Contributor: Gordon K. Klintworth
Iridocyclitis (anterior uveitis) is extremely common and has many causes, but the condition is frequently idiopathic. A high percentage (~50%) of affected individuals are HLA-B27 positive and many of these individuals (~55%) have a systemic disease (rheumatoid arthritis, ankylosing spondyitis, chronic inflammatory bowel disease). Some individuals with pauciarticular rheumatoid arthritis [rheumatoid arthritis - juvenile pauciarticular], mainly those who are HLA-B27 positive, are at risk for a bilateral chronic iridocyclitis. Patients usually develop their intial synptoms during adoescence and ~70% have recurrent episodes. At the outset topical corticosteroids are the usual mode of therapy but eventually additional periocular and/or oral corticosteroids become necessary to prevent posterior synechiae and macular edema [edema - macula]. Because of complication of corticosteroid therapy other therapic agents (methotrexate, cyclosporine, azathioprine, infliximab) are also used, particularly in chronic or recurrent cases. Glaucoma is an important common complication of anterior uveitis and is associated with as many as 25% of cases of chronic uveitis [uveitis - chronic]. This may be secondary to mechanical obstruction from exudation of inflammatory cells or release of hydrolytic enzymes, prostaglandins, cytokines, and other materials from leukocytes and damaged tissues.