Anterior Uveitis (iritis)

Anatomy

Uveitis = inflammation of the uvea Uvea = iris, cilliary body, choroid Anterior uveitis = inflammation of iris and anterior chamber Intermediate uveitis = inflammation of middle part of the uveal tract, mainly the vitreous humour. It can also affect the underlying retina. Posterior uveitis = inflammation which affects the back (posterior) part of the eye. It can affect the choroid, the head of the optic nerve, and the retina (or any combination of these structures). It includes chorioretinitis, retinitis and neuroretinitis. Panuveitis = inflammation affecting the whole of the uveal tract

WHO ? Most common in young/middle aged adults 20-59yrs Affects 17-52 people per 100,000 per yr Causes ? 50 % are idiopathic 50 % of those with anterior uveitis are HBLA27 +VE May be secondary to corneal graft Eye infections e.g. toxoplasmosis, herpes virus keratitis

Other associations .. Autoimmune : HLAB27, Reiters syndrome, Bechets Infectious : leptospirosis, lyme disease, syphilis,TB Systemic disease : IBD, MS, kawsaki’s, juvenile arthritis, polyarteritis nodosa,psoriatic/reactive arthritis, sarcoidosis, SLE Drugs : Rifabutin ( similar to rifampicin) Trauma Cancer : NHL, HL, Leukaemia, Melanoma

Presents .. Symptoms Acute onset pain Photophobia Blurred vision Decreased visual acuity Headache

Signs Watering Circumcorneal redness Small or irregular pupil +/- hypophyon ( anterior chamber pus causing white ‘fluid-level’ line)

+/- keratitic precipitates on posterior surface of cornea Cells in anterior chamber on slit lamp exam Increasing pain as the eyes converge and the pupils constrict

Management Urgent opthalmology referral (within 24hrs) normally topical/oral glucocorticoid steriods Cycloplegic drops for comfort e.g. Atropine Simple analgesia

Complications Cystoid macular oedema Secondary cataract Posterior synechiae (irregular pupil shape) Raised IOP Glaucoma, secondary to either inflammatory process or steriods Vitreous opacities Retinal detachment Neovascularisation of the retina/optic nerve/iris Relapses are common BUT with prompt and effective treatment 91% return to normal vision