Other meanings of Anterior uveitis
Ophthalmology
Anterior uveitis is inflammation of the uveal tract’s anterior structures, chiefly the iris and ciliary body. It is the most common form of uveitis, accounting for roughly 90% of cases in community-based studies. The condition typically presents with acute onset of a red, painful eye, photophobia, and blurred vision, and is often recurrent or chronic. Anterior uveitis encompasses iritis, iridocyclitis, and anterior cyclitis, and may be associated with systemic inflammatory diseases, infections, trauma, or be idiopathic. Prompt diagnosis and treatment are essential to prevent complications such as posterior synechiae, cataract, glaucoma, and cystoid macular edema.
Anterior uveitis is classified by the Standardization of Uveitis Nomenclature (SUN) Working Group according to onset (sudden or insidious), duration (limited if ≤3 months, persistent if >3 months), and course (acute, recurrent, or chronic). The hallmark symptoms are unilateral or bilateral eye pain, redness, photophobia, and decreased vision. Slit-lamp examination typically reveals inflammatory cells and flare in the anterior chamber, keratic precipitates on the corneal endothelium, and occasionally fibrin or hypopyon. The inflammation may be granulomatous or non-granulomatous, with granulomatous disease featuring large mutton-fat keratic precipitates and iris nodules (Koeppe and Busacca).
The most common causes of anterior uveitis are idiopathic (about 50% of cases), followed by HLA-B27-associated conditions, which include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease. Infectious etiologies include herpes simplex virus, varicella-zoster virus, cytomegalovirus, syphilis, tuberculosis, and Lyme disease. Fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome are distinct clinical entities. Systemic diseases such as sarcoidosis, Behçet's disease, and juvenile idiopathic arthritis (particularly in young girls with ANA positivity) are also important associations. Trauma and intraocular surgery can cause a sterile inflammatory response.
Diagnosis is primarily clinical, based on slit-lamp examination. Initial evaluation includes a thorough history and examination to identify laterality, granulomatous features, and systemic symptoms. Laboratory testing is guided by clinical suspicion and may include HLA-B27 typing, syphilis serology, chest radiography for sarcoidosis or tuberculosis, and sacroiliac imaging. Treatment aims to control inflammation, relieve symptoms, and prevent complications. Topical corticosteroids are the mainstay, with cycloplegic agents to prevent posterior synechiae and reduce pain. Severe or refractory cases may require periocular or systemic corticosteroids, and immunosuppressive agents such as methotrexate or biologic agents (e.g., adalimumab) are used for chronic or steroid-dependent disease. Infectious causes require specific antimicrobial therapy.
Anterior uveitis has been recognized since antiquity; Hippocrates described a condition consistent with it. The association with HLA-B27 was discovered in the 1970s, linking it to the spondyloarthropathies. A notable edge case is the 'uveitis-glaucoma-hyphema' (UGH) syndrome, which occurs after intraocular lens implantation and mimics anterior uveitis. In children, anterior uveitis is often asymptomatic and detected on screening in juvenile idiopathic arthritis. The SUN criteria, established in 2005, standardized terminology and grading, facilitating research. Recent studies have explored the role of the gut microbiome in HLA-B27-associated uveitis, and novel biomarkers such as tear cytokines are being investigated. Also, anterior uveitis can be a presenting sign of syphilis, and in HIV-positive patients, it may be caused by immune recovery.
Anterior uveitis is a common and treatable condition, but it requires prompt evaluation to rule out sight-threatening complications and systemic associations.
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