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For further information, see CMDT Part 7-12: Uveitis
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Essentials of Diagnosis
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Usually immunologic but possibly infective or neoplastic
Inflammation may be confined to the eye or may be systemic
Acute nongranulomatous anterior uveitis: pain, redness, photophobia, and visual loss
Granulomatous anterior uveitis: blurred vision in a variably painful and inflamed eye
Posterior uveitis: gradual loss of vision in a variably inflamed eye
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General Considerations
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Systemic disorders associated with acute nongranulomatous anterior uveitis include
Ankylosing spondylitis
Reactive arthritis
Psoriasis
Ulcerative colitis
Crohn disease
Chronic nongranulomatous anterior uveitis occurs in juvenile idiopathic arthritis
Behçet syndrome produces
Anterior uveitis, with recurrent hypopyon but little discomfort
Posterior uveitis, characteristically with branch retinal vein occlusions
Both herpes simplex and herpes zoster infections may cause nongranulomatous anterior uveitis as well as retinitis
Diseases that produce granulomatous anterior uveitis also tend to be causes of posterior uveitis, including
In toxoplasmosis, there may be evidence of previous episodes of retinochoroiditis
In HIV infection, other principal pathogens responsible for ocular inflammation are
Retinal vasculitis and intermediate uveitis
Predominantly manifest as posterior uveitis with central or peripheral retinal abnormalities in retinal vasculitis and far peripheral retinal abnormalities (pars planitis) in intermediate uveitis
Retinal vasculitis can be caused by a wide variety of infectious agents and noninfectious systemic conditions but also may be idiopathic
Intermediate uveitis is often idiopathic but can be due to multiple sclerosis or sarcoidosis
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Anterior uveitis
Characterized by inflammatory cells and flare within the aqueous humor
In severe cases, there may be hypopyon and fibrin within the anterior chamber
Cells may also be seen on the corneal endothelium as keratic precipitates (KPs)
In granulomatous uveitis, the KPs are large, and iris nodules may be seen
In nongranulomatous uveitis,
The KPs are smaller and iris nodules are not seen
The pupil is usually small, and with the development of posterior synechiae, it also becomes irregularly shaped and poorly reactive
Nongranulomatous anterior uveitis tends to present acutely with unilateral pain, redness, photophobia, and visual loss
However, the ocular inflammation associated with juvenile idiopathic arthritis is
Granulomatous anterior uveitis is also frequently chronic, recurrent, and indolent, causing blurred vision in a variably inflamed eye
Posterior uveitis
Tends to present with floaters and visual loss
Symptoms are commonly slower in onset, though acute presentations can ...