PassFinals
Eyes & Vision

Anterior uveitis

Inflammation of the iris and ciliary body causing a painful photophobic red eye; it needs urgent ophthalmic assessment because early treatment prevents synechiae and sight-threatening complications.

In a nutshell

Anterior uveitis is inflammation of the iris/ciliary body causing a painful photophobic red eye, often with blurred vision and a small irregular pupil. Confirm with slit lamp and pressure measurement, refer urgently, then use specialist-directed steroid and cycloplegic drops while excluding infection and monitoring complications.

Classic presentation

A young adult with an aching photophobic red eye, blurred vision, ciliary injection and a small irregular pupil, sometimes with recurrent episodes or HLA-B27-associated disease.

Key points

  • Pain, photophobia and visual change in a red eye are urgent; anterior uveitis is not routine conjunctivitis.
  • Slit-lamp cells and flare establish anterior-chamber inflammation; check cornea, pupil, intraocular pressure and posterior segment.
  • Topical corticosteroid suppresses inflammation, while cycloplegia relieves ciliary spasm and reduces posterior-synechiae risk.
  • Do not start or restart steroid drops without the appropriate eye-care diagnosis and follow-up, particularly if keratitis or another infection is possible.
  • Raised pressure, hypopyon, severe inflammation, marked visual loss or posterior symptoms need same-day ophthalmic escalation.
  • Recurrent, bilateral, severe or atypical uveitis warrants targeted assessment for HLA-B27 disease, inflammatory bowel disease, sarcoidosis, Behçet disease and infection.
  • Monitor response, pressure, synechiae, cataract, macular oedema and recurrence; never stop a prolonged topical steroid abruptly without direction.

First-line investigation

Urgent ophthalmic examination with visual acuity, slit lamp, corneal assessment, anterior-chamber cells/flare, pupil and intraocular pressure.

Management

Refer the painful photophobic red eye

  • Arrange urgent ophthalmic assessment, same day for major visual loss, severe pain, hypopyon, high pressure or diagnostic uncertainty.1,2,7

Confirm the compartment and exclude infection

  • Use visual acuity, slit lamp, corneal staining, pupil/pressure assessment and posterior examination before selecting anti-inflammatory treatment.1,4,3

Suppress inflammation and prevent synechiae

  • Use specialist-directed topical corticosteroid with a planned taper and cycloplegic/mydriatic treatment when indicated.4,5,6

Monitor pressure and complications

  • Review visual acuity, cells/flare, intraocular pressure, synechiae, cataract, macular oedema and treatment response through ophthalmology.1,4,3

Investigate systemic and infectious causes selectively

  • For recurrent, bilateral, severe or atypical disease, use a targeted history, examination and investigation pathway with rheumatology/infectious-disease input where indicated.1,4,3

Safety-net recurrence and visual change

  • Do not self-restart old steroid drops; return urgently for recurrent pain, photophobia, floaters, flashes, worsening redness or reduced vision.2,8,3

Exam traps

  • Conjunctivitis is usually gritty with discharge; deep pain and photophobia point to uveitis, keratitis, glaucoma or scleritis.
  • A small irregular pupil suggests iris inflammation/synechiae, not uncomplicated conjunctivitis.
  • Steroid drops can worsen infectious keratitis; exclude corneal infection and use specialist direction.
  • Hypopyon, severe visual loss or raised pressure is an eye emergency, not a routine outpatient flare.
  • Do not restart leftover drops for a recurrence; re-assess urgently.

Illustrations

Keratic precipitates in anterior uveitisSlit-lamp photograph showing fine keratic precipitates deposited on the inferior corneal endothelium in anterior uveitis.Jonathan Troost, Wikimedia Commons · CC-BY-SA-3.0
Posterior synechiaeClinical photograph showing an irregular pupil caused by posterior synechiae between the inflamed iris and the lens.Jonathan Troost, Wikimedia Commons · CC-BY-SA-3.0
Ciliary injection in anterior uveitisSlit-lamp clinical photograph showing circumcorneal ciliary injection around the limbus in acute anterior uveitis.Jonathan Troost, Wikimedia Commons · CC-BY-SA-3.0

Key sources

  1. NICE CKS: Uveitis (Recognition, urgent referral, treatment, investigation and follow-up; access may require NHS/OpenAthens authentication)
  2. NHS: Uveitis (Symptoms, urgent referral, causes, treatment and follow-up)
  3. Moorfields Eye Hospital: Uveitis and diagnosis/treatment (Anterior-uveitis features, systemic associations, specialist treatment and complications)
  4. College of Optometrists: Clinical Management Guideline — Uveitis (anterior) (Diagnosis, signs, treatment, referral and systemic-association guidance)Updated 26 Mar 2025
  5. BNF: Prednisolone — eye preparations (Current ophthalmic corticosteroid prescribing, cautions and tapering information; access may require NHS/OpenAthens authentication)
  6. BNF: Cyclopentolate hydrochloride (Current mydriatic/cycloplegic prescribing and safety information; access may require NHS/OpenAthens authentication)
  7. NHS: Red eye (Urgent red-eye and visual-loss safety-netting)
  8. Guy's and St Thomas' NHS Foundation Trust: Iritis treatment (Specialist steroid/cycloplegic treatment, tapering and recurrence advice)Updated 1 Jan 2026

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.