1. Anterior Uveitis (iritis)

2. Anatomy

3. 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

4. WHO ? Most common in young/middle aged adults 20-59yrs
Affects 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

5. 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

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

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

8. +/- 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

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

10. 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