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.

• Pain

  Granulomatous uveitis is characterized by blurred vision, mild pain, eye tearing, and mild sensitivity to light. [britannica.com]

  Some forms, such as iritis, cause pain and light sensitivity. Other forms, such as chorioretinitis, cause visual loss and floaters. [vision-and-eye-health.com]

  Signs of the condition include: blurred vision, floaters, eye pain, redness, and extreme sensitivity to light. If left untreated, intermediate uveitis can cause permanent damage to the eye and vision loss. [rebuildyourvision.com]

  Patients have little pain or photophobia except when having an acute episode. [emedicine.medscape.com]

  Uveitis symptoms Symptoms of anterior uveitis include: light sensitivity decreased visual acuity eye pain red eyes Intermediate and posterior uveitis usually are painless. [allaboutvision.com]

• Reiter Syndrome

  Autoimmune inflammation of iris and ciliary muscle Isolated or part of systemic autoimmune condition such as ankylosing spondylitis, juvenile rheumatoid arthritis, Reiter syndrome, sarcoidosis, herpes simplex, herpes zoster, or Behçet disease Delayed [kellogg.umich.edu]

  Such diseases include ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis (joint inflammation occurring in patients with psoriasis), and Reiter syndrome. [britannica.com]

  […] psoriatic arthritis Reiter's syndrome sarcoidosis syphilis systemic lupus erythematosus toxocariasis toxoplasmosis tuberculosis Vogt-Koyanagi-Harada syndrome Research has shown smoking is a risk factor for uveitis. [allaboutvision.com]

  An inflammatory disorder Chron’s disease, ulcerative colitis, Reiter’s syndrome, Bechet’s disease, Vogt Koyanagi Harada Disease, Kawasaki disease, sarcoidosis, etc. [retinaspecialistsofmichigan.com]

• Whipple Disease

  […] present with diarrhea and uveitis Crohn's dz Ulcerative colitis whipple disease what diseases present with jaundice and uveitis chronic, progressive inflammation of spine back pain (50% are asymptomatic) uveitis = acute, unilateral, recurrent and alternating [studyblue.com]

  Kawasaki's disease multiple sclerosis polyarteritis nodosa psoriatic arthritis reactive arthritis sarcoidosis systemic lupus erythematosus Vogt–Koyanagi–Harada disease Whipple's disease [edit] Rifabutin, a derivative of Rifampin, has been shown to cause [en.wikipedia.org]

• Candidiasis

  The following lists a few conditions that may be associated with uveitis: Idiopathic (unknown cause) Ankylosing Spondylitis Acute Retinal Necrosis Birdshot Chorioretinopathy Candidiasis Cytomegalovirus Endophthalmitis Herpes Simplex/Zoster Inflammatory [houstonretina.com]

  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. [symptoma.com]

  […] recurrent uveitis see periodic ophthalmia. exogenous uveitis arising from causes external to the body. granulomatous uveitis associated with toxoplasmosis and systemic mycotic infections such as cryptococcosis, blastomycosis, coccidioidomycosis and candidiasis [medical-dictionary.thefreedictionary.com]

  Traumatic uveitis Granulomatous anterior and posterior uveitis These are associated with: Sarcoidosis Toxoplasmosis Cytomegalovirus Herpes simplex virus Herpes zoster virus Tuberculosis Syphilis In AIDS : Cytomegalovirus Human syncytial virus Cryptococcosis Candidiasis [patient.info]

• Malaise

  In a retrospective study by Gangaputra et al. [ 17 ], MTX was discontinued because of the following side effects in 16% of 384 patients: gastrointestinal distress (2.9%), bone marrow suppression (2.6%), increased levels of liver enzymes (2.3%), malaise [omicsonline.org]

• Intestinal Disease

  Uveitis may be a manifestation of various systemic disorders, including sarcoidosis, some arthritis syndromes and chronic intestinal diseases. It can also result from trauma to the eye. [uclahealth.org]

  Uveitis may be a manifestation of various systemic disorders, including sarcoidosis, some arthritic syndromes and chronic intestinal diseases. It can also result from trauma to the eye. [masseyeandear.org]

  Non-infectious uveitis may affect the eye only or be related to general illnesses like idiopathic juvenile arthritis, ankylosing spondylitis, Behcet's disease, an inflammatory intestinal disease or sarcoidosis, etc. [barraquer.com]

• Ulcer

  The gene has been found in people with certain autoimmune conditions, including ankylosing spondylitis and ulcerative colitis. Page last reviewed: 3 January 2020 Next review due: 3 January 2023 [nhs.uk]

  Examine the epithelium for abrasions, edema, ulcers, or foreign bodies. Inspect the stroma for deep ulcers and edema. Keratitic precipitates (white blood cells) on the endothelium are a hallmark of iritis. [emedicine.medscape.com]

  He had an associated history of recurrent mouth and genital ulcers, predating the uveitis history by about 2 years. The measurement of his intraocular CD4/CD8 ratio helped make a diagnosis of Behçet's disease uveitis. [ncbi.nlm.nih.gov]

  However, there is a need for safe and effective alternatives to corticosteroids as first line and adjunctive therapies for uveitis and other forms of ocular inflammation given the incidence of glaucoma, cataracts, ocular infections, and corneal ulcers [aldeyra.com]

• Anterior Uveitis

  Types of Uveitis When diagnosed with uveitis, your doctor may place you under one of the four types of uveitis: anterior, posterior, intermediate and panuveitis. 1. Anterior Uveitis Anterior uveitis is the most common of the four types. [rebuildyourvision.com]

  Uveitis is inflammation of the eye involving the uveal structures (iris, ciliary body and choroid). Anterior uveitis specifically refers to uveitis in the anterior segment of eye. [aldeyra.com]

  Iritis; Pars planitis; Choroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis; Iridocyclitis Durand ML. Infectious causes of uveitis. In: Bennett JE, Dolin R, Blaser MJ, eds. [medlineplus.gov]

  Anterior uveitis typically refers to inflammation of the iris and anterior chamber; intermediate uveitis refers to inflammation of the ciliary body and vitreous humour (the jellylike filling in the anterior portion of the eye); and posterior uveitis refers [britannica.com]

  Uveitis is much less common in systemic JIA and chronic anterior uveitis is not typically associated with childhood onset enthesitis related arthritis (ERA) or Rheumatoid factor positive JIA. [pmmonline.org]

• Blurred Vision

  Granulomatous uveitis is characterized by blurred vision, mild pain, eye tearing, and mild sensitivity to light. [britannica.com]

  Signs of the condition include: blurred vision, floaters, eye pain, redness, and extreme sensitivity to light. If left untreated, intermediate uveitis can cause permanent damage to the eye and vision loss. [rebuildyourvision.com]

  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.medscape.com]

  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]

  Light sensitivity Flashing lights Dark, floating spots (floaters) Eye pain or redness Blurred or decreased vision Narrowing of the pupils Tearing If you experience any of these symptoms, please visit your ophthalmologist. [fightingblindness.ca]

• Eye Pain

  Signs of the condition include: blurred vision, floaters, eye pain, redness, and extreme sensitivity to light. If left untreated, intermediate uveitis can cause permanent damage to the eye and vision loss. [rebuildyourvision.com]

  when the middle layer of the eye (uvea or uveal tract) becomes inflamed, causing redness, eye pain and changes to your vision. [specsavers.ie]

  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]

  Granulomatous uveitis is characterized by blurred vision, mild pain, eye tearing, and mild sensitivity to light. [britannica.com]

  Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision. Most cases get better with treatment – usually steroid medicine. [nhs.uk]

• 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.medscape.com]

  The common symptoms are eye pain, tenderness on touching and light sensitivity (photophobia). Photophobia occurs because light worses the spasm of the iris muscles caused by the inflammation. The area encircling the iris will look inflamed. [vision-and-eye-health.com]

  These eyeglass lenses darken automatically in sunlight to reduce photophobia-related discomfort when going outdoors. Page updated April 2019 [allaboutvision.com]

• Lacrimation

  Physical examination findings are as follows: Lids, lashes, and lacrimal ducts are normal. [emedicine.medscape.com]

  Usual symptoms of uveitis include ocular pain, photophobia, redness of conjunctiva, visual disturbances, and excessive lacrimation. [clinicaladvisor.com]

• 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]

  General vision problems, including blurred or cloudy vision Floaters, spots in the eye that look like tiny rods or chains of transparent bubbles floating around in the field of vision Eye pain and redness Photophobia, an abnormal sensitivity to light Headaches [medicalnewstoday.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]

• Irritability

  Uveitis is swelling and irritation of the uvea. The uvea is the middle layer of the eye. The uvea provides most of the blood supply to the retina. Uveitis can be caused by autoimmune disorders. [medlineplus.gov]

  Twenty-four hours later, bilateral eye irritations, periorbital swelling, blurred vision, and diplopia presented. [ncbi.nlm.nih.gov]

  Symptoms of uveitis may include eye redness and irritation, blurred vision, eye pain, increased sensitivity to light, and floating spots. [medicinenet.com]

  Uveitis is swelling and irritation in the middle layer of the eye (the uvea). It is caused by a malfunction in the immune system, not the eye. Uveitis Symptoms Uveitis can affect one or both eyes. [wakehealth.edu]

  The anterior uvea is composed of the iris and ciliary body; an irritation of this segment, or anterior uveitis, leads to acute painful symptoms and photophobia. [bestpractice.bmj.com]

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).

• Colitis

  Autoimmune side effects including colitis, dermatitis, and endocrine abnormalities are common in patients treated with ipilimumab [anti-CTLA4 (cytotoxic T-lymphocyte-associated protein 4)]. [ncbi.nlm.nih.gov]

  Examples are: Ankylosing spondylitis Behcet disease Psoriasis Reactive arthritis Rheumatoid arthritis Sarcoidosis Ulcerative colitis Uveitis can also be caused by infections such as: AIDS Cytomegalovirus (CMV) retinitis Herpes zoster infection Histoplasmosis [medlineplus.gov]

  The gene has been found in people with certain autoimmune conditions, including ankylosing spondylitis and ulcerative colitis. Page last reviewed: 3 January 2020 Next review due: 3 January 2023 [nhs.uk]

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.

1. Lowder CY, Char DH. Uveitis. A review. The Western journal of medicine. Mar 1984;140(3):421-432.
2. Wakefield D, Abi-Hanna D. HLA antigens and their significance in the pathogenesis of anterior uveitis: a mini review. Current eye research. Jun 1986;5(6):465-473.
3. Tabbara KF. Infectious uveitis: a review. Archivos de la Sociedad Espanola de Oftalmologia. Apr 2000;75(4):215-259.
4. Jamilloux Y, Kodjikian L, Broussolle C, Seve P. Sarcoidosis and uveitis. Autoimmunity reviews. Aug 2014;13(8):840-849.
5. Sun SM. [Clinical analysis of sarcoidosis uveitis]. [Zhonghua yan ke za zhi] Chinese journal of ophthalmology. Mar 1988;24(2):83-85.
6. van Dongen CM, Gijselhart JP, van Gijn J. [Behcet and his triad]. Nederlands tijdschrift voor geneeskunde. 2012;156(41):A5230.
7. Chang JH, Wakefield D. Uveitis: a global perspective. Ocular immunology and inflammation. Dec 2002;10(4):263-279.
8. Silva LM, Muccioli C, Oliveira F, Arantes TE, Gonzaga LR, Nakanami CR. Visual impairment from uveitis in a reference hospital of Southeast Brazil: a retrospective review over a twenty years period. Arquivos brasileiros de oftalmologia. Nov-Dec 2013;76(6):366-369.
9. Kulkarni P. Review: uveitis and immunosuppressive drugs. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics. Apr 2001;17(2):181-187.
10. Franklin RM. Laser photocoagulation of retinal neovascularization in intermediate uveitis. Developments in ophthalmology. 1992;23:251-260.