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anterior uveitis (iritis, iridocyclitis)

Inflammation involving the ciliary body & iris. Classification: - iritis: inflammation of the iris - iridocyclitis: inflammation of the iris & ciliary body Etiology: 1) sarcoidosis 2) ankylosing spondylitis 3) juvenile rheumatoid arthritis 4) inflammatory bowel disease 5) psoriasis 6) Reiter's syndrome 7) Behcet's disease 8) Herpes infection 9) syphilis 10) Lyme disease (generally not associated with uveitis) [6] 11) onchocerciasis 12) tuberculosis 13) leprosy 14) post-traumatic, blunt trauma (may develop 2-3 days after injury) [7] 15) idiopathic Pathology: - may be associated with autoantibodies to UACA - may be associated with autoantibodies to TRIB2 Clinical manifestations: 1) ocular pain 2) photophobia (often extreme)* 3) blurred vision, halos around lights [4] 4) injection (redness) in the limbus area - conjunctival infection & flare [4] 5) deposits in the cornea - a clear cornea is described for 'uveitis' [5] 6) red eye: redness around the cornea (ciliary flush) 7) irregularly shaped pupil, miosis 8) pain elicited in the affected eye by the consensual light reflex - pupil remains small, does not dilate in response to swinging flashlight 9) may be unilateral or bilateral 10) may develop 2-3 days after injury [7] 11) recurrences are common [7] * key feature [7] Laboratory: - HLA-B*27 in blood Special laboratory: - slit lamp examination to identify inflammatory cells on the corneal epithelium or in the aqueous humor - keratic precipitates on the endothelium & anterior chamber cells [4] 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 [4] Management: 1) therapy aimed at reducing intraocular pressure [4] 2) topical steroids - prednisolone (Pred Forte) 3) mydriatic/cycloplegic agent such as cyclopentolate - dilation of the pupil reduces pain & prevents formation of synechiae - cycloplegia reduces pain by relaxing the ciliary muscle [7] 4) treat underlying disorder 5) referral to an ophthalmologist [4]

Specific

chronic iridocyclitis; chronic iritis; chronic anterior uveitis

General

uveitis iris disease

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 69-71
  3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 165
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  5. NEJM Knowledge+. Question of the Week. Aug 9, 2016 http://knowledgeplus.nejm.org/question-of-week/1519/
  6. NEJM Knowledge+ Rheumatology
  7. NEJM Knowledge+ Ophthalmology
  8. Wakefield D, Clarke D, McCluskey P. Recent developments in HLA B27 anterior uveitis. Front Immunol. 2020;11:608134. PMID: 33469457