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Chapter-15 Anterior Non-granulomatous Uveitis

BOOK TITLE: Uveitis: Text and Imaging

Author
1. Gupta Amod
2. Gupta Vishali
3. Singh Ramandeep
4. Khairallah Moncef
ISBN
9788184484915
DOI
10.5005/jp/books/11002_15
Edition
1/e
Publishing Year
2009
Pages
14
Author Affiliations
1. Advanced Eye Centre, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Postgraduate Institute of Medical, Education and Research, Chandigarh, India
2. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India), King Khaled Eye Specialist Hospital, Riyadh, KSA, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
4. Fattouma Bourguiba University Hospital; University of Monastir, 5019 Monastir, Tunisia, University of Monastir, Tunisia
Chapter keywords
Anterior uveitis, perilimbal injection, ciliary congestion, keratic precipitates, acute anterior uveitis, Behçet’s disease, Reiter’s syndrome, Juvenile idiopathic arthritis, fibrinous clotting, Psoriasis

Abstract

Anterior uveitis is described as inflammation of the iris and/or anterior ciliary body and is characterised by a perilimbal injection termed ciliary congestion, keratic precipitates (KPs) on the posterior corneal surface, cells and flare in the anterior chamber, posterior synechiae, and peripheral anterior synechiae. Anterior uveitis is usually characterised as granulomatous or non-granulomatous depending on the nature and character of keratic precipitates. Non-granulomatous uveitis is characterised by very fine aggregates of inflammatory cells on the posterior corneal surface that appear like dust which are predominantly composed of neutrophils and some lymphocytes. Fibrinous clotting or hypopyon may occur in severe anterior non-granulomatous uveitis. HLA-B27 associated acute anterior uveitis (AAU) is defined as anterior segment intraocular inflammation occurring in association with the HLA-B27 antigen. HLA-B27 AAU is characterised by a clear male preponderance, with most patients aged between 20 and 40 years at onset of the disease. Inflammation is typically sudden in onset and associated with significant perilimbal hyperaemia and symptoms of pain, photophobia, epiphora, and blurred vision. HLA-B27 AAU may be isolated or associated with a systemic disease. Reiter’s syndrome (RS) is a form of reactive arthritis seen commonly in young males and is characterized by a clinical triad of non-specific urethritis, arthritis, and conjunctivitis. Psoriasis is a skin disease characterised by typical dry looking scaly lesions seen particularly on the extensor surface of the knees. These lesions are caused by hyperproliferation of the epidermis. Juvenile idiopathic arthritis (JIA) is defined as an arthritis of unknown cause of at least 6 weeks duration starting before the patient’s 16th year of life. JIA was known as juvenile chronic arthritis or juvenile rheumatoid arthritis in the past. The JIA associated uveitis is a challenge because of its chronic nature. However due to advances in management and early diagnosis, the blindness rate has been reduced to less than 6%. Bilateral panuveitis, frequently associated with retinal vasculitis and retinitis, is the most common ocular presentation of Behçet’s disease (BD). Anterior uveitis may occur after trauma or cataract surgery and in cases associated with mature or hypermature cataract.

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