Uveitis, Anterior, Nongranulomatous 

  • Author: Abdullah Al-Fawaz, MD, FRCS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 24, 2010
 

Background

Iritis, or anterior uveitis, is the most common form of ocular inflammation encountered. It is a common cause of a painful red eye. Inflammation of the iris may appropriately be termed iritis, whereas inflammation of the iris and the ciliary body is called iridocyclitis. Iritis may be subdivided into 2 broad categories: granulomatous and nongranulomatous.

This article addresses nongranulomatous iritis, although iritis due to a granulomatous disease process may have a nongranulomatous appearance. For information about granulomatous disease, see Uveitis, Anterior, Granulomatous. The most common form of nongranulomatous anterior uveitis is acute anterior uveitis (AAU), which is associated with the HLA-B27 allele in half to two thirds of patients.

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Pathophysiology

The exact pathophysiology is not known. Inflammation of the iris and the ciliary body causes a breakdown of the blood-ocular barrier. This condition allows both protein and WBCs to extravasate into the aqueous, resulting in the typical iritis signs of cell and flare. Frequently, the cause is idiopathic, but certain ocular and systemic diseases may be the underlying cause of the iritis.[1]

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Epidemiology

Frequency

United States

Iritis is the most frequent form of uveitis that is encountered by ophthalmologists. In one community-based study, anterior uveitis accounted for more than 90% of all cases of uveitis. The annual incidence rate is approximately 8 cases per 100,000 population.[2]

International

No particular geographic distribution for iritis has been noted.

Mortality/Morbidity

  • Morbidity arises from iritis and any associated disease process, if present.
  • Patients may develop posterior synechiae, and, if severe, a secluded pupil and subsequent angle-closure glaucoma may result.
  • Associated ocular complications (eg, cataract, glaucoma) may result in severe vision loss.

Race

No significant racial differences exist. HLA-B27–associated anterior uveitis is more common in Caucasians.

Sex

No significant sexual differences exist. Although, the male-to-female ratio of ankylosing spondylitis, which is a common cause of iritis, is 3:1.[3]

Age

Iritis may develop in patients of any age but most commonly in the fourth and fifth decade of life.

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Contributor Information and Disclosures
Author

Abdullah Al-Fawaz, MD, FRCS  Assistant Professor, Cornea and Uveitis Department, King Abdulaziz University Hospital, Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia

Abdullah Al-Fawaz, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Coauthor(s)

Ralph D Levinson, MD  Associate Professor of Ophthalmology, Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA

Ralph D Levinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society, Association for Research in Vision and Ophthalmology, and International Ocular Inflammation Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  2. McCannel CA, Holland GN, Helm CJ, Cornell PJ, Winston JV, Rimmer TG. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol. Jan 1996;121(1):35-46. [Medline].

  3. Braun J, Sieper J. Ankylosing spondylitis. Lancet. Apr 21 2007;369(9570):1379-90. [Medline].

  4. Suzuki T, Ohashi Y. Corneal endotheliitis. Semin Ophthalmol. Jul-Aug 2008;23(4):235-40. [Medline].

  5. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. Sep 2005;140(3):509-16. [Medline].

  6. Rosenbaum JT, Smith JR. Anti-TNF therapy for eye involvement in spondyloarthropathy. Clin Exp Rheumatol. Nov-Dec 2002;20(6 Suppl 28):S143-5. [Medline].

  7. [Guideline] Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. Oct 2000;130(4):492-513. [Medline].

  8. Jap A, Chee SP. Immunosuppressive therapy for ocular diseases. Curr Opin Ophthalmol. Nov 2008;19(6):535-40. [Medline].

  9. Kump LI, Cervantes-Castaneda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. Jul 2005;112(7):1287-92. [Medline].

  10. Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. May 2007;114(5):995-9. [Medline].

  11. Menezo V, Lightman S. The development of complications in patients with chronic anterior uveitis. Am J Ophthalmol. Jun 2005;139(6):988-92. [Medline].

  12. Nussenblatt RB, Whitcup SM. Uveitis. In: Fundamentals and Clinical Practice. 3rd ed. 2003.

  13. Pepose JS, Holland GN, Wilhelmus KR. Ocular Infection and Immunity. 1996.

  14. Rodrigues EB, Farah ME, Maia M, Penha FM, Regatieri C, Melo GB. Therapeutic monoclonal antibodies in ophthalmology. Prog Retin Eye Res. Mar 2009;28(2):117-44. [Medline].

  15. Rosenbaum JT, George RK. Uveitis. In: Current Ocular Therapy 5. 2000:519-21.

 
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