Uveitis, Anterior, Granulomatous

Updated: May 09, 2016
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Background

Iritis, also known as anterior uveitis, is the most common form of intra-ocular inflammation and often causes a painful red eye. The term uveitis is synonymous with inflammation of the uveal tract, which consists of the iris, ciliary body, and choroid.

Inflammation of the iris appropriately may be termed iritis. Inflammation of the iris and the ciliary body is called iridocyclitis. Iritis may be subdivided into 2 broad categories: granulomatous and nongranulomatous.

A granulomatous iritis has an increased likelihood of being part of a systemic disease process or a component of certain ocular syndromes. However, the diagnosis of granulomatous iritis does not definitively indicate that an underlying systemic granulomatous process is present.

Patients with a granulomatous iritis may present with an acutely painful eye or with chronic subclinical inflammation that is discovered only during a routine ocular examination.

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Pathophysiology

The exact pathophysiology of granulomatous iritis is unknown. It may result from an autoimmune reaction or from the host's immune response to a systemic infectious process, such as syphilis, Lyme disease, tuberculosis (TB), or local reactivation of herpetic viral infection.

Not all cases classified as granulomatous are necessarily granulomatous upon histologic examination. Granulomas are found in certain infectious and autoimmune processes and even in inflammation secondary to foreign bodies; they represent an inflammatory response that implies chronic inflammation.

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Epidemiology

Frequency

United States

Iritis, granulomatous and nongranulomatous, is the most frequent form of uveitis that ophthalmologists encounter. In one community-based study, anterior uveitis accounted for more than 90% of all cases of uveitis seen. The annual incidence is about 8 cases per 100,000 population. [1] However, these cases were predominantly nongranulomatous anterior uveitis.

International

No particular geographic distribution has been noted for granulomatous iritis. Although certain etiologies may be more common in certain parts of the world (eg, TB in endemic areas).

Mortality/Morbidity

Morbidity may arise from both the iritis and any associated systemic disease if present.

Patients may have anterior and posterior synechiae. Extensive posterior synechiae can lead to a secluded pupil that can result in angle-closure glaucoma. In addition, trabecular obstruction, due to either cellular debris or peripheral anterior synechiae, can lead to secondary glaucoma.

The eye with a granulomatous iritis is likely to have uveitis involving other structures of the eye, including the posterior segment. This may result in an increased risk of substantial visual impairment.

Associated ocular complications (eg, cataracts, corneal decompensation, glaucoma, chronic cystoid macular edema, hypotony) may result in severe vision loss.

Race

Racial differences may exist, depending on the underlying cause of the iritis. For example, sarcoidosis is more likely to be diagnosed in the African American population than in other groups. Vogt-Koyanagi-Harada disease, although a rare cause of uveitis in the United States, is much more prevalent in persons of Mestizo, Asian, or American Indian ancestry.

Sex

No significant sex differences are reported.

Age

Granulomatous iritis may develop in individuals of any age.

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