Anterior Uveitis

Anterior uveitis

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Anterior uveitis

The uvea is the middle layer of the eye which contains much of the eye’s blood vessels. This is one way that inflammatory cells can enter the eye. Located between the sclera, the eye’s white outer coat, and the inner layer of the eye, called the retina, the uvea consists of the iris, ciliary body, and choroid: anterior uveitis #Iris: The colored circle at the front of the eye. It defines eye color, secretes nutrients to keep the lens healthy, and controls the amount of light that enters the eye by adjusting the size of the pupil. #Ciliary Body: It is located between the iris and the choroid. It helps the eye focus by controlling the shape of the lens and it provides nutrients to keep the lens healthy. #Choroid: A thin, spongy network of blood vessels, which primarily provides nutrients to the retina. Uveitis disrupts vision by primarily causing problems with the lens, retina, optic nerve, and vitreous #Lens: Transparent tissue that allows light into the eye. #Retina: The layer of cells on the back, inside part of the eye that converts light into electrical signals sent to the brain. #Optic Nerve: A bundle of nerve fibers that transmits electrical signals from the retina to the brain. #Vitreous: The fluid filled space inside the eye. Eye care professionals may describe the disease more specifically as: #Anterior uveitis= occurs in the front of the eye. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye but some are associated with rheumatologic, skin, gastrointestinal, lung and infectious diseases. [AdSense-A] #Intermediate uveitis= is commonly seen in young adults, It has been linked to several disorders including, sarcoidosis and multiple sclerosis. #Posterior uveitis=is the least common form of uveitis. It primarily occurs in the back of the eye, often involving both the retina and the choroid. It is often called choroditis or chorioretinitis. There are many infectious and non-infectious causes to posterior uveitis. #Panuveitis uveitis= is a term used when all three major parts of the eye are affected by inflammation. Behcet’s disease is one of the most well-known forms of pan-uveitis and it greatly damages the retina. Intermediate, posterior, and pan-uveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated. AETIOLOGY:– Anterior uveitis may be caused by infection (e.g. herpes simplex, herpes zoster), or occur as a manifestation of systemic inflammatory conditions e.g. juvenile chronic arthritis, HLA B27-related spondyloarthritides (ankylosing spondylitis, reactive arthritis, inflammatory bowel disease), sarcoidosis, Beh¸cets disease. Sympathetic ophthalmia: Inflammation of the contralateral eye weeks/months after penetrating injury (rare). EPIDEMIOLOGY:- Incidence of uveitis is 15 in 100,000 people (75 % are anterior uveitis). Uveitis associated with spondyloarthritis is twice as common in males as in females. HISTORY:– Pain (ciliary spasm and inflammation, pain high on accommodation), photophobia, red eyes, blurred vision, lacrimation. May rarely be associated with tubulointerstitial nephritis (flank pain, haematuria, proteinuria, sterile pyuria and acute renal failure). EXAMINATION:- low Visual acuity, ciliary flush (redness may be confined to the corneoscleral junction), hypopyon (proteinaceous exudate and inflammatory cells in the inferior angle of the anterior chamber), small irregular pupil due to posterior synechiae (adhesions of the iris to the lens). 1.An Eye Chart or Visual Acuity Test: This test measures whether a patient’s vision has decreased. 2.Slit lamp: Keratic precipitates (deposits of leucocytes on the corneal endothelium). 3.Fundoscopy: To exclude retinal detachment, posterior inflammation or a tumour that may give rise to anterior uveitis. Signs of complications: high Intraocular pressure, cataract. INVESTIGATIONS”- Investigate for associated systemic conditions depending on associated symptoms: U&Es, spondyloarthritides (sacroiliac joint X-ray, HLA typing), sarcoidosis (CXR, serum calcium, serum ACE), syphilis serology. MANAGEMENT:- Refer to an ophthalmologist. Treat the underlying infection e.g. antiviral therapy for herpes simplex or herpes zoster. Anterior uveitis not due to infection: Topical glucocorticoids (dexamethasone, prednisolone; drops for daytime and ointment for night-time), systemic steroids and immunosuppressants reserved for severe resistant cases. Mydriatic drops (antimuscarinics, e.g. cyclopentolate) to lower pain caused by ciliary spasm and prevent posterior synechiae formation. Monitor intraocular pressure. COMPLICATIONS:– Cataract, glaucoma (trabecular meshwork blocked by inflammatory cells or damaged by chronic inflammation), band keratopathy (band of calcium deposited in the cornea), posterior synechiae, rubeosis iridis (new vessels grown on the iris). PROGNOSIS Uveitis associated with spondyloarthritides tends to resolve within 3 months of its onset. Recurrences are common. The prognosis for this form of uveitis is generally excellent. #Note: Posterior uveitis is chorioretinal inflammation caused by infections, e.g. CMV, toxoplasma, TB, syphilis or systemic inflammatory conditions (e.g. sarcoidosis or vasculitides). Lymphoma may present with bilateral posterior eye inflammation. Posterior uveitis may present with floaters (caused by debris/inflammatory cells in the vitreous) and lower vision. Posterior uveitis is treated by observation, periocular and occasionally intraocular glucocorticoid injections, oral glucocorticoid, and/or systemic immunosuppression. Inflammation of pars plana (the portion of the eye just between the retina and the ciliary body) is associated with multiple sclerosis.
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