This chapter provides an overview of anterior granulomatous uveitis. Granulomatous uveitis is usually less acute than the nongranulomatous form. Keratic precipitates (KP), made of clusters of white blood cells on the corneal endothelium are seen as “mutton-fat” deposits or finer granulomatous deposits as opposed to dust in non-granulomatous uveitis. Granulomatous uveitis can further be divided into acute vs chronic, unilateral vs bilateral, infectious vs non infectious and anterior vs granulomatous panuveitis. Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology, most commonly affecting the middle aged. It may present with erythema nodosum, a symmetrical hilar lymphadenopathy, pulmonary infiltration, peripheral lymph node enlargement, hepatosplenomegaly and arthritis. Bone involvement is rarely noted as small destructive cystic lesions in the distal ends of the phalanges, metacarpals, and metatarsals. Sarcoidosis may present as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis. Anterior uveitis is usually chronic and of the granulomatous type. Tuberculosis is a chronic granulomatous disease, caused by the intracellular acid fast bacillus Mycobacterium tuberculosis or related members of the TB complex. Ocular tissues could be affected either by a direct invasion of M. tuberculosis or due to the immunologic response towards the antigens. Tuberculous uveitis often presents as a chronic granulomatous disease that causes mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Leprosy is a chronic granulomatous disease, caused by the intracellular acid fast bacillus Mycobacterium lepra. Multibacillary Leprosy causes three different forms of uveitis. Syphilis may present in a wide variety of uveitic forms and may mimic various other diseases. Numerous viruses have been suggested as causes of anterior uveitis. They include Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), Cytomegalovirus (CMV, Epstein-Barr Virus (EBV), and Human T-cell lymphotropic virus, type 1.
