Anterior uveitis is an inflammatory condition that damages the middle layer of the eye. It may be the result of an eye problem or it may be a symptom of an inflammatory process affecting multiple parts of the body. 20-40% of people with an arthritis condition called ankylosing spondylitis or rheumatoid arthritis develop anterior uveitis. Read below on different parts of the eye that can have uveitis, accompanying symptoms, major categories of anterior uveitis causes, and treatment options that doctors may prescribe.
What is anterior uveitis?
Main symptoms include pain, redness, or blurred vision in the eye, along with floaters and sensitivity to light. An eye exam is needed promptly if any of these symptoms occur, as permanent eye damage may occur if the condition is not diagnosed and treated properly.
Treatment includes medications. Surgery to remove the vitreous or implant a device may be necessary if medications do not work or the condition recurs.
You should go to the ER or walk-in ophthalmology clinic immediately. You cannot shrug off this "pink eye" because there's a possibility of vision loss without treatment. You must see an ophthalmologist within 24 hours for follow-up after your initial treatment.
Causes of anterior uveitis
Anterior uveitis refers specifically to the middle layer of the eye, also known as the uvea. This layer is composed of the iris, the choroid, and the ciliary body:
- Iris: This is the colorful portion of the eye. It not only defines eye color but also secretes important nutrients for maintaining eye health and controls the amount of light entering the eye.
- Choroid: This is a thin, spongy network of blood vessels that primarily provides nutrients to the back of the eye, also known as the retina.
- Ciliary body: This is located between the iris and the choroid. The ciliary body controls the shape of the lens to help the eye focus and provides important nutrients.
Inflammation is the body's response mechanism to damage, outside germs, and dangerous toxins. Although the exact cause of uveitis may be unknown, inflammation associated with uveitis may be related to these factors:
- Autoimmune: Many inflammatory diseases are the result of the body's immune system attacking its own tissues, such as sarcoidosis, psoriatic arthritis, and ankylosing spondylitis. These autoimmune diseases can also affect the eyes and result in uveitis. In fact, 20 to 40 percent of people who have or reactive arthritis suddenly develop anterior uveitis. These conditions often cause unilateral symptoms (one eye) but can sometimes result in bilateral symptoms (both eyes).
- Infectious: The eyes are open to the environment, making them particularly susceptible to infection by outside organisms. Bacteria, viruses, and even fungi can infect the eyes and cause uveitis.
- Environmental: Toxin exposure to the eye in the form of heavy metals or chemicals can penetrate the eye and cause uveitis.
- Traumatic: Any type of trauma to the eye falls, punches, cuts, etc. can result in uveitis by allowing bacteria into the eye or by mechanical damage to the different components of the eye.
- Genetic: People with changes in certain genes (mutations) may be more likely to develop uveitis.
- A recent study showed a significant association between uveitis and cigarette smoking.
Treatment options and prevention for anterior uveitis
Uveitis begins as an acute condition, lasting for a short amount of time, but it is important to seek treatment promptly. If left untreated, uveitis can become chronic and cause permanent damage and loss of vision. Fortunately, anterior uveitis responds well to treatment when it is diagnosed and treated early.
Treatment can be divided into two categories: medicinal and procedural. Depending on the severity and duration of your anterior uveitis symptoms, your physician will suggest the treatment option that is right for you.
- Anti-inflammatory: The first treatment modality is often eye drops with an anti-inflammatory medication, such as corticosteroids. If those don't help, a corticosteroid pill or injection may be the next step.
- Antibacterial or antiviral: If your symptoms are caused by infection, your physician may prescribe medications to fight the specific bacteria or virus to control symptoms. Sometimes your physician may also prescribe a corticosteroid to reduce swelling.
- Immunological: You may need medications that suppress the immune system if your uveitis affects both eyes, doesn't respond well to the treatments above, or becomes severe enough to threaten your vision.
For particularly resistant forms of anterior uveitis or uveitis that continues to recur despite medication, your physician may suggest the following:
- Vitrectomy: This surgery removes some of the vitreous (thick gel-like substance) inside your eyeball. A may help anterior uveitis by eliminating an easily infected component of the eye.
- Implantable device: For people with difficult-to-treat uveitis, a device implanted into the eye can be an option. This device slowly releases into the eye for two to three years. However, possible side effects include cataracts and glaucoma.
If not treated, uveitis can cause complications such as:
- Glaucoma: This is a condition of increased pressure within the eyeball that causes gradual vision loss due to pressure on the optic nerve.
- Cataracts: This is a clouding of the eye's natural lens, which lies behind the iris and the pupil. Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world.
- Optic nerve damage: The inflammation of the uvea can spread to affect the optic nerve, which can result in a host of problems including vision loss.
- Retinal detachment: The retina is the light-sensitive layer of the back of the eye, which and sends visual messages through the optic nerve to the brain. The retina is detached when it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.
- Permanent vision loss
When to seek further consultation for anterior uveitis
Contact your physician promptly if you notice any signs and symptoms of anterior uveitis. Your physician may refer you to an eye specialist (an ophthalmologist) or send you immediately to the emergency department if your anterior uveitis symptoms are very severe.
Questions your doctor may ask to determine anterior uveitis
- How long has this been going on?
- Do you have a cough?
- How long has your current headache been going on?
- How severe is your headache?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Rosenbaum JT. Uveitis: Etiology, clinical manifestations, and diagnosis.
- Rosenbaum JT. Acute anterior uveitis and spondyloarthropathies. Rheum Dis Clin North Am. 1992;18143.
- Lin P, Loh AR, Margolis TP, Acharya NR. Cigarette smoking as a risk factor for uveitis. Ophthalmology. 2010;117:585.
- Rosenbaum JT. Uveitis: Treatment.
- Sato T, Knowshita R, Taguchi M, et al. Assessment of diagnostic and therapeutic vitrectomy for vitreous opacity associated with uveitis with various etiologies. Medicine (Baltimore). 2018;97(2):e9491.
- Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group, Kempen JH, Altaweel MM, et al. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide Implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011;118:1916.