Anterior Uveitis (Iritis)

Features

•    Painful red eye

•    Photophobia

•    Blurred vision

•    Small, irregular (constricted) pupil (due to posterior synechiae)

•    Ciliary flush (perilimbal injection)

•    Cells and flare seen on slit-lamp

Associations

•    HLA-B27 diseases: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD

•    Sarcoidosis

•    Juvenile idiopathic arthritis

•    Herpetic infections

Management

•    Cycloplegic agents (e.g., atropine) to prevent synechiae

•    Topical steroids (under ophthalmology guidance)

Posterior Uveitis

Features

•    Floaters

•    Blurred vision

•    Less pain than anterior uveitis

Causes

•    Toxoplasmosis (most common infectious cause)

•    CMV (especially HIV/AIDS, CD4 <50)

•    Syphilis

•    TB

•    Sarcoidosis

Management

•    Systemic and/or local steroids

•    Antimicrobial therapy if infectious cause

Scleritis

Features

•    Severe, deep, boring eye pain, may radiate to jaw or forehead

•    Worse with eye movements

•    Diffuse or nodular redness involving deep scleral vessels

•    May lead to scleral thinning, perforation

Associations

•    Rheumatoid arthritis (most common)

•    Granulomatosis with polyangiitis

•    SLE

Management

•    Systemic NSAIDs or steroids

•    Urgent ophthalmology referral

Episcleritis

Features

•    Mild discomfort

•    Localised or diffuse redness

•    No vision loss, minimal or no pain

•    Blanches with topical phenylephrine (distinguishes from scleritis)

Associations

•    Often idiopathic

•    May be associated with systemic rheumatological disease

Management

•    Usually self-limiting

•    Artificial tears, topical NSAIDs if needed

Condition                                       Pain           Visual Loss       Other Clues

Acute angle-closure glaucoma       Severe        Yes                    Halos, mid-dilated pupil, hard eye

Anterior uveitis                                Moderate    Variable             Photophobia, small irregular pupil

Scleritis                                           Severe        Possible            Deep pain, systemic disease

Keratitis                                           Severe        Yes                    Corneal opacity, contact lens use

Endophthalmitis                               Severe        Yes                    Post-surgery, hypopyon

Extra Revision Pearls

•    Photophobia clue → intraocular inflammation (uveitis, keratitis)

•    Pain with eye movement clue → scleritis (not episcleritis)

•    Synechiae clue → anterior uveitis complication

•    Posterior uveitis clue → floaters predominant

•    Red eye that blanches with phenylephrine clue → episcleritis

•    Deep blue sclera clue → scleritis or osteogenesis imperfecta