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1. ANTERIOR UVEITIS
PRESENTED BY
Dr. Md.Ashfakur Rahaman(Rayhan)
DO Student
Rangpur Medical College

2. Applied Anatomy of the Uveal tract
• Iris
• Cilliary body
• Choroid

3. Definition of Uveitis
An Inflammation of the Uveal tract.
*may also involve the adjacent structures.

4. EPIDEMIOLOGY
• Uveitis affects approximately 1 in 4500 people and is
most common between the ages 20 to 60 with men
and women affected equally.
• In Asian countries anterior uveitis accounts for
between 28% and 50% uveitis cases.
• Responsible for approximately (10- 20)% blindness
in the USA.

5. CLASSIFICATION
International Uveitis Study Group (IUSG) categories
uveitis anatomically:
Anterior Uveitis: the anterior chamber is the primary site of
inflammation.
Intermediate Uveitis: primarily vitreous inflammation
including pars planitis.
Posterior Uveitis: Inflammation of retina and or choroid
primarily
Panuveitis : all uveal structures are involved.

6. SUN Working Group guidance includes the following
descriptions relating to the timing of inflammatory
activity
Onset: sudden or insidious.
Duration: limited or persistent.
Clinical course:
Acute : Sudden onset and limited duration
Recurrent : Repeated episodes separated by untreated inactive
periods
Chronic :Persistent duration,with relapse less than 3 months after
discontinuation of treatment
Remission is defined as inactivity (no visible cells) for 3 months
or longer.

7. IUSG CLINICAL CLASSIFICATION
BASED ON AETIOLOGY
1. Infectious
- Bacterial
- Viral
- Fungal
- Parasitic
- Others
2. Non-infectious
- With and Without known systemic association
3. Masquerade
- Neoplastic
- Non-neoplastic

8. CLASSIFICATION ON THE BASIS OF
PATHOLOGY

9. Clinical Features
Symptoms
• Pain
• Visual loss
• Photophobia
• Redness
• Watery discharge

10. Signs
Visual Acuity
Variably impaired depending on the severity of
inflammation and the presence of complications.
Ciliary Injection
Circumcorneal conjunctival hyperaemia with a violaceous
(purplish) hue due to involvement of deeper blood vessels and
is typically seen in anterior uveitis of acute onset.

11. Miosis
due to pupillary sphincter spasm predispose to the
formation of posterior synechiae.

12. Cont...

13. ANTEEIOR CHAMBER CELLS
Are a dependable indicator of inflammatory activity.
(SUN) Working Group grading of anterior chamber cells
(1 mm by 1 mm slit beam)
GRADE CELLS IN FIELD
0 <1
0.5+ 1–5
1+ 6–15
2+ 16–25
3+ 26–50
4+ >50

14. AQUEOUS FLARE
Is the haziness anterior chamber, reflecting the presence
of protein.
SUN Working Group slit lamp grading scheme
for anterior chamber flare

15. KERATIC PRECIPITATES (KP):
Are deposits on the corneal endothelium composed of
inflammatory cells such as lymphocytes, plasma cells and
macrophages

16. Large mutton fat KP
Keratic precipitates in
early ant.uveitis

17. Stellate KP in FUS Old pigmented KP

18. Endothelial cellular dusting and early KP
formation

19. HYPOPYON:
Refers to a whitish purulent exudate composed of myriad
inflammatory cells in the inferior part of the anterior chamber.
Hypopyon is common in HLA-B27-associated AAU

20. FIBRINOUS EXUDATE:
In the anterior chamber is common in severe AAU, and as
with hypopyon is often seen with HLA-B27-related
inflammation.

21. HETEROCHROMIA IRIDIS:
Refers to a difference in colour between the iris of the two
eyes, best seen in daylight. In the context of uveitis,
heterochromia characteristically occurs in FUS

22. IRIS NODULES:
Koeppe nodules are located on the pupillary margin They can
occur in both granulomatous and non-granulomatous anterior
uveitis.
Busacca nodules involve the iris stroma and are a feature of
granulomatous uveitis

23. Koeppe nodule Busacca nodule

24. POSTERIOR SYNECHIAE:
These are adhesions between the posterior surface of iris and
anterior capsule of crystalline lens. These are formed due to
organisation of the fibrin-rich exudates.

25. Extensive synechiae
Adhesion in AAU

26. IRIS ATROPHY:
May offer useful diagnostic clues. Diffuse stromal atrophy is
seen in FUS, and patchy or sectoral atrophy can occur in
herpetic uveitis

27. IRIS NEOVASCULARIZATION (RUBEOSIS
IRIDIS):
Can occur particularly in chronic inflammation. Abnormal iris
vessels are very common in FUS, but do not cause synechial
angle closure. Iris neovascularization may also occur in
posterior uveitis,particularly when retinal perfusion is
compromised.

28. INTRAOCULAR PRESSURE (IOP)
• IOP may be-
• Reduced – due to impairment of aqueous secretion
by the ciliary epithelium.
Or
• Elevated- due to a variety of mechanisms including
therapeutic steroids.

29. POSTERIOR SEGMENT EXAMINATION
Should always be performed to detect a masquerading
cause of anterior uveitis.

30. Systemic Association of Anterior Uveitis

33. JUVENILE IDIOPATHIC ARTHRITIS
• Defined as arthritis of unknown aetiology that begins
before the age of 16 years and persists for at least 6
weeks.
• Most common systemic disease associated with
childhood anterior uveitis.
• Iritis develops within 5-7 years of onset of joint
disease .
• RF- negative.
• Eye is usually white and uninflamed, some pts do not
have pain

34. JUVENILE IDIOPATHIC ARTHRITIS
• OCULAR FINDINGS: anterior uveitis associated
with JIA is a bilateral chronic non-granulomatous
diseases affecting female children more than the
male (4:1)
• COMPLICATIONS: posterior synechiae,
complicated cataract, band-shaped Keratopathy

36. TUBERCULOSIS
• Chronic granulomatous infection caused by
Mycobacterium tuberculosis
• Ocular TB may occur as a consequence of primary
infection, dissemination of systemic infection,
reactivation of latent TB or immune-mediated disease
• Ocular features:
Anterior uveitis- large, mutton fat keratic
precipitates, posterior synechiae and iris or angle
granulomas.

37. TUBERCULOSIS
• Vitritis is common.
• Choroidal granuloma (tubercle)- may be unilateral or
bilateral and solitary or multiple
Fig1: Mutton fat KP Fig2: Choroidal granuloma

38. INVESTIGATIONS
A) GENERAL-
• Complete blood count
• ESR and C-reactive protein
• HLA tissue typing (HLA-B27)
• Serological tests for syphilis, toxoplasmosis and
histoplasmosis
• Serum angiotensin-converting enzyme (ACE)

39. • Antinuclear antibody (ANA)
• Antineutrophil cytoplasmic antibody (ANCA)
• Montoux test (MT)
• Interferon-gamma release assay
• Sacroiliac joint X-ray
• Chest X-ray

40. B) OCULAR-
• B-scan ultrasonography
• Optical coherence tomography (OCT)
• Fundus autofluoresence (FAF)
• Fluoresence angiography (FA)
• Indocyanine green angiography (ICGA)
• Aqueous tap
• Biopsy- Iris, Vitreous and Conjunctival

41. Complications and Sequelae
• Secondary glaucoma
• Complicated Cataract
• Cyclitic Membrane
• Choroiditis
• Band Keratopathy
• Retinal Complications-Cystoid Macular
Oedema,Epiretinal Membrane, Exudative RD etc.
• Phthisis Bulbi

42. Treatment
1.Topical Mydriatics and Cycloplegic drugs
-Atropine,Homatropine
2.Steroids- used in following routes
a.Topical-Prednisolone,Dexamethasone
b.Periocular injections-Methylprednisolone/Triamcinalone
c.Intra-vitreal injections-Triamcinalone
d.Systematic –Predinisolone
3.Non-steroidal anti inflammatory
-Diclofenac,Indomethacin,Flurbiprofen

43. 4.Systemic immunosuppressive agents:-
-Antimetabolites:Azathioprine,Methotrexate
-Immuno-modulators: Cyclosporin
5.Specific treatment of the underlying diseases
6.Hot compression/Hot application
7.Use of dark glass

44. THANK YOU