Patient: Doctor, my right eye is red, painful, and I can barely open my eyes in the light. It started about two days ago and it feels like it has gotten worse.
Doctor: Has it happened before?
Patient: No.
Doctor: Let me take a look
The doctor examines the eye through a slit lamp and sees:
- Cells: inflammatory cells (white blood or lymphocytes) in the anterior chamber
- Redness: due to vasodilation from chemical mediators of the inflammatory process
Doctor: Based on the appearance of your eye and your symptoms it appears you have anterior uveitis, which is a fancy way of saying you have inflammation of the anterior part of your eye. You are experiencing common symptoms of uveitis like pain, light sensitivity, and redness. Tearing and blurred vision are also very common symptoms as well.
Patient: What caused it?
Doctor: In many cases, anterior uveitis can be related to a disease such as arthritis or it can be caused by infectious diseases like Lyme disease or tuberculous, and it can also be idiopathic. Because this is your first occurrence of uveitis, I will continue to monitor you. If it happens again, I will send you to your primary care provider to rule out any systemic disease or infectious cause.
Patient: What are the next steps?
Doctor: I am going to prescribe you a steroid which is an anti-inflammatory drop to calm down the inflammation. Because of your pain level, I am also going to prescribe you a cycloplegic drop which dilates the eye and decreases pain. I will see you back in 1 week to follow up on the status of the inflammation. It’s important to keep with your follow-ups because uveitis is a potentially sight-threatening condition because the inflammation is in the eye.
Patient: I understand. How long will I have to be on the drops?
Doctor: It depends on how quickly the inflammation resolves, but it can be anywhere to 4-6 weeks. Next week I will reassess the inflammation and if it has gone down significantly from today we can start tapering you off the steroid drop. We will tapper the steroid drop to prevent rebound inflammation. Also by next week if there is an improvement you will be able to stop the cycloplegic drop.
Patient: Okay that sounds good.
Doctor: I’ll see you next week but your condition worsens in the next week come back sooner
Patient: Thank you, Doctor!
Recap:
Anterior uveitis is inflammation of the anterior uveal tract which consists of the iris, ciliary body, and choroid. Common signs and symptoms are pain, light sensitivity, redness, blurred vision, and tearing. If you have any of these signs and symptoms it’s important to get them checked out because it can be a sight-threatening condition if left untreated. However when diagnosis early uveitis usually responds well to treatment. Once uveitis has subsided it is possible for the uveitis to reoccur. If it does then there may be an underlying systemic etiology - which would warrant blood workup to determine a cause.
https://timroot.com/cell-and-flare-in-the-eye-video/
https://www.tuyenlab.net/2018/03/emergency-atlas-of-anterior-uveitis.html