What causes anterior uveitis?
Anterior uveitis is when the front part of your eye (In front of the iris, the colored part inside your eye) gets inflamed. Sometimes, doctors can’t figure out why this happens, and they call it idiopathic (unknown) anterior uveitis. But when they do know the cause, it’s often linked to autoimmune diseases. These are conditions where your body’s immune system attacks itself, like ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease. Kids can get it too, especially if they have juvenile idiopathic arthritis (JIA). Other autoimmune diseases like sarcoidosis, lupus, and Behçet’s disease can also cause it.
Infections can also cause anterior uveitis. Viruses like herpes simplex, varicella-zoster (Chickenpox), and cytomegalovirus, and bacteria like syphilis and tuberculosis (TB) are common culprits. Sometimes, parasites and fungi can cause it, especially in certain places or in people with weak immune systems. Eye injuries or surgeries can also lead to inflammation because the body reacts to the damage or any infection that might have been introduced.
Certain medications, like rifabutin, bisphosphonates, and some immune modulators, can rarely cause anterior uveitis, but it usually goes away if you stop taking the medicine. Genetic factors, like having the HLA-B27 gene, can make you more likely to get it. Smoking cigarettes can also increase the risk and make it worse. In rare cases, cancers like lymphoma can look like anterior uveitis, especially in older people with long-term eye inflammation.
So, anterior uveitis can have many causes, including unknown reasons, autoimmune diseases, infections, injuries, medications, genetics, and even cancer.
How is anterior uveitis treated?
Treating non-infectious anterior uveitis means quickly stopping the inflammation to save your vision and prevent it from coming back. The first treatment is usually eye drops with steroids like prednisolone acetate (Brand name Pred forte) because they work well to reduce inflammation in the front part of the eye. If the problem is more serious or doesn’t go away, doctors might use stronger steroids injections around the eye or oral steroid pills, but they try not to use these for too long because they can cause side effects like cataracts, glaucoma, and other health issues.
If the inflammation doesn’t get better with just steroids, or if you need long-term treatment, doctors use other medicines to help reduce the need for steroids. These medicines include methotrexate, mycophenolate mofetil, and azathioprine, which help calm the immune system. These are especially helpful if the inflammation is in both eyes or if steroids cause too many side effects.
For people who don’t get better with regular treatments, new medicines called biologics have made a big difference. These include adalimumab and infliximab, which are used for very bad or stubborn cases. There are also newer biologics like tocilizumab and rituximab that are used in special cases. Sometimes, doctors use tiny steroid implants in the eye, like dexamethasone or fluocinolone acetonide, to keep the inflammation under control without affecting the whole body.
Overall, the treatment plan depends on how bad the inflammation is, whether it’s in one or both eyes, other health problems you might have, and the risk of side effects from the medicines. Doctors usually start with eye drops and move to stronger treatments if needed.
What is the prognosis of anterior uveitis?
The outlook for non-infectious anterior uveitis is generally good, especially when patients get a quick diagnosis and modern treatment from experienced eye doctors. Most people see improvement in inflammation and vision soon after starting treatment. Studies show that with proper care, vision either stays the same or gets better over the first few years. For example, data from large groups of patients show that vision improves within the first two years and stays stable over five years if the inflammation is controlled.
However, the disease can vary a lot, and some patients develop problems like cataracts, glaucoma, swelling in the retina, or sticky eye parts that can threaten vision if not managed well. But severe vision loss in both eyes is rare. One large study found that only about 4% of patients had vision loss in both eyes after one year of specialized care, though about one in five had some vision problems in one eye. New eye problems, often related to the disease or steroid treatments, are common and show the need for ongoing monitoring and care from different specialists.
It’s important to see a uveitis specialist (Like me!) to control inflammation early and aggressively, and use advanced treatments to get better long-term results and reduce the chance of permanent vision loss from non-infectious anterior uveitis.