anterior chamber on slit lamp exam
• Increasing pain as the eyes converge and the
pupils constrict
Management
• Urgent opthalmology referral (within 24hrs)
normally topical/oral glucocorticoid steriods
• Cycloplegic drops for comfort e.g. Atropine
• Simple analgesia
Complications
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Cystoid macular oedema
Secondary cataract
Posterior synechiae (irregular pupil shape)
Raised IOP Glaucoma, secondary to either
inflammatory process or steriods
Vitreous opacities
Retinal detachment
Neovascularisation of the retina/optic nerve/iris
Relapses are common BUT with prompt and
effective treatment 91% return to normal vision