INTRODUCTION
Uveitis is an inflammatory process of entire uveal tract affecting any of its three constituents :
iris, ciliary body ,and the choroid . Uveitis can be classified according to the Standardization of
Uveitis Nomenclature(SUN) based on the anatomical location and region involved i.e Anterior
uveitis , Intermediate uveitis , Posterior uveitis and Panuveitis1 . Uveitis can also involve
adjacent structures like sclera, cornea, retina, retinal blood vessels and optic nerve head2 .
Worldwide the prevalence of uveitis varies from 69.0 to 114-5 per 1,00,000 persons and its
incidence has been reported between 17.2 to 52.4 cases per 1,00,000 persons- year 3,4,5. In the
developed world ,it is the 5th leading cause of blindness accounting for 10%-15% of all case of
blindness6,[Link] et al in a study reports that prevalence of uveitis varies globally with an
estimated prevalence of 730 cases/1,00,000 in India 8. Anterior uveitis is the most common
type of uveitis and accounts for 28% -50% in the Asian countries9.
Anterior uveitis is inflammation of anterior uveal tract comprising iris and anterior part
(pars plicata) part of ciliary body . It may present in different forms as10
a) Iritis : inflammation involving the iris
b) Iridocyclitis : involvement of both iris and anterior ciliary body
c) Anterior cyclitis : Predominant involvement of pars plicata part of ciliary body.
d) Keratouveitis : Involvement of cornea with anterior chamber.
e) Sclerouveitis : Process involves sclera and uveal tract.
Etiology of anterior uveitis includes ; Immunogenic origin where an infectious agent cross
reacts with ocular specific antigens due to underlying autoimmune diseases ( HLA, antigens,
SLE, Wegner granulomatosis, sarcoidosis, ankylosing spodylitis), Exogenous infections occur by
introduction of organism through a perforating wound or ulcer and secondary infections by
inflammation of neighboring ocular tissues (cornea, sclera, retina)11
According to pathology anterior uveitis can be two types Granulomatous and
Nongranulomatous Granulomatous uveitis is due to type 4 hypersensitivity reaction
characterized by presence of large ,greasy ‘mutton fat’keratic precipitates on corneal
endothelium and dense posterior synechiae with clusters of inflammatory cells on pupillary
border (Koppe nodules) or on peripheral border of iris (Busacca nodules).
Nongranulomatous uveitis is acute in onset characterized by presence of fine keratic
precipitates ,diffuse in extension with flare and cells in anterior chamber11 .
Clinically anterior uveitis has two forms of presentation12;
a) Acute anterior uveitis : Most common form with multiple etiologic factors including
immunogenic, traumatic and inflammatory factors (HLA-B27 positivity,Ankylosing
spondylitis,Behcet’s disease,herpes simplex infection)
b) Chronic anterior uveitis less common associated with systemic disease causing
secondary structural complication like cystoid macular edema, optic disc swelling, cataract,
corneal edema, band keratopathy and iris abnormalities.
The clinical manifestation of Anterior uveitis consist of different phases 1) Acute (sudden
onset with limited duration),2) chronic(persistent duration ,with relapse <3 months after
discontinued treatment) and 3) recurrent (repeated episodes separated by untreated inactive
periods) . Symptoms are unilateral acute pain, visual loss, photophobia , redness and watery
discharge. Signs includes circumcorneal hyperaemia, pupillary miosis, hypopyon, dilated iris
vessels, fibrin in anterior chamber, iris nodule, iris atrophy, anterior & posterior synechae and
pigment dispersion. Anterior chamber cells, flare and keratitic precipitates are classic signs of
acute anterior uveitis12.
Treatment of anterior uveitis aim is to eliminate inflammation and pain with steroids and
topical cycloplegics NSAIDS and immunosuppressive drugs. Topical steroids( prednisolone
acetate 1%, dexamethasone 0.1%, difluprednate 0.05%, loteprednol 0.25%) to be used in acute
phase and involves instillation at a frequency appropriate to the severity of inflammation.
Cycloplegics ( atropine, cyclopentolate, homatropine, phenylephrine) to be used to promote
comfort by releiving spasm of pupillary and ciliary muscle, prevents the formation of posterior
synechae and breakdown recently formed synechae . Mydricaine No2 ( preaparation containing
adrenaline and atropine) to be used to try to break fresh posterior synechiae when other drops are
ineffective . Systemic steroids to be used when anterior uveitis not responding to topical and
periocular steroids12.
As far as we know no hospital based study has been conducted to know the prevalence of
anterior uveitis in Sundergarh District so here in the present study we will access the clinical
profile of anterior uveitis.
AIM OF STUDY
i)To study the prevalence of anterior uveitis.
ii)To study the clinical profile of anterior uveitis in terms of
1 Signs and symptoms
2 Etiopathogenesis
3 Drug compliance of the patient in accordance to treatment modality
MATERIALS AND METHODS
Study Area:- Hitech Medical College and Hospital, Rourkela, Dist- Sundergarh
Study Design- A hospital based study
Setting of Study:- OPD/ IPD, Department of Ophthalmology, Hi-tech MCH, Rourkela
Study Population:- Patient presenting with known diagnosis with anterior uveitis or
presenting with signs and symptoms of anterior uveitis.
SAMPLE SIZE
The minimum number of necessary samples calculated to meet the desired stastical
constraints is 8. This means 8 or more measurements/ surveys are needed to have a confidence
level of 95% that the real value is within +-5% of the measured/ surveyed value.
ELIGIBILITY CRITERIA-
A. INCLUSION CRITERIA-
Patient with clinical diagnosis with anterior uveitis and willing for follow -up.
B. EXCLUSION CRITERIA
1. Patient diagnosed with intermediate, posterior or panuveitis.
2. Patient with previous history of intraocular surgery.
3. Patient with penetrating ocular trauma , corneal ulcer, lens induced uveitis and
endopthalmitis.
4. Patient who are on cytotoxic drug or immunosuppressant therapy.
5. Patient lost to follow up.
STUDY TOOLS:-
1. Case report from
2. Questionnaire
3. Routine occular examination
4. Routine blood investigation
5. Consent form
Study Technique
- Patient will be enrolled after taking informed consent in his/ her own language
- History taking of the patient will be based on standard questionnaire including disease
severity, laterality, chronicity, occular sign, associated systemic condition and drug history
- All patient will undergo detailed ophthalmic examination with assessment of visual acuity
using snellen’s chart, slit lamp examination( keratic precipitates, aqueous flare, cells, posterior
synechiae) , Goldmans’s applanation tonometry for IOP measurement, slit lamp biomicroscopy
with 90D,Direct ophthalmoscope,Indirect ophthalmoscope wherever necessary.
Standardisation of uveitis nomenclature ( SUN) Working Group Grading of
anterior chamber cells( 1mm by1mm Slit Beam)
GRADE CELLS IN FIELD
0 <1
0.5+ 1-5
1+ 6-15
2+ 16-25
3+ 26-50
4+ >50
SUN Working Group Slit Lamp Grading scheme for Anterior Chamber Flare
GRADE DESCRIPTION
0 None
1+ Faint
2+ Moderate( Iris and lens details clear)
3+ Marked( Iris and lens details hazy)
4+ Intense( Fibrin or plastic aqueous)
Lab investigation will include CBC,ESR,ASO,CRP,Montoux test, Rheumatoid factor,
VDRL, Radiologic examination including X –Ray chest,sacroiliac joint, were considered
whenever required.
Severity of anterior uveitis will be tabulated according to signs as per SUN Working Group
Grading Scheme for anterior chamber cells and flare.
Patient will be directed to follow treatment as per (standard proctocol)[steroids
+cycloplegics] accoeding to severity for a minimum of 6 weeks .The response to treatment will
be noted at each follow [Link] compliance of patient will also be recorded.
DATA COLLECTION
Data from patient history ,questionnare ,ocular examination ,investigation reports will be
noted and entered in excel data sheet to form data base .
OBSERVATION
1. The observation will be compiled at the end of study.
2. Appropriate stastical software and tests will be used for data analysis .
RESULTS
Results will be derived from data analysis according to IBM SPSS 26 version
DISCUSSION
Discussion will be based on observation.
CONCLUSION
Conclusion will be presented as per observation and discussion.
CONFLICT OF INTEREST
None
ETHICAL APPROVAL
Research will be initated after due approval of Institutional Ethics Committee (IEC),Hi-Tech
Medical college and Hospital ,Rourkela
BIBLIOGRAPHY
1) Jabs DA, Nussenblatt RB, Rosenbaum JT,Standardization of Uveitis Nomenclature
(SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical
[Link] of the first international workshop. Am J Ophthalmol 2005;140:509-16.
2) Barisani- Asenbauer T,Maca SM, Mejdoubi L,Emminger W,Machold K,Auer [Link]
–a rare disease often associated with systemic disease and infections- a systemic review
of 2619 patients . Orphanet J Rare Dis.2012 Aug 29;7:57.
3) Darrell RW ,Wagener HP ,Kurland LT . Epidemiology of uveitis :incidence and
prevalance in a small urban [Link] Ophthalmol.1962 ;68:502-514.
4) Gritz DC ,Wong IG . Incidence and prevalence of uveitis in Northen California
Epidemiology of Uveitis [Link].2004;111(3):491-500; discussion 500.
5) Suhler EB ,Lloyd MJ, Choi D,Rosenbaum JT ,Austin DF .Incidence and prevalence of
uveitis in Veterans Affairs Medical Centers of the Pacific Northwest. Am J
Ophtalmol.2008 ;146(6):890-896.e898.
6) Durrani OM ,Tehrani NN, Marr JE,Moradi P,Stavrou P,Murray PI. Degree, duration,and
causes of visual loss in uveitis . Br J Opthalmol(2004)88:1159-62. Doi:10.1136/bjo.
2003.037226.
7) NO.
8) Rosenbaum JT ,Bodaghi B,Couto C ,Zierhut M,Acharya N,Pavesio C,et al . New
observations and emerging ideas in diagnosis and management of non infectious uveitis :
a review . Semin Arthritis Rheum.(2019)49: 438-45.
Doi:10.1016/[Link].2019.06.004.
9) Dandona L ,Dandona R , John RK, McCarty CA,Rao GN. Population based assessment
of uveitis in an urban population in southern India .British journal of ophthalmology.2000
Jul 1;84 (7):706-9.
10) Chang JH, Wakefield D, Uveitis :a global perspective . Ocul Immunol
Inflamm.2002;10 :263-79.
11) BCSC Basic and Clinical Science Course [Link] Consideration in
Uveitis; 5:67-92.
12) Parsons’ diseases of the eye ,23rd Edition, by Ramanjit Sihota and Dr Radhika
Tandon .Diseases of the Uveal Tract ;14:205-231.
13) John F. Salmon. Uveitis .Kanski’s Clinical Ophthalmology. 9th edition . Elsevier 2020 ;
12:424-427.
PROFORMA QUESTIONAIRE
CASE NO. REGD NO.
SEX
NAME RELIGION
AGE WARD[ ]/OPD[ ]
OCCUPATION
ADDRESS
CHIEF COMPLAINTS:
DURATION OF PRESENT COMPLAINTS
MEDICATIONS STEROIDAL / NON
STEROIDAL DROPS
YES{ }/NO{ }
HISTORY OF OTHER SYSTEMIC DISEASES:
DURATION :
MEDICATION :
EXAMINATION
VISUAL ACUITY UN AIDED AIDED
REFRACTION BCVA
OCULAR EXAMINATION:
OD OS
LID AND ADENEXA
CONJUCTIVA
CORNEA
ANTERIOR CHAMBER
PUPIL
LENS
IOP
FUNDUS EXAMINATION:
OD OS
IMPRESSION:
OD
OS
LABORATORY INVESTIGATION:
1)CBC
2)ESR
3)ASO
4)CRP
5)MANTOUX TEST
6)SERUM UREA
7)SERUM CREATININE
8)VDRL
