Anterior Uveitis

The uvea is the middle layer of the eye. It includes the coloured part of the eye (iris) and the tissues around it. Uveitis means inflammation (swelling and irritation) of the uvea.

Anterior uveitis is when the inflammation is mainly in the front part of the eye, in the space between the cornea and the iris [1]. It is the most common type of uveitis. It is also called iritis.

Anterior uveitis usually affects one eye at a time. It often comes back (recurrent), sometimes in the other eye.

Image to add

Simple diagram of the front of the eye labelling the cornea, the iris and the space between them, with inflammation cells floating in that space. Alt text: "Diagram of the front of the eye showing inflammation in the space between the clear cornea and the coloured iris."

What causes it?

Anterior uveitis happens when the body's immune system causes inflammation inside the eye. Sometimes this is linked to another condition in the body (such as those listed above) or an infection. Often, there is no clear cause [2].

Anyone can get anterior uveitis, but it is more common in young and middle-aged adults. Your risk is higher if you [2][3][4]:

• carry the HLA-B27 gene (a gene type that can run in families)
• have ankylosing spondylitis (a type of arthritis causing back pain and stiffness)
• have inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• have psoriasis or psoriatic arthritis
• have sarcoidosis (a condition causing lumps of inflammation in the body)
• have certain infections, such as herpes (cold sore or shingles virus), tuberculosis (TB) or syphilis
• have had uveitis before
• have had an eye injury or eye surgery

In many people, no cause is found. This is common and does not mean something was missed [2].

Symptoms usually come on over hours to a few days [2]:

• Eye pain, often a deep ache, worse when reading or focusing
• A red eye, often redness around the edge of the cornea
• Sensitivity to light (light hurts the eye)
• Blurred vision
• Watering
• A small or odd-shaped pupil

Is it just conjunctivitis? Conjunctivitis ("sore eyes") is usually gritty rather than painful, often has sticky discharge, often affects both eyes, and does not usually make light painful or vision blurred. If your red eye is painful, light hurts, or your vision is blurred, do not assume it is conjunctivitis.

At the clinic, the eye doctor will look inside the front of your eye with a microscope (slit lamp) to see the inflammation cells. They will check your eye pressure and look at the back of the eye. If uveitis keeps coming back or affects both eyes, you may need blood tests or a chest X-ray to look for a cause.

What can happen?

With quick treatment, most attacks settle well. But if it is not treated, or keeps coming back, it can cause [3][4]:

• Raised eye pressure and glaucoma (damage to the eye nerve)
• Cataract (clouding of the lens)
• Macular oedema (swelling at the centre of the retina, which blurs central vision)
• Synechiae (the iris sticking to the lens), which can make the pupil an odd shape and block fluid drainage
• Permanent loss of vision

Some of these can also be side effects of long-term steroid drops, which is why regular checks are important.

Anterior uveitis needs to be checked by an eye doctor urgently, the same day. Early treatment helps prevent complications.

If you have had uveitis before and you notice the same symptoms coming back, get seen early. Do not restart old steroid drops without talking to your eye doctor.

1. Steroid eye drops: these calm the inflammation. At first they may be needed very often (sometimes every hour), and then the dose is slowly reduced (tapered) over weeks.
   • Never stop steroid drops suddenly, even if your eye feels better. The inflammation can bounce back.
   • Steroid drops can raise eye pressure in some people, so your doctor will check your pressure at follow-up visits.
2. Dilating eye drops: these widen the pupil. They ease the pain and stop the iris sticking to the lens. They make vision blurred and light seem brighter for a while, so take care with driving.
3. Treating the cause: if an infection such as herpes or TB is found, it needs its own treatment.
4. Other treatment: if uveitis is severe or keeps coming back, you may need steroid injections, tablets, or medicines that calm the immune system. These are given by a specialist.

Keep all follow-up appointments, even if your eye feels fine.

Anterior uveitis usually cannot be prevented, but you can prevent damage from it:

• Get seen early when symptoms start or come back.
• Use your drops exactly as prescribed, and reduce them only as your doctor tells you.
• Keep conditions like arthritis, bowel disease or psoriasis under control with your other doctors.
• Do not use steroid eye drops without a doctor checking your eyes.

Where to get help in Brunei

For a painful red eye with light sensitivity or blurred vision, go to a Community Eye Clinic at your health centre the same day. No referral is needed.

After clinic hours, go to the hospital Emergency Department.