Anterior uveitis denotes intraocular inflammation that involves the iris (iritis), anterior part of the ciliary body (anterior cyclitis), or both (iridocyclitis). Primary site of inflammation, as determined clinically, is the anterior chamber and/or anterior vitreous.1 The standardization of uveitis nomenclature (SUN) working group has categorized uveitis according to the onset, duration, and course of the disease.1 Anterior uveitis can be of an acute or insidious onset. The duration of anterior uveitis can be limited (less than or equal to three months) or persistent (more than three months). Anterior uveitis is also classified based on the disease course: It is classified as acute anterior uveitis when there is an episode of sudden onset and limited duration; recurrent anterior uveitis when repeated episodes occur separated by periods of inactivity for at least three months without treatment; and chronic anterior uveitis when it persists and relapses in less than three months after discontinuing treatment. Anterior uveitis may also be classified as granulomatous or non-granulomatous according to its clinical appearance, and infectious or non-infectious according to its etiology. A clear classificaton of uveitis helps clinician in performing investigations and laboratory tests. Anterior uveitis can be associated with various systemic diseases and further systemic physical examination and investigations should be carried out when required. With a systematic approach, including detailed history, ocular examination and ancillary investigations, a diagnosis can be established in up to 70 % of cases.2 Although causes of uveitis differ among the various regions of the world, anterior uveitis is the most common form of intraocular inflammation at uveitis centers worldwide.3–6 Anterior uveitis is usually the most easily managed form of uveitis. However, in some cases it can lead to sightthreatening and serious complicatons such as glaucoma, cataract, and cystoid macular edema. Complications can be prevented or managed earlier, if anterior uveitis is promptly diagnosed and appropriately treated. Symptoms of Anterior Uveitis As anterior uveitis can present with an acute, chronic, or recurrent form, the severity of symptoms ranges from no symptoms in chronic disease to very severe symptoms in acute uveitis. Patients with insidious-onset chronic anterior uveitis do not have symptoms until the development of complications that cause blurred vision. Young children with chronic anterior uveitis are typically asymptomatic.7 By contrast, patients with acute anterior uveitis associated with the HLA-B27 antigen are severely symptomatic and start feeling a dull ocular pain even before any evidence of an acute attack can be detected on clinical examination. Symptoms of acute anterior uveitis include pain, photophobia, redness, tearing, blurred vision and floaters. Pain The pain of anterior uveitis usually results from acute inflammaton of the iris and ciliary body and is most severe when the patient fixates at a near object, especially a light source. Ciliary and iris sphincter muscle spasm can cause varying degrees of pain that may be described as a dull aching type of pain or a throbbing sensation localized to the eye, but may also be a referred pain that seems to radiate over a larger area served by the trigeminal nerve. In contrast to the ocular pain associated with scleritis or papillitis, a nocturnal pain is not specifically reported and pain does not increase with eye movements. Photophobia Photophobia is usually caused by ciliary muscle spasm but can also be associated with pupillary muscle involvement or corneal epithelial edema. Tearing Tearing is seen as a result of trigeminal nerve irritation. Floaters and Blurred Vision Inflammatory cells, fibrin, or opacities in the anterior vitreous can cause floaters. Corneal edema, occlusion of the pupillary area with a dense fibrin clot, opacities in the anterior vitreous, ciliary spasm, macular edema, and secondary cataract can cause blurred vision in anterior uveitis.
Symptoms and Signs of Anterior Uveitis
US Ophthalmic Review, 2013;6(1):33-37 DOI: 10.17925/USOR.2013.06.01.33
Abstract:Anterior uveitis is aninflammation of the uveal tract that involves the iris, anterior part of ciliary body or both. It can be classified as acute or chronic anterior uveitis, according to its clinical course, granulomatous or non-granulomatous anterior uveitis, according to its clinical appearence or infectious or non-infectious anterior uveitis, according to its etiology. It is the commonest form of uveitis and less sight-threatening than posterior segment inflammation, however in some cases it can lead to serious complications such as cataract, glaucoma, and cystoid macular edema. Nevertheless these complications can be prevented if anterior uveitis diagnosed and treated on time. Recognition of ocular findings and diagnostic clues in anterior uveitis is essential in order to identify specific ocular and systemic conditions.
Keywords: anterior uveitis, symptoms of anterior uveitis, signs of anterior uveitis, diagnosis, complications
Disclosure: The authors have no conflicts of interest to declare.
Received: October 23, 2012 Accepted November 27, 2012 Citation US Ophthalmic Review, 2013;6(1):33-37 DOI: 10.17925/USOR.2013.06.01.33
Correspondence: Esra Guney, MD. Umraniye Egitim ve Arastırma Hastanesi, Göz Kliniği, 34764,Umraniye, Istanbul. E: firstname.lastname@example.org
- Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of uveitis nomenclature for reporting clinical data, results of the first international workshop, Am J Ophthalmol, 2005;140:509–16.
- Herbort CP, Appraisal work–up and diagnosis of anterior uveitis: a practical approach, Middle East Afr J Ophthalmol, 2009; 16(4):159–67.
- Kazokoğlu H, Onal S, Tugal–Tutkun I, et al, Demographic and clinical features of uveitis in tertiary centers in turkey, Ophthalmic Epidemiol,2008;15(5):285–293.
- Khairallah M, Yahia SB, Ladjimi A, et al., Pattern of uvetis referral centre in tunisia, north africa, Eye, 2007;21(1):33–9.
- Cimino L, Aldigeri R, Salvarani C, et al., The causes of uveitis in a referral centre of northern italy, Int Ophthalmol, 2010;30:521–9.
- Yang P, Zhang Z, Zhou H, et al., Clinical Patterns and Characteristics of uveitis in a Tertiary center for uveitis in China, Curr Eye Research,2005;30:943–8.
- Tugal–Tutkun I, Pediatric Uveitis, J Ophthalmic Vis Res, 2011;6(4):259–69.
- Whitcup SM, Anterior Uveiti, In: Nussenblatt RB, Whitcup SM (eds), Uveitis Fundamentals and Clinical Practice, Philadelphia, Pennsylvania, Mosby, 2004;273–87.
- Tugal–Tutkun I, Guney–Tefekli E, Kamaci Duman F, et al., A Cross–sectional and Longitudinal Study of Fuchs Uveitis Syndrome in Turkish Patients, Am J Ophthalmol, 2009;148(4):510–15.e1.
- Chang JH, McCluskey PJ, Wakefield D, Acute anterior uveitis and HLA–B27, Surv Ophthalmol,2005;50:364–88.
- Herbort CP, Rao NA, Mochizuki M, et al, International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop on Ocular Sarcoidosis (IWOS), Ocul Immunol Inflamm,2009;17:160–9.
- Tugal–Tutkun I, Otük–Yasar B, Altinkurt E, Clinical features and prognosis of herpetic anterior uveitis: a retrospective study of 111 cases, Int Ophthalmol, 2010;30:559–65.
- Jap A, Chee SP, Cytomegalovirus–associated anterior segment infection,Exp Rev Ophthalmol, 2011;6:1–12.
- Chee SP, Jap A, Presumed Fuchs heterochromic iridocyclitis and Posner–Schlossman syndrome: comparison of cytomegalovirus–positive and negative eyes, Am J Ophthalmol, 2008;146:883–9.
- Mohamed Q, Zamir E, Update on Fuchs’ uveitis syndrome, Curr Opin Ophthalmol,2005;16:356–63.
- Jones NP, Fuchs’ heterochromic uveitis: an update, Surv Ophthalmol, 1993;37:253–72.
- Scheie HG, Cameron JD, Pigment dispersion syndrome: a clinical study, Br J Ophthalmol, 1981;65:264–9.
- Tugal–Tutkun I, Araz B, Taskapili M et al., Bilateral acute depigmentation of report of 26 new cases and four–year follow–up of two patients, Ophthalmology,2009;116:1552–7.
- Tugal–Tutkun, Onal S, Garip A et al., Bilateral acute iris transillumination, Arch Ophthalmol,2011;129(10):1312–9.
- Tyndall J, On the blue of the sky, the polarization of the skylight, and on the polarization of light by cloudy matter generally, Philos MagJ,1869;37:384–404.
- Hogan MJ, Kimura SJ, thygeson P, Signs and symptoms of uveitis. I. Anterior uveitis, Am J Ophthalmol,1959;47:155–70.
- Tugal–Tutkun I, Herbort CP, Laser flare photometry: a invasive, objective and quantitative method to measure intraocular inflammation, Int Ophthalmol, 2010;30:453–64.
- Wakefield D, Herbort CP, Tugal–Tutkun I, et al., Controversies in ocular inflammation and immunology laser flare photometry, Ocular Immunol Inflamm, 2010;18(5):334–40.
- Bernasconi O, Papadia M, Herbort CP, Sensitivity of laser flare photometry compared to slit–lamp cell evaluation in monitoring anterior chamber inflammation in uveitis, Int Ophthalmol, 2010;30:495–500.
- Davis JL, Dacanay LM, Holland GN, et al., Laser flare photometry and complications of uveitis in children, Am J Ophthalmol,2003;135:763–71.
- Holland GN, A reconsideration of anterior chamber flare and its clinical relevance for children with chronic anterior uveitis (An American Ophthalmological Society Thesis), Trans Am Ophthalmol Soc,2007;105: 344–64.
- Holland GN, Denove CS, Yu F, Chronic anterior uveitis in children: clinical characteristics and complications, Am J Ophthalmol, 2009;147:667–678.
- Tappeiner C, Heinz C, Roesel M, Heiligenhaus A, Elevated laser flare values correlate with complicated course of anterior uveitis in patients with juvenile idiopathic arthritis, Acta Ophthalmol, 2011;89:e521–7.
- Ramsay A, Lightman S, Hypopyon uveitis, Surv Ophthalmol, 2001;46:1–18.
- Tugal–Tutkun I, Behçet’s uveitis, Middle East Afr J Ophthalmol, 2009;16:219–24.
- Niyadurupola N, Broadway DC, Pigment dispersion syndrome and pigmentary glaucoma: a major review, Clin Experiment Ophthalmol, 2008;36(9):868–82.
- Ritch R, Schlötzer–Schrehardt U, Exfoliation syndrome, Surv Ophthalmol, 2001;45(4):265–315.
- Papadia M, Herbort HP, Mochizuki M, Diagnosis of Ocular sarcoidosis, Ocular Immunol Inflamm, 2010;18(6):432–41.
- Bonfioli AA, Curi AL, Orefice F, Fuchs’s Heterochromic Cyclitis, Semin Ophthalmol,2005;20(3):143–6.
- Gupta A, Bansal R, Gupta V, et al., Ocular Signs of Tuberculosis Uveitis, Am J Ophthalmol 2010; 149(4) 562–570.
- Gillies WE, Brooks AM, Clinical features at presentation of anterior pigment dispersion syndrome, Clin Exp Ophthalmol, 2001;29:125–7.
- Moorthy RS, Mermoud A, Baerveldt G, et al., Glaucoma associated with uveitis, Surv Ophthalmol, 1997;41:361–394,
- Perets WL, Tomasi TB, Aqueous humor proteins in uveitis, Immunoelectrophoretic and gel diffusion studies on normal and pathological human aqueous humor, Arch Ophthalmol,1961;65:20–3.
- Sallam A, Sheth HG, Habot–Wilmer Z, Lightman S, Outcome of raised intraocular pressure in uveitic eyes with and without a corticosteroid–induced hypertensive response, Am J Ophthalmol, 2009;148:207–13.
- Jacop E, FitzSimon JS, Brubaker RF, Combined corticosteroid and catecholamine stimulation of aqueous humor flow, Ophthalmology,1996;103:1303–8.
- Galor A, Margolis R, Brasil OM,et al., Adverse events after intravitreal triamcinolone in patients with or without uveitis, Ophthalmology, 2007;114:1912–1918.
- Takahashi T, Ohtani S, Miyata K, et al., A clinical evaluation of uveitis associated secondary glaucoma,Jpn J Ophthalmol, 2002;46:556–562.
- La Hey E, de Vries J, Langerhorst CT, et al., Treatment and prognosis of secondary glaucoma in Fuchs heterochromic cyclitis, Am J Ophthalmol, 1993;116:327–40.
- Miserocchi E, Waheed NK, Dios E, et al., Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison, Ophthalmology, 2002;109(8):1532–7.
- Jap A, Chee S, Viral anterior uveitis, Curr Opin Ophthalmol, 2011;22:483–488.
- Toris CB, Pederson JE, Aqueous humor dynamics in experimental iridocyclitis, Invest Ophthalmol Vis Sci, 1987;28(3):477–81.
Keywords: anterior uveitis, symptoms of anterior uveitis, signs of anterior uveitis, diagnosis, complications