Anterior Uveitis and Iritis

Anterior uveitis and iritis can be caused by a number of systemic and local processes including juvenile rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, Reiter's syndrome, tuberculosis, syphilis, herpes, leukemia, lymphoma, and ocular trauma.

Causes

Uveitis is an inflammation inside the eye, affecting the uvea. The uvea provides most of the blood supply to the retina. Most causes of uveitis can include autoimmune disorders, infection, or exposure to toxins.

The many different systemic disorders that can cause uveitis include:

• birdshot retinochoroidopathy
• brucellosis
• herpes simplex
• acute posterior multifocal placoid pigment epitheliopathy
• presumed ocular histoplasmosis syndrome
• systemic lupus erythematosus
• toxocariasis

Symptoms

• Photophobia (almost always)
• Unilateral gradual onset of eye pain
• Red eye without discharge
• Blurred vision (common)
• Excessive tearing
• Other symptoms of primary medical condition

Signs

• Perilimbal injection
• Consensual photophobia-pain in the involved eye when light is shined in the uninvolved eye (very common)
• Miosis may be present.
• Cornea may be normal.

Treatment

Emergency Department Care:

• The main goals in the ED are to diagnose uveitis correctly and to refer the patient to an ophthalmologist.
• The patient's eye is erythematous and cells are present in the anterior chamber, antibiotics are not indicated.

Treatment is consistent with treatment for the systemic diseases of toxoplasmosis, tuberculosis, sarcoidosis, and so forth. For infectious diseases, corticosteroids are often used along with antibiotic therapy. For autoimmune diseases, various forms of suppression of the immune system may be required.