Anterior Uveitis

Anterior uveitis or iritis is the inflammation of the iris (the coloured part of the eye) and ciliary body which lies next to it. If not treated, iritis can result in permanent damage and vision loss from glaucoma, cataract or retinal swelling.

A specific cause of uveitis is often not found, however, uveitis is often associated with:

• Systemic inflammatory conditions (eg. rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, lupus, Crohn’s disease, ulcerative colitis, psoriasis, syphilis)
• A virus (eg. Mumps, herpes simplex or herpes zoster virus infection)
• Trauma to the eye.

The symptoms of anterior uveitis can be similar to many other eye conditions causing a “red eye”.

They may include:

• A red, sore and inflamed eye
• Increased glare sensitivity (photophobia)
• Blurred vision
• Pain with reading or using the eye
• Abnormal pupil shape or small pupil
• Increased floater
• White area covering the lower part of the iris (hypopyon)

Investigation of uveitis may include the following tests:

• Vision assessment.
• Dilated eye examination – uveitis can affect the anterior, intermediate or posterior segment of the eye. It is important to examine the entire eye in order to target treatment.
• A slit lamp is used to look for cells (white blood cells) or flare (protein) in the anterior chamber in anterior uveitis.
• Blood tests – may be ordered to identify any systemic conditions that may be associated.
  X-rays – may be ordered to assist with diagnosis of associated systemic conditions.

Anterior uveitis usually responds well to treatment, which is generally eye drops, but treatment must be slowly tapered over weeks and in some cases months.

Treatment usually includes:

• A mydriatic – these are pupil dilating drops which rest the ciliary body and help reduce the pain associated with the pupil changing size.
• Anti-inflammatory steroid drops – which reduces the inflammatory response. These need to be slowly tapered in dose to reduce the chance of the uveitis recurring.

For more severe inflammation, oral or injectable steroids may be required.

Without treatment, uveitis can result in glaucoma, cataract, growth of new and abnormal blood vessels, and retinal swelling or oedema. Some cases or uveitis, particularly those for which no associated condition is identified, may occur once in a lifetime. Other cases, particularly those that have a systemic association, may be chronic or recurrent.