Anterior Segment
Anterior Uveitis
Also known as: iritis, iridocyclitis, anterior uveitis, uveitis, AC cells, cells and flare, HLA-B27 uveitis, painful photophobic eye
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Inflammation of the iris and/or ciliary body. The most common form of uveitis in clinical practice. Presents with painful, photophobic red eye, circumcorneal flush, and anterior chamber cells and flare on slit lamp. Therapeutically endorsed optometrists may initiate in-clinic management for uncomplicated acute anterior uveitis when slit-lamp findings are documented, epithelial disease and posterior involvement have been excluded, IOP can be monitored, and follow-up is reliable. Same-day ophthalmology referral is required for severe, hypopyon, posterior, herpetic, infectious, recurrent, bilateral, granulomatous, paediatric, post-operative, traumatic, poor-response, or atypical presentations.
Recognition
Symptoms: what patients report
- Aching, moderately severe ocular pain — deep, not superficial.
- Photophobia — often disproportionate to the visible redness.
- Redness, typically unilateral.
- Blurred vision (from cells in the anterior chamber or posterior synechiae).
- History of prior episodes in 30–40% of cases — unilateral recurrent acute anterior uveitis strongly suggests HLA-B27 association.
- May have systemic symptoms if associated with inflammatory bowel disease, spondylarthropathy, or sarcoidosis.
Signs: what the examination shows
- Circumcorneal (perilimbal) flush — ciliary injection pattern, deepest at the limbus.
- Cells in the anterior chamber — seen with slit lamp, graded 0–4+.
- Flare in the anterior chamber — protein leakage from inflamed iris vessels.
- Keratic precipitates (KPs) on the corneal endothelium — mutton-fat KPs suggest granulomatous disease.
- Posterior synechiae — iris adhesions to the anterior lens capsule; indicate chronicity or severity.
- Small or irregular pupil — may be miotic from ciliary spasm, or irregular from synechiae.
- Raised or reduced intraocular pressure depending on mechanism.
- Hypopyon in severe cases — white fluid level in the inferior anterior chamber.
What OptoGuide™ covers for anterior uveitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Uveitis (anterior) — College of Optometrists CMG
- Acute Anterior Uveitis — EyeWiki
- The Red Eye. Leibowitz HM. The New England Journal of Medicine. 2000;343(5):345-51.
- Uveitis in Adults: A Review. Maghsoudlou P, Epps SJ, Guly CM, Dick AD. JAMA. 2025;334(5):419-434.
- The Eyes Have it. Rosenbaum JT, Dick AD. Arthritis & Rheumatology (Hoboken, N.J.). 2018;70(10):1533-1543.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.