When we talk about the uvea, it refers to the:
- Iris - pigmented muscular curtain of the eye that regulates the amount of light allowed into the eye.
- Ciliary body - controls the lens of the eye and contracts/relaxes to cause bulgingof the
- Choroid - supplies retina with nutrients as it is highly vascular.
We have different manifestations of uveitis:
- Iritis - inflammation of iris solely.
- Anterior uveitis - inflammation of iris and ciliary body.
- Intermediate uveitis - inflammation of the vitreous.
- Posterior uveitis - inflammation of choroid.
- Panuveitis - inflammation of the entire uvea.
It can also be chronic (persists >3 months), acute (lasts <3 months) or recurrent (recurs after 3 months of no inflammation).
ANTERIOR UVEITIS/IRITIS
It is an important differential for red eye.
Pathophysiology
Associated with HLA-B27 and other HLA-B27 associated conditions. Some important conditions to note are:
- Ankylosing spondylitis
- Idiopathic juvenile arthritis
- Multiple sclerosis
- SLE
- Sarcoidosis
- IBD
- Granulomatosis with polyangiitis
- Reactive arthritis
- Behçet’s disease
It is also associated with TB, syphilis, HIV, Lyme disease.
😷 Presentation
- Acute onset of unilateral symptoms (however, if related to sarcoidosis, it may present bilaterally).
- Red eye - perilimbal hyperaemia but does not extend into the cornea.
- Painful eye - with a dull, aching pain. Pain is exacerbated by movement of the eye.
- Blurred vision
- Ciliary flush - redness from the cornea outwards.
- Floaters and flashes
- Meiosis due to constriction of the iris sphincter muscle.
- Excessive lacrimation - leading to a watery eye.
- Posterior synechiae - adhesions causing abnormally shaped iris.
- Hypopyon
- Photophobia - due to spasm of the ciliary muscle.
- More commonly unilateral.
🔍 Investigations
Once again, it requires urgent same-day referral and assessment from an ophthalmologist.
🏆 Slit-lamp examination is needed along with intraocular pressure assessment.
🧰 Management
Medical management:
- Steroids - may be topical, oral, or IV. 0.5% 4x daily.
- Cycloplegics and mydriatics - relieve pain caused by ciliary spasm by antagonising the iris sphincter muscle and ciliary body.
- Cyclopentalone - antimuscarinic. 1% 4x daily.
- Atropine - antimuscarinic.
- Immunosuppressants - dependant on the underlying disease.
If infectious aetiology is suspected, we can give the necessary antibiotics.
Surgical management:
Laser therapy, cryotherapy or vitrectomy may be considered in severe cases.