Nongranulomatous Iritis (Anterior Uveitis)
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Iritis, or anterior uveitis, is the most common form of intraocular inflammation. It is a common cause of a painful red eye. Inflammation of the iris may appropriately be termed iritis, whereas inflammation of the iris and the ciliary body is called iridocyclitis. Iritis may be subdivided into 2 broad categories: granulomatous and nongranulomatous.
This article discusses nongranulomatous iritis, although iritis due to a granulomatous disease process may have a nongranulomatous appearance. For information about granulomatous disease, see Uveitis, Anterior, Granulomatous. The most common form of nongranulomatous anterior uveitis is acute anterior uveitis (AAU), which is associated with the human leukocyte antigen (HLA)–B27 allele in one half to two thirds of cases. However, only 1% of people who carry the HLA-B27 allele develop acute anterior uveitis. [1]
The exact pathophysiology is not known. Inflammation of the iris and the ciliary body causes a breakdown of the blood-ocular barrier. This condition allows both protein and WBCs to extravasate into the aqueous, resulting in the typical iritis signs of cell and flare. Frequently, the cause is idiopathic, but certain ocular and systemic diseases may be the underlying cause of the iritis. [2]
In the case of HLA-B27–associated acute anterior uveitis, speculation about molecular mimicry has yet to be substantiated in humans. Certainly, recent interest in the microbiome (gut and other resident micro-organisms) in disease, as well as the observation that rats transgenic for HLA-B27 do not form ankylosis and other evidence of disease until the gut is colonized, suggest a possible connection to disease. A close relationship between asymptomatic (subclinical) ileocolitis has been demonstrated in patients with recurrent uveitis. [3]
United States
Iritis is the most frequent form of uveitis encountered by ophthalmologists. In one community-based study, anterior uveitis accounted for more than 90% of all cases of uveitis. The annual incidence rate is approximately 8 cases per 100,000 population. [4]
International
No particular geographic distribution for iritis has been noted.
Morbidity arises from iritis and any associated disease process, if present.
Episodes of acute anterior uveitis are often associated with pain, photophobia, decreased vision, and the need for follow-up visits, all of which affect quality of life.
Patients may develop posterior synechiae, and, if severe, a secluded pupil and subsequent angle-closure glaucoma may result.
Associated ocular complications (eg, cataract, glaucoma, macular edema, hypotony) may result in severe vision loss.
No significant racial differences exist. HLA-B27–associated anterior uveitis is more common in whites.
No significant sexual differences exist. However, the male-to-female ratio of ankylosing spondylitis, which is a common cause of iritis, is 3:1. [5]
Iritis may develop in persons of any age but most commonly in the fourth and fifth decades of life.
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Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center
Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society
Disclosure: Nothing to disclose.
Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society
Disclosure: Nothing to disclose.
R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Retina Society, American College of Healthcare Executives, American Uveitis Society
Disclosure: Nothing to disclose.
Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.
Abdullah Al-Fawaz, MD, FRCS Assistant Professor, Cornea and Uveitis Department, King Abdulaziz University Hospital, Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
Abdullah Al-Fawaz, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.
Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Instructor, Department of Ophthalmology, Oregon Health and Sciences University
Disclosure: Nothing to disclose.
Ralph D Levinson, MD Associate Professor of Ophthalmology, Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA
Ralph D Levinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society, Association for Research in Vision and Ophthalmology, and International Ocular Inflammation Society
Disclosure: Nothing to disclose.
Nongranulomatous Iritis (Anterior Uveitis)
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