Uveitis is intraocular inflammation that involves the uvea of the eye. The uvea consists of the pigmented vascular structures of the eye, including the iris, ciliary body, pars plana, and choroid. Uveitis can result from a variety of different etiologies including trauma, surgery, viral and bacterial infections, inflammatory disorders, autoimmune diseases, and even malignancies. Uveitis is typically classified into three parts: anterior uveitis, intermediate uveitis, and posterior uveitis; if it contains all three areas of the eye, it is known as panuveitis. Anterior uveitis is most commonly seen in the emergency room and primary care settings and is the focus of this summary.
Anterior uveitis is intraocular inflammation confined to the anterior chamber of the eye, namely the iris and ciliary body. It can be either acute or chronic and have infectious or noninfectious etiologies. It has a wide range of presentations from a white and quiet eye with inflammation only noted on examination with high magnification, to a painful red eye with moderate to severe inflammation, light sensitivity (photophobia), and decreased vision.
Typical symptoms include:
Visual disturbances / blurry vision
Typical signs include:
Cells and/or flare in anterior chamber
Keratic precipitates on inner aspect of cornea
Hypopyon (pus in the anterior chamber)
Pupillary miosis with posterior synechiae
Patients with anterior uveitis will often prefer the lights off in the examination room due to severe photophobia. Checking the visual acuity is very important, as the inflammation and excessive tearing may cause reduced vision.
Certain systemic medications, such as rifabutin, bisphosphonates, sulfonamides, diethylcarbamazine, oral contraceptives, and etanercept have been reported to cause anterior uveitis. Neoplastic masquerade syndromes, such as primary central nervous system lymphoma, can present with a nonimmune mediated uveitis.
Overall, idiopathic causes are more frequently the cause of anterior uveitis, whereas posterior uveitis is more often caused by infectious etiologies.
Intermediate uveitis involves inflammation of the ciliary body and pars plana and manifests mainly as floaters in an otherwise quiet eye. Vision loss is often from macular edema or cataracts secondary to the chronic inflammation. A fundus examination reveals vitreous cells, "snowballs," and "snow banking" (accumulations of inflammatory cells inside the eye). This type of uveitis is associated with multiple sclerosis, sarcoidosis, Lyme disease, toxocariasis, syphilis, tuberculosis, and human T-cell lymphotropic virus type 1 infection.
Intraocular lens-induced uveitis or uveitis glaucoma hyphema (UGH) syndrome
Primary central nervous system lymphoma – Suspect in elderly patient with new onset anterior uveitis.
Intraocular leukemia – Also highly correlated with central nervous system involvement.
Ocular ischemic syndrome – Typically males aged > 65 with cardiac risk factors; Doppler ultrasound can show > 90% stenosis.
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.