From the Guidelines
Anterior uveitis and anterior scleritis are primarily caused by inflammatory conditions, with the most common causes being juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), and Behçet's syndrome.
Causes of Anterior Uveitis
- Juvenile idiopathic arthritis (JIA): Chronic anterior uveitis (CAU) is a common extra-articular manifestation of JIA, particularly in children with oligoarthritis and those who are antinuclear antibody (ANA) positive 1.
- Inflammatory bowel disease (IBD): Anterior uveitis is a common ocular manifestation of IBD, and can be independent of bowel symptoms and other extra-intestinal manifestations 1.
- Behçet's syndrome: Isolated anterior uveitis can occur in patients with Behçet's syndrome, and may be treated with topical agents or systemic immunosuppressives in patients with poor prognostic factors 1.
- HLA-B27 associated conditions: Acute anterior uveitis (AAU) is often associated with HLA-B27, and can occur in patients with spondyloarthritis, such as ankylosing spondylitis and reactive arthritis 1.
Causes of Anterior Scleritis
- Inflammatory bowel disease (IBD): Anterior scleritis is a rare but potentially sight-threatening ocular manifestation of IBD, and can occur in patients with Crohn's disease or ulcerative colitis 1.
- Rheumatoid arthritis: Anterior scleritis can occur in patients with rheumatoid arthritis, particularly those with long-standing disease and extra-articular manifestations.
- Infections: Anterior scleritis can also be caused by infections, such as herpes zoster or bacterial infections. It is essential to note that the causes of anterior uveitis and anterior scleritis can vary depending on the population and the specific clinical context. A thorough diagnostic evaluation, including a complete medical history, physical examination, and laboratory tests, is necessary to determine the underlying cause of these conditions.
From the Research
Causes of Anterior Uveitis and Anterior Scleritis
- Anterior uveitis can be caused by various factors, including infections, autoimmune disorders, and trauma 2
- Anterior scleritis is often associated with systemic illnesses, such as rheumatoid arthritis and granulomatosis with polyangiitis 3
- The etiopathogenesis of scleritis is unclear, but it can be immune complex-mediated or due to a local delayed hypersensitivity reaction 3
- Anterior uveitis can accompany scleritis, and the occurrence of anterior uveitis in the course of scleritis entails a poor ocular prognosis 4
- Scleritis-associated uveitis is more common in patients with necrotizing scleritis and is associated with a higher risk of ocular complications, such as peripheral ulcerative keratitis and glaucoma 4
Systemic Associations
- Rheumatoid arthritis is the most common associated systemic rheumatic disease and the commonest systemic association of scleritis 3
- Granulomatosis with polyangiitis is the most common cause of vasculitis-associated scleritis 3
- Inflammatory bowel disease can be associated with anterior uveitis, episcleritis, or scleritis, and adequate control of ocular inflammation can be achieved with corticosteroids, systemic nonsteroidal anti-inflammatory drugs, or systemic cytotoxic immunosuppressive therapy 5
- HLA-B27-positive anterior uveitis is more refractory to corticosteroid therapy and may require systemic cytotoxic immunosuppressive therapy 5
Clinical Characteristics
- Anterior uveitis can present with anterior chamber cell and flare, and its features can be classified as granulomatous or non-granulomatous 6, 2
- Scleritis can involve either the anterior or posterior sclera and has a wide spectrum of clinical presentations, including necrotizing scleritis, which has an increased risk of complications 3
- The diagnosis of anterior uveitis and scleritis requires a comprehensive clinical examination, including a detailed history and ocular examination, as well as targeted investigations to rule out underlying systemic diseases 3, 2