Anterior Uveitis (Iritis)

Introduction: The uvea is the middle layer of the eye. Its anterior portion includes the iris and ciliary body; the posterior portion includes the choroid. Inflammation of the anterior portion is called anterior uveitis or iritis.

Etiology: It is often idiopathic, but approximately half of cases are associated with systemic
disease. These include :

• Inflammatory disorders (rheumatoid arthritis, Behçet disease, sarcoid), 
• HLA-B27-associated conditions (ankylosing spondylitis, inflammatory bowel disease, Reiter syndrome), and 
• Infectious causes (zoster, tuberculosis, toxoplasmosis, AIDS).

Clinical features include conjunctival hyperemia, hyperemic perilimbal vessels (“ciliary flush”), miosis, decreased visual acuity, photophobia, tearing, and pain.

Anterior Uveitis. Marked conjunctival injection and perilimbal hyperemia (“ciliary flush”) are seen in this patient with recurrent iritis

The slit-lamp may demonstrate a hypopyon, cells, flare, and keratic precipitates.
Keratic precipitates are agglutinated inflammatory cells adherent to the posterior corneal endothelium. These precipitates appear either as fine gray-white deposits or as a large, flat, greasy-looking area (“mutton fat”).
The IOP may be decreased due to decreased aqueous production by the inflamed ciliary body, or increased secondary to inflammatory debris within the trabeculae of the anterior chamber angle obstructing outflow.


Learning Points: 
1. Iritis is usually associated with a miotic pupil, pain, and redness primarily at the limbus (“ciliary flush”).
2. When uveitis is associated with a systemic disorder, the associated condition is usually evident. Common exceptions include sarcoidosis and syphilis.
3. In patients with uveitis of unknown etiology, a chest x-ray looking for sarcoidosis and serologic testing for syphilis are reasonable.
4. Visual loss may occur with uveitis.
5. Topical analgesics do not significantly ameliorate the pain of anterior uveitis.
6. Consider sympathetic ophthalmia with unexplained uveitis and a history of eye trauma.

Management:

• The patient’s history forms the basis for the evaluation and laboratory testing. The history should focus on rheumatic illness, dermatologic problems, bowel disease, infectious exposures, and sexual history. 
• Treatment of the uveitis is nonspecific.
• Topical cycloplegics and corticosteroids may be prescribed in conjunction with the ophthalmologist. Antibiotics are not usually prescribed.