Skip to main content

Anterior Uveitis

  • Living reference work entry
  • First Online:
Albert and Jakobiec's Principles and Practice of Ophthalmology

Abstract

Anterior uveitis is the most common presentation of uveitis. The ocular morbidity ranges from minimal clinical signs, such as keratic precipitates, iris heterochromia, or nodules, to extensive synechiae, severe forms of glaucoma, and cataract formation, rendering a variable prognosis which is usually benign.

The diagnosis of anterior uveitis can be challenging since it can be caused by a variety of etiologies, but the main diagnosis still remains idiopathic, even after extensively studying the patient with lab work or even anterior chamber fluids. Many times, the clinicians pretest suspicion that defines the presumed etiology.

The treatment is discussed with an evidence-based insight. The mainstay of therapy is topical steroids, which can cause glaucoma and cataracts, so its use should be cautious. Systemic therapy can be helpful in acute attack and to prevent flares of the disease. Advances are promising in biologic agents.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Bloch-Michel E, Nussenblatt RB. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol. 1987;103:234–5.

    Article  CAS  PubMed  Google Scholar 

  2. Durrani OM, Meads CA, Murray PI. Uveitis: a potentially blinding disease. Ophthalmologica. 2004;218:223–36.

    Article  CAS  PubMed  Google Scholar 

  3. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–16.

    Article  PubMed  Google Scholar 

  4. Myers TD, Smith JR, Lauer AK, Rosenbaum JT. Iris nodules associated with infectious uveitis. Br J Ophthalmol. 2002;86(9):969–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Spaide RF, Ward DL. Conjunctival biopsy in the diagnosis of sarcoidosis. Br J Ophthalmol. 1990;74(8):469–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dandona L, Dandona R, John RK, McCarty CA, Rao GN. Population based assessment of uveitis in an urban population in southern India. Br J Ophthalmol. 2000;84(7):706–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Darrell RW. Epidemiology of uveitis. Arch Ophthalmol. 1962;68(4):502.

    Article  CAS  PubMed  Google Scholar 

  8. Gritz D. Incidence and prevalence of uveitis in Northern California The Northern California epidemiology of uveitis study. Ophthalmology. 2004;111(3):491–500.

    Article  PubMed  Google Scholar 

  9. Päivönsalo-Hietanen T, Tuominen J, Vaahtoranta-Lehtonen H, Saari KM. Incidence and prevalence of different uveitis entities in Finland. Acta Ophthalmol Scand. 1997;75(1):76–81.

    Article  PubMed  Google Scholar 

  10. Tran VT, Auer C, Guex-Crosier Y, Pittet N, Herbort CP. Epidemiology of uveitis in Switzerland. Ocul Immunol Inflamm. 1994;2:169–76.

    Article  CAS  PubMed  Google Scholar 

  11. Gupta R, Murray PI. Chronic non-infectious uveitis in the elderly. Drugs Aging. 2006;23(7):535–58.

    Article  CAS  PubMed  Google Scholar 

  12. Ziade NR. HLA B27 antigen in Middle Eastern and Arab countries: systematic review of the strength of association with axial spondyloarthritis and methodological gaps. BMC Musculoskelet Disord. 2017;18:280. BioMed Central Ltd.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wakefield D, Montanaro A, McCluskey P. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 1991;36(3):223–32.

    Article  CAS  PubMed  Google Scholar 

  14. Suhler EB, Martin TM, Rosenbaum JT. HLA-B27 associated uveitis: overview and current perspectives. Curr Opin Ophthalmol. 2003;14(6):378–83.

    Article  PubMed  Google Scholar 

  15. Monnet D. Ophthalmic findings and frequency of extraocular manifestations in patients with HLA-B27 uveitis: a study of 175 cases. Ophthalmology. 2004;111(4):802–9.

    Article  PubMed  Google Scholar 

  16. Rothova A, Buitenhuis HJ, Christiaans BJ, et al. Acute anterior uveitis (AAU) and HLA-B27. Br J Rheumat. 1983;22:144–5.

    Article  CAS  Google Scholar 

  17. Herzberg L. Unusual presentation of diabetes mellitus. BMJ. 1969;2:695–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rodriguez A, Akova YA, Pedroza-Seres M, Foster CS. Posterior segment ocular manifestations in patients with HLA-B27-associated uveitis. Ophthalmology. 1994;101(7):1267–74.

    Article  CAS  PubMed  Google Scholar 

  19. Dodds EM, Lowder CY, Meisler DM. Posterior segment inflammation in HLA-B27+ acute anterior uveitis: clinical characteristics. Ocul Immunol Inflamm. 1999;7(2):85–92.

    Article  CAS  PubMed  Google Scholar 

  20. D’Ambrosio EM, La Cava M, Tortorella P, Gharbiya M, Campanella M, Iannetti L. Clinical features and complications of the HLA-B27-associated acute anterior uveitis: a metanalysis. Semin Ophthalmol. 2017;32:689–701.

    Article  PubMed  Google Scholar 

  21. Goto K, Ota M, Ando H, Mizuki N, Nakamura S, Inoue K, et al. MICA gene polymorphisms and HLA-B27 subtypes in Japanese patients with HLA-B27-associated acute anterior uveitis. Invest Ophthalmol Vis Sci. 1998;39(3):634–7.

    CAS  PubMed  Google Scholar 

  22. Martin TM, Zhang G, Luo J, Jin L, Doyle TM, Rajska BM, et al. A locus on chromosome 9p predisposes to a specific disease manifestation, acute anterior uveitis, in ankylosing spondylitis, a genetically complex, multisystem, inflammatory disease. Arthritis Rheum. 2005;52(1):269–74.

    Article  CAS  PubMed  Google Scholar 

  23. Robinson PC, Claushuis TAM, Cortes A, Martin TM, Evans DM, Leo P, et al. Genetic dissection of acute anterior uveitis reveals similarities and differences in associations observed with ankylosing spondylitis. Arthritis Rheumatol. 2015;67(1):140–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Rosenbaum JT, Asquith M. The microbiome and HLA-B27-associated acute anterior uveitis. Nat Rev Rheumatol. 2018;14(12):704–13.

    Google Scholar 

  25. Braun J, Baraliakos X, Listing J, Sieper J. Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept. Arthritis Rheum. 2005:2447–51. https://doi.org/10.1038/s41584-018-0097-2.

  26. Rudwaleit M, Rødevand E, Holck P, Vanhoof J, Kron M, Kary S, et al. Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study. Ann Rheum Dis. 2009;68(5):696–701.

    Article  CAS  PubMed  Google Scholar 

  27. Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014;121:785–96.

    Article  PubMed  Google Scholar 

  28. El-Shabrawi Y, Hermann J. Anti-tumor necrosis factor-alpha therapy with infliximab as an alternative to corticosteroids in the treatment of human leukocyte antigen B27-associated acute anterior uveitis. Ophthalmology. 2002;109(12):2342–6.

    Article  PubMed  Google Scholar 

  29. Bodaghi B, Bui Quoc E, Wechsler B, Tran THC, Cassoux N, Le Thi HD, et al. Therapeutic use of infliximab in sight threatening uveitis: retrospective analysis of efficacy, safety, and limiting factors. Ann Rheum Dis. 2005;64(6):962–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kruithof E, Kestelyn P, Elewaut C, Elewaut D, Van den Bosch F, Mielants H, et al. Successful use of infliximab in a patient with treatment resistant spondyloarthropathy related uveitis. Ann Rheum Dis. 2002;61:470.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Cordero-Coma M, Calvo-Río V, Adán A, Blanco R, Álvarez-Castro C, Mesquida M, et al. Golimumab as rescue therapy for refractory immune-mediated uveitis: a three-center experience. Mediat Inflamm. 2014;2014:1–5.

    Article  CAS  Google Scholar 

  32. zu Hoerste MM, Walscheid K, Tappeiner C, Zurek-Imhoff B, Heinz C, Heiligenhaus A. The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol. 2018;256:1985–92.

    Article  PubMed  CAS  Google Scholar 

  33. Menezo V, Lightman S. The development of complications in patients with chronic anterior uveitis. Am J Ophthalmol. 2005;139(6):988–92.

    Article  PubMed  Google Scholar 

  34. Park SW, Yu HG. Association of cytomegalovirus with idiopathic chronic anterior uveitis with ocular hypertension in Korean patients. Ocul Immunol Inflamm. 2013;21(3):192–6.

    Article  PubMed  Google Scholar 

  35. Stavrou P, Murray PI. Long-term follow-up of trabeculectomy without antimetabolites in patients with uveitis. Am J Ophthalmol. 1999;128:434–9.

    Article  CAS  PubMed  Google Scholar 

  36. Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Ophthalmology. 2000;107(6):1164–70.

    Article  PubMed  Google Scholar 

  37. Miserocchi E, Waheed NK, Dios E, Christen W, Merayo J, Roque M, et al. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology. 2002;109(8):1532–7.

    Article  PubMed  Google Scholar 

  38. Takase H, Kubono R, Terada Y, Imai A, Fukuda S, Tomita M, et al. Comparison of the ocular characteristics of anterior uveitis caused by herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Jpn J Ophthalmol. 2014;58(6):473–82.

    Article  CAS  PubMed  Google Scholar 

  39. Stavrou P, Mitchell SM, Fox JD, Hope-Ross MW, Murray PI. Detection of varicella-zoster virus DNA in ocular samples from patients with uveitis but no cutaneous eruption. Eye. 1994;8:684–7.

    Article  PubMed  Google Scholar 

  40. De Groot-Mijnes JDF, Rothova A, Van Loon AM, Schuller M, Ten Dam-Van Loon NH, De Boer JH, et al. Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol. 2006;141(2):313–8.

    Article  PubMed  CAS  Google Scholar 

  41. Westeneng AC, Rothova A, de Boer JH, de Groot-Mijnes JDF. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis. Am J Ophthalmol. 2007;144(5):781–5.

    Article  PubMed  Google Scholar 

  42. Mietz H, Aisenbrey S, Bartz-Schmidt KU, Bamborschke S, Krieglstein GK. Ganciclovir for the treatment of anterior uveitis. Graefes Arch Clin Exp Ophthalmol. 2000;238(11):905–9.

    Article  CAS  PubMed  Google Scholar 

  43. Markomichelakis NN, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiadis G. Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002;109(5):879–82.

    Article  PubMed  Google Scholar 

  44. Teoh S-B, Thean L, Koay E. Cytomegalovirus in aetiology of Posner–Schlossman syndrome: evidence from quantitative polymerase chain reaction. Eye. 2005;19(12):1338–40.

    Article  PubMed  Google Scholar 

  45. de Schryver I, Rozenberg F, Cassoux N, Michelson S, Kestelyn P, LeHoang P, et al. Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis. Br J Ophthalmol. 2006;90(7):852–5.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hwang YS, Shen CR, Chang SHL, Lai CC, Liu CL, Chen KJ, et al. The validity of clinical feature profiles for cytomegaloviral anterior segment infection. Graefes Arch Clin Exp Ophthalmol. 2011;249(1):103–10.

    Article  PubMed  Google Scholar 

  47. Chung RSH, Chua CN. Intravitreal ganciclovir injections in aqueous cytomegalovirus DNA positive hypertensive iritis. Eye. 2006;20(9):1080.

    Article  CAS  PubMed  Google Scholar 

  48. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834–840.e1.

    Article  PubMed  Google Scholar 

  49. Hwang YS, Lin KK, Lee JS, Chang SHL, Chen KJ, Lai CC, et al. Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis. Graefes Arch Clin Exp Ophthalmol. 2010;248(2):263–9.

    Article  CAS  PubMed  Google Scholar 

  50. Chee SP, Jap A. Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol. 2010;94(12):1648–52.

    Article  PubMed  Google Scholar 

  51. Lesin M, Domazet Bugarin J, Puljak L. Factors associated with postoperative pain and analgesic consumption in ophthalmic surgery: a systematic review. Surv Ophthalmol. 2015;60:196–203. Elsevier USA.

    Article  PubMed  Google Scholar 

  52. The Royal College of Ophthalmologists Cataract Surgery Guidelines. 2010. https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2010-SCI-069-Cataract-Surgery-Guidelines-2010-SEPTEMBER-2010-1.pdf.

  53. Bajwa A, Osmanzada D, Osmanzada S, Khan I, Patrie J, Xin W, et al. Epidemiology of uveitis in the mid-atlantic United States. Clin Ophthalmol. 2015;9:889–901.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Patel C, Kim SJ, Chomsky A, Saboori M. Incidence and risk factors for chronic uveitis following cataract surgery. Ocul Immunol Inflamm. 2013;21(2):130–4.

    Article  PubMed  Google Scholar 

  55. Neatrour K, McAlpine A, Owens TB, Trivedi RH, Poole Perry LJ. Evaluation of the etiology of persistent iritis after cataract surgery. J Ophthalmic Inflamm Infect. 2019;9(1):1–7.

    Article  Google Scholar 

  56. Reddy AK, Patnaik JL, Miller DC, Lynch AM, Palestine AG, Pantcheva MB. Risk factors associated with persistent anterior uveitis after cataract surgery. Am J Ophthalmol. 2019;206:82–6.

    Article  PubMed  Google Scholar 

  57. Hahn I-H, Stillman MC. A case of glaucomatocyclitic crisis in the emergency department. Ann Emerg Med. 2006;47(2):167–9.

    Article  PubMed  Google Scholar 

  58. Yamamoto S, Pavan-Langston D, Tada R, Yamamoto R, Kinoshita S, Nishida K, et al. Possible role of herpes simplex virus in the origin of Posner-Schlossman syndrome. Am J Ophthalmol. 1995;119(6):796–8.

    Article  CAS  PubMed  Google Scholar 

  59. Mandeville JT, Levinson RD, Holland GN. The tubulointerstitial nephritis and uveitis syndrome. Surv Ophthalmol. 2001;46(3):195–208.

    Article  CAS  PubMed  Google Scholar 

  60. Mackensen F, David F, Schwenger V, Smith LK, Rajalingam R, Levinson RD, et al. HLA-DRB1*0102 is associated with TINU syndrome and bilateral, sudden-onset anterior uveitis but not with interstitial nephritis alone. Br J Ophthalmol. 2011;95(7):971–5.

    Article  CAS  PubMed  Google Scholar 

  61. Peräsaari J, Saarela V, Nikkilä J, Ala-Houhala M, Arikoski P, Kataja J, et al. HLA associations with tubulointerstitial nephritis with or without uveitis in Finnish pediatric population: a nation-wide study. Tissue Antigens. 2013;81(6):435–41.

    Article  PubMed  CAS  Google Scholar 

  62. Rosenberg AM, Oen KG. The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis. Arthritis Rheum. 1986;29(6):797–800.

    Article  CAS  PubMed  Google Scholar 

  63. Kanski JJ. Juvenile arthritis and uveitis. Surv Ophthalmol. 1990;34:253–67.

    Article  CAS  PubMed  Google Scholar 

  64. Goel KM. Shanks royal hospital for sick children RA. Follow-up study of 100 cases of juvenile rheumatoid arthritis. Ann Rheum Dis. 1974;33:25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Smiley WK. The eye in juvenile rheumatoid arthritis. Trans Ophthalmol Soc UK. 1974;94:817–29.

    CAS  PubMed  Google Scholar 

  66. Vesterdal ESB. Iridocyclitis and bandshaped corneal opacity in juvenile rheumatoid arthritis. Acta Ophthalmol. 1950;28:321–35.

    Article  CAS  Google Scholar 

  67. Kanski JJ. Uveitis in juvenile chronic arthritis: incidence, clinical features and prognosis. Eye. 1988;2(6):641–5.

    Article  PubMed  Google Scholar 

  68. Kotaniemi K, Savolainen A, Karma A, Aho K. Recent advances in uveitis of juvenile idiopathic arthritis. Surv Ophthalmol. 2003;48(5):489–502.

    Article  PubMed  Google Scholar 

  69. Tugal-Tutkun I, Havrlikova K, Power WJ, Foster CS. Changing patterns in uveitis of childhood. Ophthalmology. 1996;103(3):375–83.

    Article  CAS  PubMed  Google Scholar 

  70. Boone MI, Moore TL, Cruz OA. Screening for uveitis in juvenile rheumatoid arthritis. J Pediatr Ophthalmol Strabismus. 1998;35(1):41–3.

    Article  CAS  PubMed  Google Scholar 

  71. Petty RE, Smith JR, Rosenbaum JT. Arthritis and uveitis in children. A pediatric rheumatology perspective. Am J Ophthalmol. 2003;135(6):879–84.

    Article  PubMed  Google Scholar 

  72. Ohno S, Char DH, Kimura SJ, O’Connor GR. HLA antigens and antinuclear antibody titres in juvenile chronic iridocyclitis. Br J Ophthalmol. 1977;61(1):59–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Leak AM, Ansell BM, Burman SJ. Antinuclear antibody studies in juvenile chronic arthritis. Arch Dis Child. 1986;61

    Google Scholar 

  74. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology. 1997;104(2):236–44.

    Article  CAS  PubMed  Google Scholar 

  75. Chia A, Lee V, Graham EM, Edelsten C. Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program. Am J Ophthalmol. 2003;135(6):757–62.

    Article  PubMed  Google Scholar 

  76. Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, et al. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol. 2002;29(11):2446–53.

    PubMed  Google Scholar 

  77. Petty RE, Southwood TR. Classification of childhood arthritis: divide and conquer. J Rheumatol. 1998;25(10):1869–70.

    CAS  PubMed  Google Scholar 

  78. Fink CW, Baum J, Bhettay E, Goldenberg J, He X, Maldonado-Coco J, et al. Proposal for the development of classification criteria for idiopathic arthritides of childhood. J Rheumatol. 1995;22:1566–9.

    Google Scholar 

  79. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.

    Google Scholar 

  80. Cleary AG, Sills JA, Davidson JE, Petty RE. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 2000;27:1568.

    Google Scholar 

  81. Heiligenhaus A, Niewerth M, Mingels A, Ganser C, Thon A, Pleyer U, et al. Epidemiologische daten zur uveitis bei juveniler idiopathischer arthritis aus einer bundesweiten pädiatrischen und ophthalmologischen datenerhebung (uveitis-modul der kerndokumentation). Klin Monatsbl Augenheilkd. 2005;222(12):993–1001.

    Article  CAS  PubMed  Google Scholar 

  82. Rauz S, Murray PI, Southwood TR. Juvenile idiopathic arthritis and uveitis: the classification conundrum. Eye. 2000;14(6):817–20.

    Article  CAS  PubMed  Google Scholar 

  83. Chalom EC, Goldsmith DP, Koehler MA, Bittar B, Rose CD, Ostrov BE, et al. Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol. 1997;24(10):2031–4.

    CAS  PubMed  Google Scholar 

  84. Kotaniemi K, Kautiainen H, Karma A, Aho K. Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study. Ophthalmology. 2001;108(11):2071–5.

    Article  CAS  PubMed  Google Scholar 

  85. Key Hi SN, Kimura SJ, Francisco S. Iridocyclitis associated with juvenile rheumatoid arthritis. Am J Ophthalmol. 1975;80:425–9.

    Google Scholar 

  86. Cassidy JT, Sullivan DB, Petty RE. Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis. Arthritis Rheum. 1977;20:224–7.

    CAS  PubMed  Google Scholar 

  87. Wolf MD, Lichter PR, Ragsdale CG. Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology. 1987;94(10):1242–8.

    Article  CAS  PubMed  Google Scholar 

  88. Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Clin Immunol. 2020;211:108322. Academic Press Inc.

    Google Scholar 

  89. Foeldvari I, Wierk A. Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol. 2005;32:362–5.

    Google Scholar 

  90. Malik AR, Pavesio C. The use of low dose methotrexate in children with chronic anterior and intermediate uveitis. Br J Ophthalmol. 2005;89:806–8.

    Google Scholar 

  91. Saurenmann RK, Levin AV, Rose JB, Parker S, Rabinovitch T, Tyrrell PN, et al. Tumour necrosis factor α inhibitors in the treatment of childhood uveitis. Rheumatology. 2006;45:982–9.

    Google Scholar 

  92. Ramanan AV, Dick AD, Jones AP, McKay A, Williamson PR, Compeyrot-Lacassagne S, et al. Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N Engl J Med. 2017;376(17):1637–46.

    Article  CAS  PubMed  Google Scholar 

  93. Skrabl-Baumgartner A, Seidel G, Langner-Wegscheider B, Schlagenhauf A, Jahnel J. Drug monitoring in long-term treatment with adalimumab for juvenile idiopathic arthritis-associated uveitis. Arch Dis Child. 2019;104(3):246–50.

    Article  PubMed  Google Scholar 

  94. Quartier P, Taupin P, Bourdeaut F, Lemelle I, Pillet P, Bost M, et al. Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type. Arthritis Rheum. 2003;48(4):1093–101.

    Article  CAS  PubMed  Google Scholar 

  95. Schmeling H, Horneff G. Etanercept and uveitis in patients with juvenile idiopathic arthritis. Rheumatology. 2005;44(8):1008–11.

    Article  CAS  PubMed  Google Scholar 

  96. Smith JA, Thompson DJS, Whitcup SM, Suhler E, Clarke G, Smith S, et al. A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis. Arthritis Care Res. 2005;53(1):18–23.

    Article  CAS  Google Scholar 

  97. Simonini G, Druce K, Cimaz R, Macfarlane GJ, Jones GT. Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs. Arthritis Care Res. 2014;66:1073–84. Wiley.

    Article  CAS  Google Scholar 

  98. Huizinga T, Nigrovic P, Ruderman E, Schulze-Koops H. Prevention of flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab – commentary. Int J Adv Rheumatol. 2011;9:101.

    Google Scholar 

  99. Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis–associated uveitis. Arthritis Care Res. 2019;71(6):703–16.

    Article  Google Scholar 

  100. Holder GE, Robson AG, Pavesio C, Graham EM. Electrophysiological characterisation and monitoring in the management of birdshot chorioretinopathy. Br J Ophthalmol. 2005;89(6):709–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Freedman SF, Rodriguez-Rosa RE, Rojas MC, Enyedi LB. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133(5):617–21.

    Article  PubMed  Google Scholar 

  102. Ho CL, Wong EYM, Walton DS. Goniosurgery for glaucoma complicating chronic childhood uveitis. Arch Ophthalmol. 2004;122:838–44.

    Google Scholar 

  103. Kirwan JF, Shah P, Khaw PT. Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas. Ophthalmology. 2002;109(2):316–23.

    Article  PubMed  Google Scholar 

  104. Ceballos EM, Beck AD, Lynn MJ. Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma. 2002;11(3):189–96.

    Article  PubMed  Google Scholar 

  105. Sidoti PA, Belmonte SJ, Liebmann JM, Ritch R. Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas. Ophthalmology. 2000;107(3):422–9.

    Article  CAS  PubMed  Google Scholar 

  106. Kafkala C, Hynes A, Choi J, Topalkara A, Foster CS. Ahmed valve implantation for uncontrolled pediatric uveitic glaucoma. J AAPOS. 2005;9(4):336–40.

    Article  PubMed  Google Scholar 

  107. Kanski JJ. Lensectomy for complicated cataract in juvenile chronic iridocyclitis. Br J Ophthalmol. 1992;76(2):72–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Paikos P, Fotopoulou M, Papathanassiou M, Choreftaki P, Spyropoulos G. Cataract surgery in children with uveitis. J Pediatr Ophthalmol Strabismus. 2001;38(1):16–20.

    Article  CAS  PubMed  Google Scholar 

  109. Lam LA, Lowder CY, Baerveldt G, Smith SD, Traboulsi EI. Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis. Am J Ophthalmol. 2003;135(6):772–8.

    Article  PubMed  Google Scholar 

  110. Murray P. Serum autoantibodies and uveitis. Br J Ophthalmol. 1986;70:266–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Rosenbaum JT, Wernick R. Selection and interpretation of laboratory tests for patients with uveitis. Int Ophthalmol Clin. 1990;30(4):238–43.

    Article  CAS  PubMed  Google Scholar 

  112. Rosenbaum JT. An algorithm for the systemic evaluation of patients with uveitis: guidelines for the consultant. Semin Arthritis Rheum. 1990;19(4):248–57.

    Article  CAS  PubMed  Google Scholar 

  113. Wade NK. Diagnostic testing in patients with ocular inflammation. Int Ophthalmol Clin. 2000;40:37–54.

    Article  CAS  PubMed  Google Scholar 

  114. Rahi AHTK. Laboratory investigations in posterior uveitis. Int Ophthalmol Clin. 1995;35:59–74.

    Article  CAS  PubMed  Google Scholar 

  115. de Parisot A, Kodjikian L, Errera MH, Sedira N, Heron E, Pérard L, et al. Randomized controlled trial evaluating a standardized strategy for uveitis etiologic diagnosis (ULISSE). Am J Ophthalmol. 2017;178:176–85.

    Article  PubMed  Google Scholar 

  116. Weinreb RN, Tessler H. Laboratory diagnosis of ophthalmic sarcoidosis. Surv Ophthalmol. 1984;28(6):653–64.

    Article  CAS  PubMed  Google Scholar 

  117. Levinson RD, Brezin A, Rothova A, Accorinti M, Holland GN. Research criteria for the diagnosis of birdshot chorioretinopathy: results of an international consensus conference. Am J Ophthalmol. 2006;141:185–7.

    Article  PubMed  Google Scholar 

  118. Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB. Toxoplasma gondii infection in the United States: seroprevalence and risk factors. Am J Epidemiol. 2001;154(4):357–65.

    Article  CAS  PubMed  Google Scholar 

  119. Balba GP, Kumar PN, James AN, Malani A, Palestine AG, Welch JN, et al. Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med. 2006;119(5):448.e21–5.

    Article  Google Scholar 

  120. Tamesis RR, Foster CS. Ocular syphilis. Ophthalmology. 1990;97(10):1281–7.

    Article  CAS  PubMed  Google Scholar 

  121. Le Scanff J, Sève P, Kodjikian L, Grange JD, Broussolle C. Apport de la consultation interniste dans le diagnostic étiologique des uvéites. Étude comparative portant sur 66 patients. Rev Med Interne. 2006;27(9):671–8.

    Article  PubMed  Google Scholar 

  122. Sève P, Cacoub P, Bodaghi B, Trad S, Sellam J, Bellocq D, et al. Uveitis: diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev. 2017;16(12):1254–64.

    Article  PubMed  Google Scholar 

  123. Rosenbaum JT, Wernick R. The utility of routine screening of patients with uveitis for systemic lupus erythematosus or tuberculosis: a bayesian analysis. Arch Ophthalmol. 1990;108(9):1291–3.

    Article  CAS  PubMed  Google Scholar 

  124. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146(5):340–54.

    Article  PubMed  Google Scholar 

  125. Antcliff RJ, Stanford MR, Chauhan DS, Graham EM, Spalton DJ, Shilling JS, et al. Comparison between optical coherence tomography and fundus fluorescein angiography for the detection of cystoid macular edema in patients with uveitis. Ophthalmology. 2000;107(3):593–9.

    Article  CAS  PubMed  Google Scholar 

  126. Spaide RF, Koizumi H, Pozonni MC. Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol. 2008;146(4):496–500.

    Article  PubMed  Google Scholar 

  127. Lim LL, Xie J, Chua CC, Wong T, Hoang LT, Becker MD, et al. In vivo laser confocal microscopy using the HRT-Rostock cornea module: diversity and diagnostic implications in patients with uveitis. Ocul Immunol Inflamm. 2018;26(6):900–9.

    Article  PubMed  Google Scholar 

  128. Kaiser PK, Lowder CY, Sullivan P, Sanislo SR, Kosmorsky GS, Meziane MA, et al. Chest computerized tomography in the evaluation of uveitis in elderly women. Am J Ophthalmol. 2002;133(4):499–505.

    Article  PubMed  Google Scholar 

  129. Sobrin L, Lam BL, Liu M, Feuer WJ, Davis JL. Electroretinographic monitoring in birdshot chorioretinopathy. Am J Ophthalmol. 2005;140(1):52.e1–52.e18.

    Article  Google Scholar 

  130. CMG C, Durrani OM, Murray PI. The safely of anterior chamber paracentesis in patients with uveitis [4]. Br J Ophthalmol. 2004;88:582–3.

    Article  Google Scholar 

  131. Grumet P, Kodjikian L, de Parisot A, Errera MH, Sedira N, Heron E, et al. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (uveitis: clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev [Internet]. 2018;17(4):331–43.

    Article  Google Scholar 

  132. Chronopoulos A, Roquelaure D, Souteyrand G, Seebach JD, Schutz JS, Thumann G. Aqueous humor polymerase chain reaction in uveitis – utility and safety. BMC Ophthalmol. 2016;16(1):1–7.

    Article  CAS  Google Scholar 

  133. Anwar Z, Galor A, Albini TA, Miller D, Perez V, Davis JL. The diagnostic utility of anterior chamber paracentesis with polymerase chain reaction in anterior uveitis. Am J Ophthalmol. 2013;155(5):781–6.

    Article  CAS  PubMed  Google Scholar 

  134. Van Der Lelij A, Rothova A. Diagnostic anterior chamber paracentesis in uveitis: a safe procedure? Br J Ophthalmol. 1997;81(11):976–9.

    Article  PubMed  PubMed Central  Google Scholar 

  135. Trivedi D, Denniston AK, Murray PI. Safety profile of anterior chamber paracentesis performed at the slit lamp. Clin Exp Ophthalmol. 2011;39(8):725–8.

    Article  PubMed  Google Scholar 

  136. Apt L, Henrick A, Silverman LM. Patient compliance with use of topical ophthalmic corticosteroid suspensions. Am J Ophthalmol. 1979;87(2):210–4.

    Article  CAS  PubMed  Google Scholar 

  137. Yamaguchi M, Yasueda SI, Isowaki A, Yamamoto M, Kimura M, Inada K, et al. Formulation of an ophthalmic lipid emulsion containing an anti-inflammatory steroidal drug, difluprednate. Int J Pharm. 2005;301(1–2):121–8.

    Article  CAS  PubMed  Google Scholar 

  138. Tsai E, Till GO, Marak GE. Effects of mydriatic agents on neutrophil migration. Ophthalmic Res. 1988;20(1):14–9.

    Article  CAS  PubMed  Google Scholar 

  139. Islam N, Pavesio C. Uveitis (acute anterior). BMJ Clin Evid. 2015;2015:0705.

    Google Scholar 

  140. Fiorelli VMB, Bhat P, Stephen FC. Nonsteroidal anti-inflammatory therapy and recurrent acute anterior uveitis. Ocul Immunol Inflamm. 2010;18(2):116–20.

    Article  PubMed  Google Scholar 

  141. Gómez-Gómez A, Loza E, Rosario MP, Espinosa G, JMGR DM, Herreras JM, et al. Efficacy and safety of immunomodulatory drugs in patients with anterior uveitis. Med (United States). 2017;96(42)

    Google Scholar 

  142. Jaffe GJ, Dick AD, Brézin AP, Nguyen QD, Thorne JE, Kestelyn P, et al. Adalimumab in patients with active noninfectious uveitis. N Engl J Med. 2016;375(10):932–43.

    Article  CAS  PubMed  Google Scholar 

  143. Yazgan S, Celik U, Işık M, Yeşil NK, Baki AE, Şahin H, et al. Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis. Int Ophthalmol. 2017;37(1):139–45.

    Article  PubMed  Google Scholar 

  144. Arellanes-García L, Padilla-Aguilar G, Navarro-López P, Espinoza-Martínez C. Efficacy of prednisolone and rimexolone in HLA-B27 positive patients with acute anterior uveitis. Gac Med Mex. 2005;141(5):363–6.

    PubMed  Google Scholar 

  145. Biswas J, Ganeshbabu TM, Raghavendran SR, Raizada S, Mondkar SV, Madhavan HN. Efficacy and safety of 1% rimexolone versus 1% prednisolone acetate in the treatment of anterior uveitis – A randomized triple masked study. Int Ophthalmol. 2004;25(3):147–53.

    Article  PubMed  Google Scholar 

  146. Sheppard JD, Toyos MM, Kempen JH, Kaur P, Foster CS. Difluprednate 0.05% versus prednisolone acetate 1% for endogenous anterior uveitis: a phase III, multicenter, randomized study. Investig Ophthalmol Vis Sci. 2014;55(5):2993–3002.

    Article  CAS  Google Scholar 

  147. Foster CS, DaVanzo R, Flynn TE, McLeod K, Vogel R, Crockett RS. Durezol® (difluprednate ophthalmic emulsion 0.05%) compared with pred forte® 1% ophthalmic suspension in the treatment of endogenous anterior uveitis. J Ocul Pharmacol Ther. 2010;26(5):475–83.

    Article  CAS  PubMed  Google Scholar 

  148. O’Neill D, Murray PI, Patel BC, Hamilton AM. Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs heterochromic cyclitis. Ophthalmology. 1995;102(9):1362–8.

    Article  PubMed  Google Scholar 

  149. Okhravi N, Lightman SL, Towler HMA. Assessment of visual outcome after cataract surgery in patients with uveitis. Ophthalmology. 1999;106(4):710–22.

    Article  CAS  PubMed  Google Scholar 

  150. Meacock WR, Spalton DJ, Bender L, Antcliff R, Heatley C, Stanford MR, et al. Steroid prophylaxis in eyes with uveitis undergoing phacoemulsification. Br J Ophthalmol. 2004;88(9):1122–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  151. Rauz S, Stavrou P, Murray PI. Evaluation of foldable intraocular lenses in patients with uveitis. Ophthalmology. 2000;107(5):909–19.

    Article  CAS  PubMed  Google Scholar 

  152. Abela-Formanek C, Amon M, Schild G, Schauersberger J, Kolodjaschna J, Barisani-Asenbaum T, et al. Inflammation after implantation of hydrophilic acrylic, hydrophobic acrylic, or silicone intraocular lenses in eyes with cataract and uveitis: comparison to a control group. J Cataract Refract Surg. 2002;28(7):1153–9.

    Article  PubMed  Google Scholar 

  153. Abela-Formanek C, Amon M, Schauersberger J, Kruger A, Nepp J, Schild G. Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract: comparison to a control group. J Cataract Refract Surg. 2002;28(7):1141–52.

    Article  PubMed  Google Scholar 

  154. Alió JL, Chipont E, BenEzra D, Fakhry MA. International ocular inflammation society, study group of uveitic cataract surgery. Comparative performance of intraocular lenses in eyes with cataract and uveitis. J Cataract Refract Surg. 2002;28(12):2096–108.

    Article  PubMed  Google Scholar 

  155. Dana MR, Chatzistefanou K, Schaumberg DA, Foster CS. Posterior capsule opacification after cataract surgery in patients with uveitis. Ophthalmology. 1997;104(9):1387–93.

    Article  CAS  PubMed  Google Scholar 

  156. Estafanous MFG, Lowder CY, Meisler DM, Chauhan R. Phacoemulsification cataract extraction and posterior chamber lens implantation in patients with uveitis. Am J Ophthalmol. 2001;131(5):620–5.

    Article  CAS  PubMed  Google Scholar 

  157. Hazari A, Sangwan VS. Cataract surgery in uveitis. Indian J Ophthalmol. 2002;50(2):103–7.

    PubMed  Google Scholar 

  158. Akova YA, Kucukerdonmez C, Gedik S. Clinical results of phacoemulsification in patients with uveitis. Ophthalmic Surg Lasers Imaging. 2006;37:204–11.

    Article  PubMed  Google Scholar 

  159. Rahman I, Jones NP. Long-term results of cataract extraction with intraocular lens implantation in patients with uveitis. Eye. 2005;19(2):191–7.

    Article  CAS  PubMed  Google Scholar 

  160. Takahashi T, Ohtani S, Miyata K, Miyata N, Shirato S, Mochizuki M. A clinical evaluation of uveitis-associated secondary glaucoma. Jpn J Ophthalmol. 2002;46(5):556–62.

    Article  PubMed  Google Scholar 

  161. Herbert HM, Viswanathan A, Jackson H, Lightman SL. Risk factors for elevated intraocular pressure in uveitis. J Glaucoma. 2004;13(2):96–9.

    Article  PubMed  Google Scholar 

  162. Neri P, Azuara-Blanco A, Forrester JV. Incidence of glaucoma in patients with uveitis. J Glaucoma. 2004;13(6):461–5.

    Article  PubMed  Google Scholar 

  163. Aman R, Engelhard SB, Bajwa A, Patrie J, Reddy AK. Ocular hypertension and hypotony as determinates of outcomes in uveitis. Clin Ophthalmol. 2015;9:2291–8.

    PubMed  PubMed Central  Google Scholar 

  164. Prata JA Jr, Neves RA, Minckler DS, et al. Trabeculectomy with mitomycin C in glaucoma associated with uveitis. Ophthalmic Surg. 1994;25:616–20.

    PubMed  Google Scholar 

  165. Towler HM, McCluskey P, Shaer B, Lightman S. Long-term follow-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology. 2000;107(10):1822–8.

    Article  CAS  PubMed  Google Scholar 

  166. Yalvac IS, Sungur G, Turhan E, Eksioglu U, Duman S. Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behçet disease. J Glaucoma. 2004;13(6):450–3.

    Article  PubMed  Google Scholar 

  167. Souissi K, El Afrit MA, Trojet S, Kraiem A. La trabéculectomie dans la prise en charge du glaucome uvéitique. J Fr Ophtalmol. 2006;29(2):153–6.

    Article  CAS  PubMed  Google Scholar 

  168. Shimizu A, Maruyama K, Yokoyama Y, Tsuda S, Ryu M, Nakazawa T. Characteristics of uveitic glaucoma and evaluation of its surgical treatment. Clin Ophthalmol. 2014;8:2383–9.

    Article  PubMed  PubMed Central  Google Scholar 

  169. Da Mata A, Burk SE, Netland PA, Baltatzis S, Christen W, Foster CS. Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Ophthalmology. 1999;106(11):2168–72.

    Article  PubMed  Google Scholar 

  170. Özdal PÇ, Vianna RNG, Deschênes J. Ahmed valve implantation in glaucoma secondary to chronic uveitis. Eye. 2006;20:178–83. Nature Publishing Group.

    Article  PubMed  Google Scholar 

  171. Papadaki TG, Zacharopoulos IP, Pasquale LR, Christen WB, Netland PA, Foster CS. Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol. 2007;144(1):62–69.e2.

    Article  PubMed  Google Scholar 

  172. Ramdas WD, Pals J, Rothova A, Wolfs RCW. Efficacy of glaucoma drainage devices in uveitic glaucoma and a meta-analysis of the literature. Graefes Arch Clin Exp Ophthalmol. 2019;257(1):143–51.

    Article  CAS  PubMed  Google Scholar 

  173. Al Obeidan SA, Osman EA, Mousa A, Al-Muammar AM, Abu El-Asrar AM. Long-term evaluation of efficacy and safety of deep sclerectomy in uveitic glaucoma. Ocul Immunol Inflamm. 2015;23(1):82–9.

    Article  PubMed  Google Scholar 

  174. Auer C, Mermoud A, Herbort CP. Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data. Klinische Monatsblatter fur Augenheilkunde. 2004;221:339–42.

    Article  CAS  PubMed  Google Scholar 

  175. Souissi K, El Afrit MA, Trojet S, Kraiem A. Deep sclerectomy for the management of uveitic glaucoma. J Fr Ophtalmol. 2006;29(3):265–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Victor L. Perez .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Venkateswaran, N., Soifer, M., Perez, V.L. (2021). Anterior Uveitis. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_335-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90495-5_335-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90495-5

  • Online ISBN: 978-3-319-90495-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics