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Anterior uveitis (iritis)
Anterior uveitis is inflammation of the iris and ciliary body with cells and flare in the anterior chamber; it presents as a painful red eye with photophobia, is treated with topical steroids and cycloplegics, and the work-up follows the type of inflammation — unilateral recurrent non-granulomatous points to HLA-B27, and granulomatous points to sarcoidosis, tuberculosis and syphilis.
Why it matters in the exam
The exam picture: a young person with inflammatory back pain presents with a red eye, pain, photophobia and blur. On examination: redness around the limbus (ciliary flush), cells and flare, keratic precipitates (KP), sometimes hypopyon, a small pupil and posterior synechiae, and low pressure. HLA-B27 is linked to acute unilateral inflammation that alternates between eyes, and to the diseases ankylosing spondylitis, reactive arthritis, IBD and psoriasis.
Large greasy KP (mutton-fat) point to granulomatous inflammation — sarcoidosis, tuberculosis, syphilis, VKH and sympathetic ophthalmia. High pressure with iris atrophy points to herpes viruses. Fuchs uveitis: unilateral, diffuse stellate KP, heterochromia, cataract, no synechiae, linked to rubella. In a girl with oligoarticular JIA and positive ANA the inflammation is silent — a white painless eye — so slit-lamp screening every 3 months is needed in the high-risk group. In an adolescent with uveitis and renal failure — TINU.
A first, unilateral, non-granulomatous, typical episode does not need an extensive work-up beyond HLA-B27 and history. In recurrent, bilateral or granulomatous inflammation — syphilis serology, chest X-ray, IGRA or tuberculin test, ACE and as the picture suggests. Treatment: prednisolone acetate 1% frequently with a gradual taper, cyclopentolate or atropine for pain relief and to prevent synechiae, and in recurrent or chronic disease — periocular injection, systemic therapy and steroid-sparing agents such as adalimumab.
Key points
- Painful red eye, photophobia, cells and flare.
- HLA-B27: unilateral, acute, alternating between eyes.
- Mutton-fat KP → sarcoidosis, tuberculosis, syphilis.
- Treatment: prednisolone acetate 1% and a cycloplegic.
- JIA: quiet eye; screening every 3 months.
Summary table
| Type | Clues | Associations | Work-up |
|---|---|---|---|
| HLA-B27 | Unilateral acute, alternating eyes, hypopyon | AS, IBD, psoriasis, reactive arthritis | HLA-B27, pelvic X-ray |
| Granulomatous | Mutton-fat KP, iris nodules | Sarcoidosis, tuberculosis, syphilis | Chest X-ray, ACE, IGRA, syphilis |
| Herpetic | High pressure, iris atrophy | HSV, VZV, CMV | Clinical; PCR of aqueous |
| JIA | White quiet eye, ANA-positive girl | Oligoarticular JIA | Screening every 3 months |
| Fuchs uveitis | Stellate KP, heterochromia, no synechiae | Rubella | Clinical; prolonged steroids not needed |
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Sources
- Standardization of Uveitis Nomenclature (SUN) Working Group, 2005 (classification criteria 2021) — Anatomical classification and grading
- American College of Rheumatology / Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of JIA-Associated Uveitis, 2019 — Screening and treatment
- AAO Basic and Clinical Science Course, Section 9: Uveitis and Ocular Inflammation, 2024-2025 — Anterior uveitis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.