anterior uveitis (iritis, iridocyclitis)

Introduction

Inflammation involving the ciliary body & iris.

Classification

• iritis: inflammation of the iris
• iridocyclitis: inflammation of the iris & ciliary body

Etiology

• sarcoidosis
• ankylosing spondylitis
• juvenile rheumatoid arthritis
• inflammatory bowel disease
• psoriasis
• Reiter's syndrome
• Behcet's disease
• Herpes infection
• syphilis
• Lyme disease (generally not associated with uveitis)
• onchocerciasis
• tuberculosis
• leprosy
• post-traumatic, blunt trauma (may develop 2-3 days after injury)
• idiopathic

Pathology

• may be associated with autoantibodies to UACA
• may be associated with autoantibodies to TRIB2

Clinical manifestations

• ocular pain
• photophobia (often extreme)*
• blurred vision, halos around lights
• injection (redness) in the limbus area
  • conjunctival infection & flare
• deposits in the cornea
  • a clear cornea is described for 'uveitis'
• red eye: redness around the cornea (ciliary flush)
• irregularly shaped pupil, miosis
• pain elicited in the affected eye by the consensual light reflex
  • pupil remains small, does not dilate in response to swinging flashlight
• may be unilateral or bilateral
• may develop 2-3 days after injury
• recurrences are common

* key feature

Laboratory

• HLA-B*27 in blood

Diagnostic procedures

• slit lamp examination to identify inflammatory cells on the corneal epithelium or in the aqueous humor
• keratic precipitates on the endothelium & anterior chamber cells

Differential diagnosis

• corneal abrasion
  • symptoms apparent immediately after trauma
  • foreign body sensation
• traumatic optic neuropathy
  • severe facial trauma as from motor vehicle accident
  • afferent pupillary defect
• hyphema
  • blood covers part of the iris & occasionally the pupil
• hyperacute bacterial conjunctivitis due to Neisseria
  • copious purulent discharge
  • Keratitis, iritis, & scleritis do not cause copious purulent drainage

Management

• therapy aimed at reducing intraocular pressure
• topical steroids - prednisolone (Pred Forte)
• mydriatic/cycloplegic agent such as cyclopentolate
  • dilation of the pupil reduces pain & prevents formation of synechiae
  • cycloplegia reduces pain by relaxing the ciliary muscle
• treat underlying disorder
• referral to an ophthalmologist

More general terms

• uveitis
• iris disease

More specific terms

• chronic iridocyclitis; chronic iritis; chronic anterior uveitis