What is Medicine – What is Anterior Uveitis ?
Uvea includes the choroid, ciliary body and iris.
Choroid is the layer between the sclera and retina all the way around the eye
An inflammation of the anterior part of the uvea is known as anterior uveitis. Anterior uveitis is also known as iritis. The anterior chambers being infiltrated with lymphocytes, neutrophils and macrophages. This happens due to infection, malignancy, autoimmune and ischemia. Patients may present with floaters in their vision due to the present of the inflammatory cells.
There are two forms of anterior uveitis such as acute anterior uveitis and chronic anterior uveitis.
Acute anterior uveitis is associated with HLA B27 linked conditions such as ankylosing spondylitis, reactive arthritis and inflammatory bowel disease.
Chronic anterior uveitis is more granular in nature due to it has more macrophages. Chronic anterior uveitis is associated with herpes virus, tuberculosis, syphilis and sarcoidosis.
However it is less severe with longer duration of symptoms which lasted more than 3 months.
The common symptoms and signs of anterior uveitis include painful dull aching red eye, reduction in visual acuity, ciliary flush ( a red ring spreading from the cornea outwards), floaters and flashes, miosis / constricted pupils due to contraction of sphincter muscle, lacrimation / excessive tear production, pain on movement, photophobia due to spasm of ciliary muscle and abnormally shaped pupil due to posterior synechiae / adhesions pulling the iris into abnormal shapes
All the symptoms and signs are usually unilateral in nature and happen spontaneously
In terms of management patients are referred to ophthalmologist. The treatments include, oral, topical or intravenous steroids and cycloplegic mydriatic medications (paralyzing ciliary muscle and dilating the pupils) such as atropine eye drops or cyclopentalone.
Cyclopentolate and atropine are anti muscarinic agents which block the action of the ciliary body and the iris sphincter muscles. As a result dilate the pupil and stopping the action of the ciliary body to avoid any pain due to ciliary spasm.
The other treatments include DMARDS and TNF inhibitors which are immunosuppressant, cryotherapy, laser therapy or surgery such as vitrectomy.
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