Anterior Segment
Fuchs' Heterochromic Iridocyclitis
Also known as: Fuchs' uveitis, Fuchs heterochromic cyclitis, FHI, FHU, Fuchs uveitis syndrome, heterochromic iridocyclitis, iris heterochromia uveitis, stellate KPs uveitis
Filed as: Soon
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
A chronic, low-grade anterior uveitis characterised by iris heterochromia (the affected eye becomes lighter in fair-skinned patients), diffuse stellate keratic precipitates, absence of posterior synechiae, and no signs of acute inflammation. Usually unilateral. Complicated by cataract and glaucoma. Frequently undiagnosed for years because the eye is characteristically white and quiet.
Recognition
Symptoms: what patients report
- Often asymptomatic — the eye is characteristically white and non-injected.
- Mild blurred vision from early cataract or vitritis.
- Occasionally noted as a colour difference between the two eyes.
- No pain, no photophobia, no red eye in the active phase.
- Floaters from vitritis.
- Progressive visual loss from cataract or secondary glaucoma.
Signs: what the examination shows
- Heterochromia iridis: the affected eye is lighter (iris atrophy causes depigmentation) — most evident in fair-skinned individuals with coloured eyes.
- Stellate (star-shaped) keratic precipitates: fine, filiform, distributed across the entire endothelium — NOT inferiorly clustered as in other uveitis.
- Iris stromal atrophy: the iris looks moth-eaten or depigmented on the affected side.
- Absence of posterior synechiae — a distinguishing feature; iris pupil margin remains free.
- Vitreous cells and floaters (vitritis).
- Rubeosis iridis: fine neovascularisation of the iris angle — can cause bleeding at paracentesis (Amsler's sign).
- Secondary cataract — develops in most patients eventually.
- Raised IOP / secondary open-angle glaucoma in ~15–25% of patients.
What OptoGuide™ covers for fuchs' heterochromic iridocyclitis
- 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
- Fuchs Heterochromic Iridocyclitis — EyeWiki
- Fuchs’ uveitis syndrome: a 20-year experience in 466 patients. Kianersi F, Kianersi H, Pourazizi M, Beni AN, Noorshargh P. Scientific Reports. 2024;14(1):8621.
- The Eyes Have it. Rosenbaum JT, Dick AD. Arthritis & Rheumatology (Hoboken, N.J.). 2018;70(10):1533-1543.
- Demystifying Viral Anterior Uveitis: A Review. Chan NS, Chee SP. Clinical & Experimental Ophthalmology. 2019;47(3):320-333.
- Centre for Eye Health — Chair-side Reference: Secondary Glaucomas
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.