review the differential diagnosis of anterior uveitis
review the relationship between HLA-B27 and uveitis
review various treatment options for anterior uveitis
A 34 year old male is referred to the eye clinic for a painful red right eye. He says the eye became red and painful overnight three days ago and has persisted since. He also complains of severe photophobia and blurred vision. There are no symptoms of floaters, flashes, or field loss. His past ocular and medical history are unremarkable and there is no recent history of illness.
On exam, best-corrected visual acuity is 6/12 and 6/6 in the right and left eyes, respectively. Intraocular pressures are 18 and 14. Anterior segment exam is shown below- there is diffuse erythema of the conjunctiva with circumcorneal congestion. There is also keratic precipitates, 3+ cell, and a hypopyon. Posterior segment exam is normal.
What is the most common systemic condition associated with this patient’s presentation?
Tuberculosis can cause anterior uveitis, which is usually granulomatous in nature. While more common in developing countries, tuberculosis is relatively rare (uncommon) in the developed world and a rare cause of anterior uveitis.
• Reactive arthritis
Reactive arthritis (e.g. Reiter’s syndrome) is a seronegative spondyloarthropathy that is associated with anterior uveitis, although it is not the most common cause.
• Rheumatoid arthritis
Rheumatoid arthritis is a relatively common condition that can be associated with anterior uveitis, although it is not the most common cause.
• Ankylosing spondylitis
Anterior uveitis is defined as inflammation of the iris alone (iritis), anterior part of the ciliary body (anterior cyclitis) or both structures (iridocyclitis).1 It is the most common cause of uveitis overall, accounting for about 90% of cases.2 The annual incidence is approximately 8 cases per 100,000 per year.2 There are numerous causes of anterior uveitis, with the condition being more common in HLA-B27 positive individuals. Generally it is more common and less serious than posterior uveitis, especially with early treatment.