Anterior uveitis
At a glance
Inflammation of the anterior uvea is defined clinically by anterior chamber cells; determine whether infection or systemic disease is plausible.
CAVE
- Exclude corneal infection and endophthalmitis.
- Unilateral recurrent inflammation with raised IOP can suggest viral disease.
Clinical presentation
- Pain, photophobia, circumlimbal injection and reduced vision; keratic precipitates and synechiae may be present.
| Finding | Action | Timing / detail |
|---|---|---|
| 1 × 1 mm slit beam | 0: <1 cell; 0.5+: 1–5; 1+: 6–15; 2+: 16–25; 3+: 26–50; 4+: >50 | Record flare separately; use comparable illumination at follow-up |
Diagnosis & investigations
- Document acuity, IOP, cells/flare, keratic precipitates, synechiae and lens; examine vitreous and dilated fundus. OCT for unexplained reduced vision or suspected macular oedema.
- Characterise unilateral/bilateral, granulomatous/non-granulomatous and acute/recurrent/chronic disease. Tailor tests to the phenotype: HLA-B27 for recurrent typical acute disease; syphilis, TB or sarcoidosis evaluation when indicated by presentation, exposure and epidemiology. Unilateral hypertensive uveitis with iris atrophy warrants a viral work-up, sometimes aqueous PCR. Avoid an indiscriminate blood panel.
Differential diagnosis
- Keratitis, angle closure, scleritis, postoperative infection and masquerade syndromes.
Treatment
- Treat confirmed non-infectious inflammation and ciliary spasm as below. If infection is suspected, obtain specialist assessment and pathogen-directed treatment; steroid monotherapy can worsen infectious disease. Recurrent, bilateral, posterior or steroid-dependent disease needs a uveitis service plan.
| Finding | Action | Timing / detail |
|---|---|---|
| Confirmed non-infectious anterior uveitis | Prednisolone acetate 1% or dexamethasone 0.1% topically; marked inflammation may require hourly dosing while awake | Exclude epithelial herpetic disease and microbial keratitis first; shake suspensions |
| Ciliary spasm or risk of posterior synechiae | Cyclopentolate 1%, typically 2–3 times daily in adults; adapt to inflammation and pupil response | Check angle-closure risk, anticholinergic contraindications and driving advice |
| Cells clearly decreasing and no new complication | Reduce topical steroid stepwise, based on slit-lamp findings rather than symptoms alone | Rebound: reassess cause and adherence, return to an effective step; do not stop intensive treatment abruptly |
Follow-up
- Severe inflammation, hypopyon, raised IOP or uncertain diagnosis: review within 24–48 hours. An uncomplicated improving episode is usually reassessed within 1 week; adjust the taper only after checking cells and IOP. Monitor for steroid response, cataract and macular oedema. Failure to improve requires reassessment of infection, adherence and posterior involvement.
Risk factors & context
- Ask about previous episodes, inflammatory back or joint symptoms, skin and bowel disease, infection, trauma and recent surgery.
- Avoid indiscriminate laboratory panels.
Complications
- Posterior synechiae, ocular hypertension or glaucoma, cataract and cystoid macular oedema.
- Check pressure during corticosteroid treatment.
When to refer
- Urgent escalation for hypopyon, severe visual loss, posterior involvement or suspected infection.
References 3
- NHS Greater Glasgow and Clyde · Uveitis Management (021) ↗Version 6 · April 2026 · Assessment; treatment; investigation; review
- College of Optometrists · Uveitis (anterior) ↗Version 8 · March 2025 · Recognition; differential diagnosis; management
- SUN Working Group · Standardization of uveitis nomenclature ↗2005 · Anterior chamber cell grading, 1 × 1 mm slit beam
UK guidance: referral pathways and funding criteria may differ elsewhere.