It is the inflammation of the uveal tract i.e. iris, ciliary body and choroid. Inflammation of iris and ciliary body constitutes iridocyclitis and anterior uveitis.

Clinical features:

Ø  Symptoms of acute uveitis include pain, redness, photophobia, consensual photophobia (pain in the affected eye when a light is shown in the fellow eye), excessive tearing and decreased vision.

Ø  Symptoms of chronic uveitis include decreased vision (from vitreous debris, cystoid macular edema (CME), or cataract, periods of exacerbations and remissions with few acute symptoms [e.g. juvenile idiopathic (rheumatoid) arthritis].

Ø  Cells and flare in the anterior chamber, ciliary flush and keratic precipitates (KP) are observed by slit lamp microscopy.

Complete ocular examination, including an IOP check and a dilated fundus examination. The vitreous should be evaluated for cells.

Non- pharmacological treatment:

l  Wear dark glasses.

Pharmacological treatment:

1.       Cycloplegic e.g., cyclopentolate 1% eye drops BD for mild to moderate inflammation; atropine ointment 1% TDS for severe inflammation.

2.       Topical steroid like prednisolone acetate 1% one drop 1 to 6 hourly, depending on the severity. Most cases of moderate to severe acute uveitis require 1 to 2 hourly dosing initially. Consider FML (flurometholone) 1% ophthalmic ointment at night.

3.       If the anterior uveitis is severe and is not responding to topical steroids, then consider periocular repository steroids (e.g., triamcinolone 20 to 40 mg subtenon injection).

4.       If there is no improvement on maximal topical and repository steroids, or if the uveitis is bilateral and severe, consider systemic steroids (Tab. prednisolone 1mg/kg), or immunosuppressive therapy.

5.       Treat secondary glaucoma with beta blockers, not with pilocarpine or prostaglandin analogues.

6.       If an exact etiology for the anterior uveitis is determined (herpes, tuberculosis, ankylosing spondylitis etc.), then appropriate systemic management is required.

7.       Follow-up is done every 1 to 7 days in the acute phase, depending on the severity and every 1 to 6 months when stable. At each visit, the anterior chamber reaction and IOP should be evaluated.

If the anterior chamber reaction is improving, then the steroid drops can be slowly tapered [usually one drop per day every 3 to 7 days (e.g., QID for 1 week, then TDS for 1 week, then BD for 1 week)].

Patient education:

u  Recurrent nature of the disease which may interfere with vision should be explained and possible complications like cataract and glaucoma should be mentioned.

u  Possible side effects of long term topical, periocular and systemic corticosteroid therapy should be explained.