Acute Anterior Uveitis
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The uvea is the middle layer of the eye, between sclera & retina
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consists of:
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iris (anterior)
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ciliary body (intermediate)
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choroid (posterior)
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Uveitis most often refers to acute anterior uveitis (iritis)
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Causes
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Trauma/ surgery
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Infection
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Bacterial e.g. TB
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Herpes zoster virus
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Toxoplasmosis
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Autoimmune
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Sarcoidosis
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Ankylosing spondylitis
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Crohn’s disease/ ulcerative colitis
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Symptoms
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Red eye
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Aching pain in the eye
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Blurred vision (rather than complete loss)
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Photophobia, glare from bright lights
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Irregular pupil
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Complications
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Cataract
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Glaucoma
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Optic nerve damage
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Retinal detachment
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Permanent visual loss
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About 50% of all patients with anterior uveitis are HLA-B27 positive
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linked with ankylosing spondylitis; patients diagnosed with AS have 25-40% likelihood of developing AAU​
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​classic MCQ question stem: blurred vision and back pain, probably anterior uveitis + ankylosing spondylitis
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Posterior synechiae
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seen on examination
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inflammatory exudate (pus) leaks from small blood vessels in the iris into the anterior chamber
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aqueous becomes more viscous
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leads to adhesions between iris and anterior lens surface
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this is more marked when mydriatic (dilating) drops applied to eye - pupil tries to dilate but iris is tethered to lens (by posterior synechiae)
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give irregular appearance of pupil margins
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Hypopyon (uveitis)
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Collection of pus in the inferior anterior chamber as a result of gravity
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pus collects as a result of inflammation in the eye
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This settles at the bottom of the anterior chamber and may be visible = hypopyon
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Treatment
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mydriatc (dilating) eye drops - force dilation to break posterior synechiae (sticking points between iris and lens)​
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topical steroids - typically high doses of steroid over several weeks
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if severe - subconjunctival steroid injection may be considered
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