The symptoms of anterior uveitis are as below.

• Photophobia
• Ocular pain
• Tenderness of the globe
• Decreased visual acuity
• Lacrimation

Photophobia is due to the reactive spasm of the inflamed muscles of the iris; whereas spasm of the ciliary muscles leads to brow pain. Visual acuity is only decreased in severe cases associated with hypopyon.
The signs of anterior uveitis include the following.

• Miosis
• Ciliary flush
• Anterior chamber cells and flare
• Hypopyon
• Keratic precipitates
• Reduced intraocular pressure (IOP)

Ciliary flush results from perilimbal conjunctival injection. Spasm of the ocular sphincter muscle causes miosis. Anterior chamber cells are infact white blood cells that are seen in the anterior chamber; whereas anterior chamber flare refers to the presence of protein precipitates in the anterior chamber. Both of these manifestations are secondary to inflammation. Hypopyon results from the collection of neutrophilic exudates inferiorly in the anterior chamber. Keratic precipitates are only occasionally present and are seen as clumps of cells on the corneal epithelium. Iritis typically reduces the intraocular pressure because the inflammation of the ciliary body causes decreased production of the aqueous humor. However, there is an exception to this rule in which severe iritis, or iritis resulting from herpes simplex and herpes zoster may cause an inflammatory glaucoma.

Intermediate uveitis usually has an insidious onset. Blurred vision accompanied by vitreous floaters are usually present. Initially, the symptoms are usually unilateral but inflammatory changes are often bilateral and asymmetric. Vitreous cells, condensations and “snowballs” are often seen on examination, the latter being vitreous aggregates of inflammatory cells. Posterior segment snowbanking is also seen.

Posterior uveitis is usually painless. This is because the choroid has no sensory innervation. Conjunctival or scleral injection is often not present. Visual acuity may be decreased. Floaters (due to debris and inflammatory cells) are present. Vitreous cells and opacities may also be seen. In certain cases, hypopyon may also form.

• Whipple Disease

  disease [edit] Rifabutin, a derivative of Rifampin, has been shown to cause uveitis.[9] Several reports suggest the use of quinolones, especially Moxifloxacin, may lead to uveitis.[10] All of the widely[11] administered vaccines have been reported to [en.wikipedia.org]

• Blurred Vision

  The second case was related to a 45-year-old female patient who complained of blurred vision and a dark shadow before her right eye for 3 months. [ncbi.nlm.nih.gov]

  Acute anterior uveitis presents as follows: [2] Pain, generally developing over a few hours or days except in cases of trauma Redness Photophobia Blurred vision Increased lacrimation Chronic anterior uveitis presents primarily as blurred vision and mild [emedicine.com]

  It causes eye redness and pain, blurred vision, light sensitivity and small pupils. It occurs in the front of the eye and is often associated with other inflammatory and infectious diseases. Eye drops are the main form of treatment. [fightingblindness.ca]

• Eye Pain

  A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. [ncbi.nlm.nih.gov]

  Book now Uveitis is a fairly rare condition, when the middle layer of the eye (uvea or uveal tract) becomes inflamed, causing redness, eye pain and changes to your vision. [specsavers.co.uk]

  When to get medical advice Contact a GP as soon as possible if you have persistent eye pain or an unusual change in your vision, particularly if you've had previous episodes of uveitis. [nhs.uk]

  The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications and eye pain. [web.archive.org]

• Photophobia

  Pupillary examination may reveal direct photophobia when the light is directed into the affected eye, as well as consensual photophobia when light is directed into the uninvolved eye; consensual photophobia is typical of iritis, whereas photophobia due [emedicine.com]

  Pupils There may be direct photophobia There may be consensual photophobia (typical of iritis: photophobia due to more superficial causes is typically direct but not consensual). Miosis is common. [patient.info]

• Miosis

  Pupillary miosis is common. Slit-lamp examination This is the most important aspect of the examination. Examine the cornea via direct illumination with a broad beam at a 30 -40 angle between the viewing microscope and the light source. [emedicine.com]

  Miosis Ciliary flush Anterior chamber cells and flare Hypopyon Keratic precipitates Reduced intraocular pressure (IOP) Ciliary flush results from perilimbal conjunctival injection. Spasm of the ocular sphincter muscle causes miosis. [symptoma.com]

• Conjunctival Injection

  injection of mydriatic Possible systemic immunosuppression Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradeworkinggroup.org) Sources of evidence Huang JJ, Elia M. [college-optometrists.org]

  Miosis Ciliary flush Anterior chamber cells and flare Hypopyon Keratic precipitates Reduced intraocular pressure (IOP) Ciliary flush results from perilimbal conjunctival injection. Spasm of the ocular sphincter muscle causes miosis. [symptoma.com]

  Children can present with unilateral or bilateral symptoms with or without conjunctival injection with the appearance of iridocyclitis with a pseudohypopyon or a spontaneous hyphema.10 Figure 2. [retinatoday.com]

  Recurrent uveitis is defined as repeat episodes occurring after three months of disease inactivity without treatment. 1 Most eyes with anterior uveitis display conjunctival injection, often associated with a blush of limbal vessels. [aafp.org]

• Headache

  RESULTS: A 30-year-old man presented with headaches, ocular pain, photophobia, and blurred vision. He was found to have significant skin inflammation, predominantly involving areas of tattoos. [ncbi.nlm.nih.gov]

  Symptoms can vary slightly depending on where the uveitis is in your eye, but they can include: Pain Blurred/cloudy vision Loss of peripheral vision Sensitivity to light Redness of the eye Headaches Floating spots in field of vision How is uveitis diagnosed [ibdrelief.com]

  Signs & Symptoms Uveitis may present with one or more of the following symptoms: Headaches Reddening in the eye Pain in the eye – the eye may feel sore or tender, with the pain ranging from mild to severe. [essilor.ie]

The diagnosis of uveitis is usually clinical and no specific tests are needed. Intraocular pressure measurement may be required to rule out glaucoma. Tests may be performed to determine the underlying cause of uveitis (e.g. infections, autoimmune causes and malignancies).

• Francisella Tularensis

  Literature reports on ophthalmological manifestations related to tularemia, a zoonose caused by the bacterium Francisella tularensis, largely refer to Parinaud's oculoglandular syndrome, which consists of the association of conjunctivitis with preauricular [ncbi.nlm.nih.gov]

• Central Scotoma

  Uveitis was rapidly controlled following treatment with doxycycline, yet three years after initiation of the treatment, the patient still complained of loss of vision in the left eye with a central scotoma. [ncbi.nlm.nih.gov]

The treatment of anterior uveitis consists of the following components.

• Mydriatics: Mydriatics are given to counter the severe miosis. Dilation of the pupil prevents the formation of the posterior synechiae and also decreases the pain resulting from ciliary spasm.
• Steroids: Steroids are given to reduce inflammation. Depending upon the severity, steroids may be administered topically, subconjunctivally or systemically.
• Systemic analgesia: This is necessary to reduce pain.
• Treatment of the cause: The cause of anterior uveitis should also be promptly treated.

The treatment strategies for intermediate uveitis include the following.

• Systemic steroids are given to reduce inflammation.
• Immunosuppressive agents are also given in severe cases [9].
• Surgical options included in the treatment of intermediate uveitis include vitrectomy, cryotherapy and laser photocoagulation [10].

Posterior uveitis is treated with steroids which may be given through retrobulbar or systemic route.

With proper treatment, the prognosis of uveitis is usually good.

Untreated anterior uveitis may lead to inflammatory glaucoma and the formation of posterior synechiae and peripheral anterior synechiae. The former refers to adhesions of posterior iris to anterior lens capsule whereas the latter refers to adhesions of the iris to the cornea. Cataracts and band keratopathy may also occur.

Untreated intermediate uveitis can lead to cystoid and macular edema in up to 30% of the cases. Cataract and glaucoma may also develop in some cases.

Temporary or permanent visual impairment or even blindness may occur from uveitis in severe cases [8].

The etiological factors depend upon the type of uveitis.

Anterior uveitis is usually idiopathic. It may be the result of several connective tissue diseases. Several causes of anterior uveitis are related to HLA-B27 and include reactive arthritis, ankylosing spondylitis, psoriatic arthritis and inflammatory bowel disease [2]. Causes unrelated to HLA-B27 include juvenile idiopathic arthritis, sarcoidosis, ocular trauma, ocular surgery and infections (such as toxoplasmosis, syphilis, Lyme’s disease, herpes simplex virus, herpes zoster virus and tuberculosis) [3].

Intermediate uveitis is mostly idiopathic. Secondary causes such as sarcoidosis, Lyme’s disease and multiple sclerosis may also cause intermediate uveitis [4] [5]. Intermediate uveitis is often associated with anterior uveitis.

Posterior uveitis results from infections, autoimmune mechanisms and malignancies. The infection may be bacterial, viral, fungal or parasitic. The most common cause of posterior uveitis is parasitic infection (toxoplasmosis). Bacterial causes include syphilis and tuberculosis whereas viral causes are herpes simplex virus, cytomegalovirus (in acquired immunodeficiency syndrome). Fungal infections leading to posterior uveitis include histoplasmosis and candidiasis. Behcet’s disease is an autoimmune cause of posterior uveitis. It includes a triad of oral ulcers, genital ulcers and posterior uveitis [6]. Malignant melanoma and metastatic lesions can also cause posterior uveitis.

Uveitis is affects around 1 in 4500 people worldwide. Adults of age 20 to 60 years are usually affected whereas children are relatively spared. Anterior uveitis is the most common type of uveitis and accounts for 50 to 90% of the cases in the United States and around 30 to 50% in Asia [7].

The clinical features and manifestations of the disease result from the infection of the various parts of the uveal tract.

Uveitis results from multifactorial causes and there are no specific preventive measures against it.

If any causal infection has developed, prompt treatment is mandatory to prevent the progression of the disease and involvement of the eye(s).

Uvetis refers to the inflammation of the uveal tract of the eye. Depending upon the regions involved, may be classified into 3 types; namely anterior uveitis, intermediate uveitis and posterior uveitis [1].

Anterior uveitis is usually unilateral and can be defined as the inflammation of the iris (iritis). Iritis is usually accompanied by cyclitis (inflammation of the ciliary body). When both the iris and the ciliary body are involved, the condition is called iridocyclitis.

Intermediate uveitis refers to the inflammation of the vitreous; while inflammation of the choroid is known as posterior uveitis.

Uveitis refers to pain and swelling in the component of the eyes known as uveal tract. It may have different features depending upon the type.

Prompt treatment is necessary to avoid the development of complications.

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