Acute uveitis

Acute anterior uveitis associated with ankylosing spondylitis is one of the main causes of uveitis in the UK and USA (1).

Characteristically, acute anterior uveitis presents with:

• pain
• photophobia
• redness
• lacrimation

Examination of the eye shows redness all around the limbus (i.e. ciliary injection). The hyperaemia is followed by an exudation of protein and leukocytes into the anterior chamber; this gives rise to an "aqueous flare" as light is reflected back from the protein and cellular elements - analagous to the manner in which dust in the air shows in shafts of sunlight. The exudate may precipitate on the posterior surface of the cornea as keratic precipitates (KP's). Vision is blurred.

In advanced disease there may be:

• inflammatory irritation of the pupil resulting in miosis
• adhesions of the iris to the anterior surface of the lens (posterior synechiae)
• administration of a mydriatic may result in irregular dilatation of the pupil

In Behcet's disease, acute anterior uveitis often presents with a hypopyon in one eye. The disease recurs and affects both eyes, resulting eventually, in blindness.

Reference:

• (1) Hajj-Ali RA et al. Uveitis in the internist’s office: Are a patient’s eye symptoms serious? Cleve Clin J Med. 2005;72(4):329-39