Infectious anterior uveitis

Infectious anterior uveitis is an inflammatory condition affecting the front portion of the uveal tract of the eye, specifically the iris and ciliary body, caused by an identifiable infectious agent. Unlike non-infectious (autoimmune or idiopathic) anterior uveitis, this form is directly triggered by bacterial, viral, fungal, or parasitic pathogens. Common infectious causes include herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), Toxoplasma gondii, Treponema pallidum (syphilis), and Mycobacterium tuberculosis. The condition primarily affects the ocular system but may be associated with systemic infectious diseases. Patients typically present with eye pain, redness (ciliary injection), photophobia (light sensitivity), blurred vision, and tearing. On clinical examination, characteristic findings include inflammatory cells and protein flare in the anterior chamber, keratic precipitates on the corneal endothelium, and possible posterior synechiae (adhesions between the iris and lens). The presentation may be acute, recurrent, or chronic depending on the causative organism. Herpetic anterior uveitis, one of the most common infectious forms, may present with elevated intraocular pressure and characteristic iris atrophy. Treatment is directed at the underlying infectious cause and typically involves targeted antimicrobial therapy — antiviral agents (such as acyclovir or valacyclovir for herpetic uveitis), antibiotics, antifungals, or antiparasitic medications as appropriate. Topical corticosteroids are often used adjunctively to control inflammation, but must be used cautiously and only with concurrent antimicrobial coverage to avoid worsening the infection. Cycloplegic agents are employed to reduce pain and prevent synechiae formation. Early diagnosis and appropriate treatment are essential to prevent complications such as glaucoma, cataract formation, cystoid macular edema, and permanent vision loss. Prognosis varies depending on the causative organism, promptness of treatment, and whether the condition is acute or chronic.

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