Anterior uveitis involves inflammation of the anterior uvea. The uvea consists of the iris, ciliary body and choroid. The choroid is the layer between the retina and the sclera. Intermediate uveitis and posterior uveitis are less common.
An autoimmune process usually causes it, but it can be due to infection, trauma, ischaemia or malignancy.
Anterior uveitis involves inflammation in the anterior chamber of the eye. The anterior chamber becomes infiltrated by neutrophils, lymphocytes and macrophages. Hypopyon refers to a fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.
Associations
Anterior uveitis may be associated with underlying an autoimmune condition, particularly:
- Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
- Inflammatory bowel disease
- Sarcoidosis
- Behçet’s disease
Presentation
Anterior uveitis may present with symptoms of:
- Painful red eye (typically a dull, aching pain)
- Reduced visual acuity
- Photophobia (due to ciliary muscle spasm)
- Excessive lacrimation (tear production)
Examination findings include:
- Ciliary flush (a ring of red spreading from the cornea outwards)
- Miosis (a constricted pupil due to sphincter muscle contraction)
- Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
- Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)
Management
Patients should be referred for urgent assessment and management by an ophthalmologist.
The usual first-line treatment involves:
- Steroids (eye drops, oral or intravenous)
- Cycloplegics (e.g., cyclopentolate or atropine eye drops)
Cycloplegics dilate the pupil and reduce pain associated with ciliary spasm. Cycloplegic refers to paralysing the ciliary muscles. Cyclopentolate and atropine are antimuscarinic drugs that reduce the action of the iris sphincter muscles and ciliary muscles.
Recurrent cases may require DMARDs or anti-TNF medications.
Last updated October 2023