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Anterior Uveitis

Anterior Uveitis

What is it?
Anterior uveitis (iritis, iridocyclitis) is an inflammation of the iris and ciliary muscle. It is an autoimmune reaction that may be either isolated or part of a systemic condition such as ankylosing spondylitis, juvenile rheumatoid arthritis, Reiter's syndrome, sarcoidosis, herpes simplex, herpes zoster, or Behçet's disease.

How does it present?
Symptoms of uveitis are periocular pain and photophobia. Vision is often normal. As in keratitis, the conjunctival vessels are most dilated at the corneal edge (ciliary flush, circumcorneal flush). The pupil may have an irregular shape because a portion has become attached to the anterior surface of the lens or the posterior surface of the cornea.

Slit-lamp biomicroscopy reveals turbidity and cells floating in the aqueous humor and pigment on the anterior lens surface. The edge of the iris may become adherent to the anterior lens capsule (posterior synechiae). Inflammatory cells may form clumps (keratic precipitates) on the posterior surface of the cornea.

Intraocular pressure may be markedly elevated or depressed.

What to do?
Refer urgently to an ophthalmologist because diagnosis depends on skilled slit-lamp biomicroscopy. Treatment includes topical cycloplegics and corticosteroids, agents to lower intraocular pressure, and systemic corticosteroids in refractory cases.

Most cases are unassociated with systemic disease and resolve within weeks of treatment. An evaluation for a systemic autoimmune disorder should take place if the patient has suggestive systemic symptoms or repeated attacks of uveitis.

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