Uveitis, Anterior

Key Features

Essentials of Diagnosis

• Iridocyclitis associated with juvenile idiopathic arthritis

  • May be asymptomatic despite severe ocular inflammation

  • Occurs most often in girls with oligoarticular arthritis and a positive antinuclear antibody test

General Considerations

• Other causes

  • Syphilis

  • Tuberculosis

  • Sarcoidosis

  • Relapsing fever (borreliosis)

  • Lyme disease

• Juvenile spondyloarthropathies, including ankylosing spondylitis, reactive arthritis (Reiter syndrome), and psoriatic arthritis, are associated with anterior uveitis

• A substantial percentage of cases are of unknown origin

Clinical Findings

Symptoms and Signs

• Injection, photophobia, pain, and blurred vision usually accompany iritis (anterior uveitis or iridocyclitis)

• Other ocular findings of the anterior segment include conjunctivitis, episcleritis, and sterile corneal infiltrates

Differential Diagnosis

• Iridocyclitis due to autoimmune disorder

• Trauma

• Infection

• Malignancy

• Idiopathic etiology

Diagnosis

• Slit-lamp examination reveals anterior chamber inflammation with inflammatory cells and protein flare

Treatment

• Topical corticosteroid and a cycloplegic agent is aimed at quieting the inflammation and preventing or delaying the onset of cataract and glaucoma

• Methotrexate and other systemic immunosuppressive agents can be used in refractory cases

• Systemic antitumor necrosis factor agents such as etanercept, infliximab, and adalimumab show promise in treating refractory cases

Outcome

Complications

• Permanent decreased vision due to

  • Cataracts

  • Secondary glaucoma

  • Band keratopathy

Prognosis

• Depends on the severity of ocular inflammation, development of cataracts, and secondary glaucoma

Reference