Signs and Symptoms: The typical presentation of anterior uveitis involves pain, photophobia and hyperlacrimation. Patients report a deep, dull aching of the involved eye and surrounding orbit. Associated sensitivity to lights may be severe. Excessive tearing results secondary to increased neural stimulation of the lacrimal gland, and is not associated with a foreign-body sensation.
Visual acuity is variable, ranging from mild blur to significant vision loss if synechia or a cyclitic membrane are present. External exam may reveal mild to moderate lid swelling, resulting in pseudoptosis. A deep, perilimbal injection of the conjunctiva and episclera is typical, while the palpebral conjunctiva is characteristically normal. The cornea may display mild edema upon biomicroscopy.
The hallmark signs of anterior uveitis are cells and flare in the anterior chamber. If the anterior chamber reaction is significant, small gray to brown endothelial deposits known as keratic precipitates may arise. This can then lead to endothelial cell dysfunction and the corneal edema.
Iris findings may include adhesions to the lens capsule (posterior synechia) or, less commonly, to the peripheral cornea (anterior synechia). Additionally, granulomatous nodules may appear on the surface of the iris stroma. Intraocular pressure is initially reduced in the involved eye, due to secretory hypotony of the ciliary body. However, as the reaction persists, inflammatory by-products may accumulate in the trabeculum. If this debris builds significantly, and if the ciliary body resumes its normal secretory output, the pressure may rise sharply, resulting in a secondary uveitic glaucoma.
Pathophysiology: Uveitis, as the name implies, represents an inflammation of the uveal tissues, chiefly the iris and ciliary body. This inflammation may be associated with underlying systemic disease or autoimmunity, or it may occur as a direct result of ocular trauma. Occasionally, inflammatory reactions in adjacent tissues--for example, keratitis--can induce a secondary uveitis.
Both acute and chronic forms of anterior uveitis are clinically recognizable. The chronic form is more often associated with a host of systemic disorders (see table). Chronic uveitis most likely occurs due to an immunopathological mechanism that is not fully understood.
Management: Your two primary goals in the manage ment of anterior uveitis should be to first immobilize the iris to decrease the pain and prevent synechia, and to aggressively quell the inflammatory response.
Other reports in this section
& Eyelashes | Conjunctiva
& Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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