Anterior Uveitis (Iritis)

Anterior uveitis may be a primary or secondary disorder. It is strongly associated in 70% of cases with the HLA-B27 serotype [15]. Although sometimes occurring in eye disorders, such as herpetic keratitis and following recent intraocular surgery, it is more commonly associated with diseases such as sarcoidosis, ankylosing spondylitis and inflammatory bowel disease.

A typical presentation is of a painful, photophobic eye; the pain is described as deep, boring and worse on accommodation (due to constriction of the iris). Photophobia may be consensual, i.e. the patient experiences discomfort when light is shone into the unaffected eye. There is perilimbal injection on examination and although the pupil may appear normal [16], it may be irregular due to the formation of adhesions (synechiae) between the iris and cornea or lens.

Learning Bite

A painful eye with perilimbal injection, photophobia and an irregular pupil are all indicative of anterior uveitis. The presence of keratitic precipitates, inflammatory cells and flare confirm the diagnosis.

All patients with suspected anterior uveitis must be referred for an urgent ophthalmology assessment.