Anterior Uveitis

Inflammation in the anterior part of the uvea; the uvea involves the iris, ciliary body and choroid

Aetiology

• Involves inflammation and immune cells in the anterior chamber of the eye

• This is usually caused by an autoimmune process but can be due to infection, trauma, ischaemia or malignancy

Idiopathic

• Accounts for a significant proportion of cases

Autoimmune and Inflammatory Associations

• HLA-B27–associated spondyloarthropathies:
• Ankylosing spondylitis
• Reactive arthritis
• Psoriatic arthritis
• Inflammatory bowel disease–associated arthritis

• Juvenile idiopathic arthritis

• Sarcoidosis

• Behçet disease

Infectious Causes

• Herpes simplex virus (HSV)

• Varicella-zoster virus (VZV)

• Mycobacterium tuberculosis

• Treponema pallidum (syphilis)

• Toxoplasma gondii (less common in isolated anterior uveitis)

Trauma and Iatrogenic Causes

• Blunt or penetrating ocular trauma

• Postoperative inflammation

• Lens-induced uveitis

Clinical presentation

Symptoms

• Usually presents with unilateral symptoms that start spontaneously without a history of trauma or precipitating events

• May occur with a flare of an associated disease such as reactive arthritis (Reiter's) - 'can't see, pee, or climb a tree'

• Dull, aching, painful red eye

• Vision may be reduced

• Photophobia

Signs

• Circumcorneal red eye

• Ciliary injection

• Keratic precipitates (mutton fats)

• Hypopyon

• Synechiae - small or irregular pupil due to adhesions pulling the iris into abnormal shapes

• Cells and flare in the anterior chamber (Tyndal Phenomenon)

• Iris Nodules → Koeppe’s Nodules, Busacca’s Nodules

• Iris neovascularization (rubeosis iridis)

• Pupil miosis

Keratic precipitates

Posterior Synechiae

Flare in anterior chamber

Cells in anterior chamber

Management

• Topical Corticosteroids
• Mainstay of treatment
• Prednisolone acetate 1% eye drops every 1-2 hours
• Tapered based on clinical response

• Cycloplegic–Mydriatic Agents
• Atropine, homatropine, or cyclopentolate
• Prevent posterior synechiae and relieve ciliary spasm

• Antimicrobial Therapy
• Indicated when an infectious cause is identified (e.g., antivirals for HSV/VZV)

• Systemic Therapy
• Oral corticosteroids or immunosuppressive agents for severe, bilateral, or refractory cases