Related Subjects:
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|Assessing a Red eye
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|Allergic and Infective Conjunctivitis
|Anterior and Posterior Uveitis
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|Herpes simplex keratitis (HSK)
|Acute Blepharitis
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🍇 “Uveitis” comes from the Latin word uva, meaning grape.
⚠️ If there is recent intraocular surgery (e.g. cataract or intravitreal injections), always consider endophthalmitis as the cause of pain and photophobia.
📖 About
- 🔴 Inflammation of the uveal tract: iris, ciliary body, and choroid.
- ⚡ Causes include trauma, iatrogenic sources, infection, drugs, systemic autoimmune disease, or idiopathic.
- 👁️ Anterior uveitis often affects young adults and can cause long-term, sight-threatening complications.
📊 Epidemiology
- ~50% of cases are idiopathic.
- Can occur at any age, but peak ~40 years.
- Anterior uveitis = ~90% of cases.
🔎 Types
- Anterior uveitis: Iritis, cyclitis, or iridocyclitis.
- Posterior uveitis: Choroiditis, retinitis, chorioretinitis, or retinal vasculitis.
- Intermediate uveitis: Involves vitreous and peripheral retina.
- Panuveitis: Inflammation of the entire uveal tract.
🧬 Aetiology (50% idiopathic)
- Idiopathic anterior uveitis (often HLA-B27 positive).
- Trauma or ophthalmic surgery.
- Ocular syndromes: Fuchs’ heterochromic cyclitis, Posner–Schlossman syndrome.
- Rheumatology: Ankylosing spondylitis, Psoriatic arthritis, Reactive arthritis, JIA, Behçet’s, PAN, GPA (Wegener’s).
- Infective: HSV, VZV, CMV, TB, syphilis, toxoplasmosis, brucellosis, Lyme, leptospirosis.
- Systemic: Sarcoidosis, MS, Crohn’s, ulcerative colitis, Whipple’s disease.
- Rare: Primary CNS lymphoma.
👁️ Clinical Features
- ⚡ Severe ocular pain, tearing, and photophobia.
- 👁️ Small pupil (miosis) due to iris spasm.
- 🔴 Diffuse redness, often worse at limbus (ciliary flush).
- 🌫️ Cloudy anterior chamber from WBCs/protein (“cells and flare”).
- ⬇️ Visual acuity may be reduced; look for hypopyon.
- 🔍 Posterior synechiae, keratic precipitates, corneal infiltrates may be seen.
- 📏 Always check IOP and corneal staining (exclude keratitis/trauma).
🧪 Investigations
- 🔬 Slit lamp: anterior chamber cells, flare, keratic precipitates (fine = nongranulomatous; “mutton-fat” = granulomatous).
- 🧬 PCR useful in herpetic uveitis/acute retinal necrosis.
- 🩺 Systemic work-up: FBC, ESR/CRP, ANA, HLA-B27, syphilis serology, TB screen, chest X-ray (sarcoid/TB).
- 🖼️ Ocular imaging (OCT, B-scan) for posterior disease.
❓ Differentials
- Endophthalmitis (post-surgery/injection).
- Keratitis (bacterial, viral, chemical burn).
- Acute angle-closure glaucoma.
- Intraocular foreign body.
⚠️ Complications
- Glaucoma (raised IOP).
- Cataracts (from disease or steroid treatment).
- Corneal scarring or band keratopathy.
- Cystoid macular oedema.
- Steroid-related systemic side effects.
💊 Management (Ophthalmology referral essential)
- 📞 Urgent referral if suspected endophthalmitis or corneal involvement.
- 🌿 Idiopathic anterior uveitis:
- Topical corticosteroids (prednisolone acetate) tapered over 4–6 weeks.
- Cycloplegics (homatropine 5%, scopolamine 0.25%, or atropine) → relieve spasm & prevent synechiae.
- Mydriatics (phenylephrine) sometimes used in-office to break synechiae.
- 😎 Sun protection: sunglasses, brimmed hat, dimmed lighting during acute flare.
- 💊 Herpetic anterior uveitis: topical steroids + oral aciclovir 400 mg BD (long-term prophylaxis if recurrent).
- 💉 Severe or posterior uveitis: systemic steroids, immunosuppressants (methotrexate, azathioprine, biologics).
📚 References
