Treatment and Management

Once the diagnosis has been made, it is usual to embark on a number of investigations, guided in part by the history and especially taking into account any previous chest or joint disease. An X-ray of the chest, and a blood count, including measurement of the erythrocyte sedimentation rate (ESR), are routine in most clinics, but the expense of further investigations is now often spared if the patient appears completely fit and well in other respects. The history and background of the patient might lead one to suspect the possibility of venereal disease. In the case of some infective types of anterior uveitis, the diagnosis is usually made before the uveitis appears because the condition occurs as a secondary event. This is the case following herpes simplex keratitis and also in patients with herpes zoster affecting the upper division of the fifth cranial nerve. By contrast, anterior uveitis can be an important clue to the diagnosis of a venereal disease.

The treatment involves the administration of local steroids and mydriatic drops. When the condition is severe, a subconjunctival injection of steroid should be given and relief of symptoms can be further achieved by local heat in the form of a warm compress. Atropine is the mydri-atic of first choice except in the mildest cases, when homatropine or cyclopentolate drops can be used. Steroid drops should be administered every hour during the acute stage and then gradually tailed off over a period of a few weeks. Systemic steroids are not usually indicated and should be reserved for those cases in which the sight becomes seriously jeopardised. If any underlying systemic disease is identified, then, of course, this should also be treated if effective treatment is available. The proper management of anterior uveitis demands the expertise of a specialist ophthalmologist and, when the condition is affecting both eyes, it might be preferable to admit the patient to hospital.

A special word of warning is needed for those patients who have undergone previous intraocular surgery. For these patients, what is normally a mild infective conjunctivitis can lead to intraocular infection. The development of anterior uveitis, weeks, and occasionally even years, after the operation, can indicate disastrous consequences if urgent and intensive antibiotic treatment is not applied.

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