anterior uveitis (iritis)

Question 1

what is the uvea?

Answer 1

the uvea is made up of the iris, ciliary body and choroid (choroid is between retina and sclear

Question 2

what is anterior uveitis

Answer 2

inflammation of the anterior part of the uvea (also known as iritis)

involves inflammation and immune cells in the anterior chamber of the eye. becomes infiltrated with neutrophils, lymphocytes and macrophages

can be caused by autoimmune process, infection, trauma, ischaemia, malignancy

Question 3

acute / chronic anterior uveitis

Answer 3

chronic- more granulomatous (macrophages), less severe and longer duration >3 months. associated with sarcoidosis, syphilis, Lyme disease, TB, herpes virus

acute- associated with HLA B27 conditions: ankylosing spondylitis, IBD, reactive arthritis

Question 4

how might anterior uveitis present?

Answer 4

unilateral symptoms that start spontaneously without history of trauma or precipitating events

can occur with a flare of an associated disease e.g reactive arthritis

• dull, achey painful red eye
• inflammatory cells cause floaters / flashers
• reduced visual acuity (can be mild)
• photophobia
• miosis
• pain on movement
• ciliary fluid (ring of red fro cornea outwards)
• abnormally shaped pupil***
• hypopyan (WBC in anterior chamber)

**abnormal shaped pupil is due to posterior synechiae (adhesions) which pulls the iris into abnormal shapes

Question 5

how to manage anterior iritis

Answer 5

referral for same day assessment

investigations: fully slit lamp assessment of structures in eye and IOP

management:
steroids
cycloplegic-mydriatic meds (cycclopentalone, atropine) block the iris sphincter muscle and ciliary body to reduce pain and stop spasm

immunosuppressants (DMARD / TNF inhibitors)
laser therapy, cryotherapy, surgery (vitrectomy)