Uveitis refers to the inflammation of the uveal tract of the eye.
The symptoms of anterior uveitis are as below.
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.
- Ciliary flush
- Anterior chamber cells and flare
- 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.
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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:  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]
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]
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]
The causes of red eye are virtually endless. The treatment required needs to be tailored for the particular cause of red eye. [opto.ca]
If you have chronically red eyes—this is likely not caused by an infection. Optometrist sometimes attempt to treat these patients with antibiotics, steroids and allergy drops with no improvement. [sanantonioeyeinstitute.com]
[…] by · Published October 6, 2017 · Updated October 5, 2017 The “ Pediatric Red Eye ” is a commonly encountered presentation that we are all accustomed to evaluating. [pedemmorsels.com]
If you have a “red eye” that does not clear up quickly, contact your ophthalmologist. [klinikamaja.rs]
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]
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]
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).
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 .
- Surgical options included in the treatment of intermediate uveitis include vitrectomy, cryotherapy and laser photocoagulation .
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 .
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 . 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) .
Intermediate uveitis is mostly idiopathic. Secondary causes such as sarcoidosis, Lyme’s disease and multiple sclerosis may also cause intermediate uveitis  . 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 . 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 .
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 .
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.
- Lowder CY, Char DH. Uveitis. A review. The Western journal of medicine. Mar 1984;140(3):421-432.
- 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.
- Tabbara KF. Infectious uveitis: a review. Archivos de la Sociedad Espanola de Oftalmologia. Apr 2000;75(4):215-259.
- Jamilloux Y, Kodjikian L, Broussolle C, Seve P. Sarcoidosis and uveitis. Autoimmunity reviews. Aug 2014;13(8):840-849.
- Sun SM. [Clinical analysis of sarcoidosis uveitis]. [Zhonghua yan ke za zhi] Chinese journal of ophthalmology. Mar 1988;24(2):83-85.
- van Dongen CM, Gijselhart JP, van Gijn J. [Behcet and his triad]. Nederlands tijdschrift voor geneeskunde. 2012;156(41):A5230.
- Chang JH, Wakefield D. Uveitis: a global perspective. Ocular immunology and inflammation. Dec 2002;10(4):263-279.
- 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.
- 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.
- Franklin RM. Laser photocoagulation of retinal neovascularization in intermediate uveitis. Developments in ophthalmology. 1992;23:251-260.