Red Eye - Anterior Chamber
Anterior uveitis (iritis, iridocyclitis)
NOTE: It is unusual for primary uveitis to first manifest in old age, suspect masquerade syndrome, especially intraocular lymphoma.
Complications
Acute angle-closure glaucoma
Hyphema
Blood in anterior chamber
Hypopyon
Pus in anterior chamber
Endophthalmitis
Inflammation of aqueous/ vitreous humour
Source
Toronto Notes 2012
- Inflammation of iris, usually accompanied by cyclitis (inflammation of ciliary body), when both = iridocyclitis
- Usually unilateral
- Usually idiopathic
- Connective tissue diseases (see Rheumatology, RHS)
- HLA-B27: reactive arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease
- Non-HLA-B27: juvenile idiopathic arthritis
- Infectious: syphilis, Lyme disease, toxoplasmosis, TB, HSV, herpes zoster
- Other: sarcoidosis, trauma, large abrasion, post ocular surgery
- Photophobia (due to reactive spasm of inflamed iris muscle), ocular pain, tenderness of the globe, brow ache (ciliary muscle spasm), decreased VA (in severe cases with hypopyon), lacrimation
- Ciliary flush (perilimbal conjunctival injection) (Figure 16), miosis (spasm of sphincter muscle)
- Anterior chamber "cells" (WBC in anterior chamber due to anterior segment inflammation) and "flare" (protein precipitates in anterior chamber 2° to inflammation), hypopyon (collection of neutrophilic exudates inferiorly in the anterior chamber)
- Occasionally keratic precipitates (clumps of cells on corneal endothelium)
- Iritis typically reduces IOP because ciliary body inflammation causes decreased aqueous production; however, severe iritis, or iritis from herpes simplex and zoster may cause an inflammatory glaucoma
NOTE: It is unusual for primary uveitis to first manifest in old age, suspect masquerade syndrome, especially intraocular lymphoma.
Complications
- Inflammatory glaucoma
- Posterior synechiae: Adhesions of posterior iris to anterior lens capsule; Indicated by an irregularly shaped pupil; if occurs 360°, entraps aqueous in posterior chamber, iris bows forward "iris bombe" --> angle closure glaucoma
- Peripheral anterior synechiae (rare): adhesions of iris to cornea --> glaucoma
- Cataracts
- Band keratopathy (with chronic iritis); superficial corneal calcification keratopathy
- Macular edema with chronic iritis
- Mydriatics: dilate pupil to prevent formation of posterior synechiae and to decrease pain from ciliary spasm
- Steroids: topical, subconjunctival or systemic
- Systemic analgesia
- Extensive medical workup may be indicated to r/o 2° causes
Acute angle-closure glaucoma
Hyphema
Blood in anterior chamber
Hypopyon
Pus in anterior chamber
Endophthalmitis
Inflammation of aqueous/ vitreous humour
Source
Toronto Notes 2012