Ophthalmology - anterior uveitis

Question 1

What is anterior uveitis?

Answer 1

Inflammation in the anterior part of the uvea?

Uvea - iris, ciliary body and choroid

Choroid - layer between retina and sclera all the way around the eye

Question 2

Types of anterior uveitis and associations

Answer 2

Acute anterior uveitis - associated with HLA-B27 conditions:

• Ank Spond
• IBD
• Reactive arthritis

Chronic anterior uveitis - associated with:

• Sarcoidosis
• Syphilis
• Lyme disease
• TB
• Herpes virus

Chronic anterior uveitis is more granulomatous (has more macrophages) and has a less severe and longer duration of symptoms, lasting more than 3 months.

Question 3

Possible presentations of anterior uveitis

Answer 3

Unilateral usually
Dull painful red eye
Ciliary flush
Reduced visual acuity

Flashes and floaters - (Inflammatory cells in the anterior chamber)

Photophobia - due to ciliary muscle spasm

Pain on eye movement

Lacrimation

Abnormal or small shaped pupil:

• Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
• Constricted pupil - caused by sphincter muscle contraction

Hypopyon

Question 4

Management of anterior uveitiis

Answer 4

It is sight-threatening so same day assessment by an ophthalmologist, slit lamp examination

Treatment options include:

• Topical steroids e.g. prednisolone
• Cycloplegic-mydriatic drugs (e.g. cyclopentolate 1%) or atropine eye drops

Laser therapy, cryotherapy or surgery (vitrectomy) are also options in severe cases

Cycloplegic means paralysing the ciliary muscles.
Mydriatic means dilating the pupils.