International Journal of Innovative Research in Medical Science (IJIRMS)

Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737

Available online at - www.ijirms.in
Open Access Journal Research Article DOI: 10.23958/ijirms/vol03-i01/18

Demographic and Clinical Profile of Anterior Uveitis

Patients Presenting in a Tertiary Eye Care
Hospital
Shivcharan Lal Chandravanshi
Assistant Professor, Department of Ophthalmology, Shyam Shah Medical College, Rewa, MP

Address for Correspondence:

Dr. SCL Chandravanshi,
E-15, Old Doctor’s Colony, Rewa MP, India Pin 486001
Mobile No. +91 9977106674

Abstract
Introduction - Anterior uveitis is referred as an inflammation of the iris and ciliary body. Anterior uveitis is the most common
type of uveitis and frequently affecting young adults. Aim of this study was to evaluate the clinical presentation, etiology,
pathological pattern, complications and treatment outcome of anterior uveitis in the Rewa district of Madhya Pradesh.

Materials and Methods - A Prospective, hospital based, interventional study was conducted on all anterior uveitis patients,
treated at the Department of ophthalmology, S. S. Medical College, Rewa, Madhya Pradesh for the period of two years from
January 2016 to December 2017.

All patients aged 0-80 years that were treated for anterior uveitis are taken in consideration. Complete ophthalmic evaluation,
necessary lab investigations and imaging were performed to establish the etiology. Demographic data, uveitis characteristics,
pathological pattern, investigations, etiology, complications and the treatment outcome were collected for each patient. Patients
of anterior uveitis with incomplete investigations, intermediate, posterior and panuveitis, postoperative uveitis, sympathetic
ophthalmia, endophthalmitis and masquerade syndromes were excluded from study.

Results - Present study included 212 patients over a period of two years (January 2016 to December 2017). Anterior uveitis affect
most frequently in the 5th decade of life (33.96%). Majority of patients had non-granulomatous type of uveitis (73.11%). Etiology
of anterior uveitis remained unknown (idiopathic) in 126 cases (59.43%). The most common etiology identify in present study is
tuberculosis in 47 cases (22.16%) followed by syphilis in 8 cases (3.77%). The most common complication of anterior uveitis is
complicated cataract 18 cases (8.49%) followed by secondary glaucoma in 8 cases (3.77%).

Conclusion - This study gives valuable information on clinical and demographic characteristics of anterior uveitis in resident of
the Rewa, district of Madhya Pradesh.

Keywords - Anterior uveitis, Intermediate uveitis, Posterior uveitis, Panuveitis, Tuberculosis, Rewa District

Introduction such as rheumatoid arthritis, idiopathic juvenile arthritis,

ankylosing spondylitis, chrohn’s disease, Reiter’s syndrome,
Uveitis is a complex intraocular inflammatory disorder that sarcoidosis, herpes simplex, herpes zoster, human immune
resulted from multiple etiological factors. Anterior uveitis virus, tuberculosis, leprosy and syphilis. Trauma and
referred to inflammation of the anterior part of the uveal postoperative anterior uveitis were also common in clinical
tract, viz iris and ciliary body.[1] The pattern of anterior practice. Uveitis requires large number of investigations to
uveitis influenced by personality, several geographic, establish primary etiology. Misdiagnosis of etiology is quite
demographic and ethnic factors and also shows variable common in uveitis.[2-4]
changes over a period of time because of emerging and
identification of new uveitic entities.[2-7] Uveitis is The incidence of uveitis in developed countries has been
associated with ocular as well as many systemic disorders estimated between 17 and 52 per 100 000 of population per

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 International Journal of Innovative Research in Medical Science (IJIRMS)
Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737
Available online at - www.ijirms.in

year, and the prevalence as 38–714 cases per 100 000 of Immunological tests include Mantoux text, Venereal disease
population.[2-7] Research Laboratory (VDRL), or Rapid plasma regain
(RPR), immunofluroscent test for toxoplasmosis, antinuclear
It is a major cause of severe visual impairment. The number antibodies for juvenile rheumatoid arthritis, ELISA for
of patients blind as a result of uveitis is unknown; it has tuberculosis and rheumatoid factor. Other investigations
been estimated that uveitis accounts for 10% to 15% of all are ordered according to clinical diagnosis which included
cases of total blindness in the United States.[8] Accurate sacro-iliac joint and knee joint X-ray, X-ray chest PA view,
diagnosis of specific etiology is essential for adequate human leukocyte antigen (HLA) typing for HLA B27,
treatment of uveitis. Timely treatment may save vision in serology for herpes simplex, human immune deficiency
the eyes. virus.

So far there was no study on anterior uveitis from the Rewa

district of Madhya Pradesh about etiological pattern of
anterior uveitis. Shyam Shah Medical College, Rewa MP is
a tertiary care hospital and taking care of Rewa (Population
2.8 lacs), Satna, Sidhi, Singrauli, Shahdol, Umaria, Katni
and other adjacent districts. Large number of patients of
anterior uveitis present to the ophthalmology outpatient
department. Hence, this prospective study was conducted to
evaluate clinical presentation, etiology, pathological pattern,
complications and treatment outcome of anterior uveitis in
the Rewa district of Madhya Pradesh. Only residents of the
Rewa District were included in the study. We followed a
standard protocol and the results were compared with the
pattern of anterior uveitis in other geographic area of India
and other parts of the world.
Figure 1: Slit lamp image showing fine keratic
Materials and Methods
precipitates on back of cornea in idiopathic anterior
This is hospital based, interventional, non-randomized, uveitis
prospective study. The study was conducted at department
of ophthalmology, Shyam Shah Medical College, Rewa MP.
All newly diagnosed anterior uveitis patients presenting
from January 2016 to December 2017 were included in
study. Demographic data (age sex, address), ocular and
systemic complaints, past history of ophthalmic and
systemic disorders were recorded. Slit-lamp assisted anterior
segment examination was done to record presence of ciliary
congestion; presence, distribution and type of keratic
precipitates (figure 1); grade of anterior chamber reaction,
hypopyon, presence and type of anterior synechiae (figure
2); iris atrophic patches, iris color and nodule; status of
crystalline lens and grading of cells in anterior vitreous.
Intraocular pressure was measured with Goldmann
applanation tonometer. Posterior segment examination was
carried out with the help of direct and indirect
ophthalmoscope and 90 D lens. Fundus Fluorescein Figure 2: Slit-lamp examination showing synechiae in
angiography, B-scan ultrasonography, ultrasound patient with anterior uveitis
biomicroscopy and optical coherence tomography were
Inclusion criteria
performed to rule out intermediate or posterior uveitis or
complication of anterior uveitis. Systemic evaluation was  All cases of anterior uveitis treated at department
done by physician to rule out systemic disorders. All of ophthalmology, S. S. Medical College, the
patients underwent routine blood investigations which Rewa, MP, India were taken into consideration
includes complete blood count, blood sugar, erythrocyte  Patients from the Rewa District.
sedimentations rate, urine routine and microscopy.

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 International Journal of Innovative Research in Medical Science (IJIRMS)
Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737
Available online at - www.ijirms.in

Exclusion criteria

 Patients with incomplete investigations and non

resident of the Rewa District
 Patients with intermediate, posterior and panuveitis
 Patients with postoperative uveitis
 Sympathetic ophthalmia
 Masquerade syndromes
 Endophthalmitis

All patients were treated with oral steroids, atropine 1%

ointment and topical prednisolone1%. Some patients with
recurrent uveitis were treated with posterior sub-Tenon’s
Triamcinolone Acetonide, 20 mg, injection. Oral
prednisolone 1mg/kg body weight with pentoprazole 40 mg
once a day. Patients recalcitrant with oral steroid were
received azathioprime 50 mg once a day. Specific
underlying disorder treated as per standard guidelines.
Children with juvenile rheumatoid arthritis associated
anterior uveitis were treated with intravenous methyl
prednisolne followed by oral prednisolone for several
weeks. All patients initially reviewed on weekly bases than
once a month for 1 year. During follow up every patient was
examined for visual acuity, anterior chamber reaction, lens
opacity, intraocular pressure and fundus examination. Figure 3: (A) Slit-lamp photograph showing complicated
Complicated cataract was treated with small incision cataract, (B) Hand deformities in patient with long
cataract extraction with posterior chamber intraocular lens standing rheumatoid arthritis.
implantation under local anesthesia. Patients with secondly
glaucoma were treated with topical antiglaucoma
medications. Patient data were feed in excel sheet and
analyzed. Informed consent was obtained from all
participants before study. During entire study periods
investigator adhered to the tenets of Declaration of Helsinki.
Written consent was taken from all participants prior to
study. Results were expressed in percentage.

Results

Total 212 cases of anterior uveitis were seen from January

2016 to December 2017 at our centre. Annual incidence of
anterior uveitis is 37.85 per 100000 in present study.
Anterior uveitis seen most frequently in the 5th decade of
life (33.96%) followed by the 3rd decade of life (27.35%)
(Table 1). Out of 212 anterior uveitis patients 59.43% were
males and 40.09% were females (Table 2). Majority of
patient have unilateral involvement. Bilateral anterior uveitis
is seen in only 5.66% cases (Table 3). Acute anterior uveitis
was seen in 82.07% of cases. Only 11.32% cases have
recurrent episodes of disease and 6.6% cases turned up into
chronic course (Table 4).

Figure 4: (A) Slit-lamp photograph showing mutton fat

keratic precipitates on back of cornea in anterior uveitis
secondary to leprosy.(B) Numerous nodule on skin in
patient with lapromatous leprosy.
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 International Journal of Innovative Research in Medical Science (IJIRMS)
Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737
Available online at - www.ijirms.in

Table no. 5. Etiology of anterior uveitis

Etiology of Anterior No of patients Percentage
uveitis 212 (%)
Idiopathic 126 59.43
Tuberculosis 47 22.16
Syphilis 8 3.77
Rheumatoid arthritis 6 2.83
Phacogenic 5 2.35
Fuchs uveitis 4 1.88
Herpes simplex 3 1.41
JIA 3 1.41
HIV 2 0.94
Trauma 2 0,94
Ankylosing spondylitis 2 0.94
Figure 5: Slit-lamp photograph showing fungal colony Leprosy 2 0.94
and fibrious exudation in anterior chamber after Infective 1 0.47
penetration injury. Behcet’s 1 0.47
Table no 1. Age distribution of patients with anterior Table no. 6. Pathological pattern of anterior uveitis
uveitis Pathological pattern No of Percentage
Age No of Percentage (%) of anterior uveitis patients (%)
(years) patients
Non-granulomatous 155 73.11
0-10 2 0.94
Granulomatous 57 26.88
11-20 7 3.30
21-30 22 10.37 Table no 7. Complications of anterior uveitis
31-40 58 27.35 Complication No of Percentage
patients (%)
41-50 72 33,96
Complicated cataract 18 8.49
51-60 27 12.73 Secondary Glaucoma 8 3.77
61-70 14 6.60 Phthisis bulbi 1 0.47
71-80 8 3.77 Painful blind eye 1 0.47
81-90 2 0.94 In anterior uveitis, specific diagnosis could be made in 86
Table no 2: Gender distribution of patients with anterior cases (40.57%), of which the most common underlying
uveitis cause was tuberculosis in 47 cases (22.16%) followed by
syphilis in 8 cases (3.77%), Rheumatoid arthritis (figure 3)
Gender No of patients Percentage (%)
in 6 cases (2.83%). Other causes were phacogenic uveitis in
Males 126 59.43 5 cases (2.35%), Fuchs heterochromic cyclitis 4 cases
Females 85 40.09 (1.88%), herpes simplex uveitis 3 cases (1.41%), juvenile
Transgender 1 0.47 idiopathic arthritis 3 cases (1.41%) and leprosy ((figure 4) in
2 cases (0.94%). Other specific uveitis etiology is shown in
Table no. 3: Laterality anterior uveitis Table 5. Diagnosis remained idiopathic in 126 cases
Laterality No of patients Percentage (59.43%). One case of trauma has developed fungal uveitis
Unilateral 200 94.33 (figure 5).

Bilateral 12 5.66 Non-granulomaous uveitis seen in 73.11% cases while

granulomatous uveitis seen only in 26.88% cases (Table 6).
Table no 4. Clinical presentation of anterior uveitis Most cases responded well to treatment. Complicated
Clinical No of patients Percentage cataract was formed in 8.49% of cases while secondary
presentation glaucoma developed in 3.77% cases (Table 7).
Acute 174 82.07
Recurrent 24 11.32 Discussion
Chronic 14 6.60 To identify the pattern of anterior uveitis in the Rewa
district of Madhya Pradesh, a prospective study was carried
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Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737
Available online at - www.ijirms.in

out on all cases of anterior uveitis seen at Department of segment of the eye. Typical tubercular uveitis is
ophthalmology, S. S. Medical College. Total 212 cases of granulomatous type of uveitis but non-granulomatous
anterior uveitis were seen. Annual incidence of anterior uveitis also a rare presentation. There may be nodular
uveitis is 37.85 per 100000 in present study. The incidence lesions on the iris and angle of anterior chamber. A high
of uveitis in the developed countries has been estimated index of suspicious based on clinical findings such as
between 17 and 52 per 100 000 of population per year, and granulomatous type of uveitis, poor response to steroids,
the prevalence as 38-714 cases per 100 000 of population. recurrence after stopping steroids, pigmented hypopyon, and
Anterior uveitis seen most frequently in the 5th decade of early neovascularization of iris should be helpful in correct
life (33.96%) followed by 4th decade of (27.35%) in this diagnosis of tubercular uveitis. Standard antitubercular
study. In Hyderabad study, Hussain and Mirza, observed treatment must be given to patient with probable/confirmed
that 40-50 years age group is more prone for anterior uveitis tubercular anterior uveitis. The duration of therapy should
(27.53%).[9] be for 6-9 months.

Biswas et al conducted study in Chennai and disclosed Ocular leprosy can manifest with episcleritis, scleritis,
maximum incidence of uveitis at 5th decade of life. [10] keratitis and iritis but the most common cause of blindness
Similarly other researcher also noted that uveitis is more in this disease is the chronic low grade anterior uveitis that
common among 40-50 years age group.[11-12] However Singh is usually asymptomatic until the late stage of the disease. In
et al reported anterior uveitis in the 4th decade of life.[13] our study nongranulomatous uveitis is seen in 73.11% of
Anterior uveitis is less common under 10 years of age and patient of anterior uveitis while 26.88% patients have
above 60 years of age.[11] granulomatous uveitis. Sudha Madhavi et al reported
nongranulomatous uveitis in 90% of cases and only 10% of
Out of 212 anterior uveitis patients 59.43% were males and patient had granulomatous uveitis in Karnataka.[17]
40.09% weres female in present study. Anterior uveitis is
more frequently seen in males than females.[10-14] Juvenile Intraocular fungal infection can develop in a variety of
idiopathic arthritis is a type of auto-immune arthritis that patients including immunosuppresed patients,
affect children below the age of 16 years. It is more immunocompetent patient with systemic mycotic infection,
common in females than males.[10,12] intravenous drug users, patients who have undergone ocular
trauma or ocular surgery and postoperative patients. One
Majority of patient have unilateral involvement. Bilateral case develops fungal anterior uveitis after penetrating injury
anterior uveitis is seen in only 5.66% cases in this study. which was managed with topical and systemic antifungal
Most of the patients had unilateral presentation. Rathinam et treatment.
al reported 85.3% unilateral presentation in their study.[11]
Both right and left eyes have equal predilection of disease. Uveitis is associated with a wide variety of ocular
complications including cataract, glaucoma, band shaped
Acute anterior uveitis was seen in 82.07% of cases. Only keratopathy, macular edema, epiretinal membrane,
11.32% cases have recurrent episodes of disease and 6.6% proliferative vitreoretinopathy, neovascularization of
cases turned up into chronic course in present study. Sudha choroid and retina, painful blind eye and phthisical eye.
Madhvi et al from Karnataka reported about 75.86% of These complications often result in visual impairment. In the
acute anterior uveitis and 17.82% had chronic, and 6% had present study, complications were seen in 28 eyes (13.20%).
recurrent uveitis.[17] Most common complication was complicated cataract
formation seen in 18 eyes (8.49%), followed by secondary
Specific etiology of anterior uveitis was established only in
glaucoma 8 eyes (3.77%) painful blind eye 1 case (0.47%),
40.57% in present study. Singh et al identified specific
and phthisical eye 1 case (0.47%). %). Rothova et al19
etiology of uveitis in 48.82% of cases.[13] Specific etiology
reported cataract in 19% cases, glaucoma 11% cases and
of uveitis detection possible nearly 50% of cases. The most
phthisical eye in 2.4% cases. Cataract formation in uveitis is
common underlying cause of anterior uveitis was
usually developed by uncontrolled prolonged inflammation
tuberculosis, 47 cases (22.16%) followed by syphilis in 8
and long term use of high doses of topical as well as
cases (3.77%), and Rheumatoid arthritis in 6 cases (2.83%).
systemic steroid. All patients with complicated cataract
Das et al identified collagen disease (29.4%) as a most
underwent small incision cataract extraction with PMMA
common identifiable cause for anterior uveitis.[18] Rathinam
intraocular lens implantation under steroid coverage. All
et al identified leptospiral uveitis as a most common
patients had best corrected vision 6/6 in the operated eye.
identifiable etiology of uveitis in their study.[11]
Both, Secondary open angle and secondary angle closure
Tuberculosis, syphilis and leprosy are common causes of glaucoma can develop in uveitis patients. Secondary open
granulomatous uveitis in the developing countries. angle glaucoma develops due to blockage of trabecular
Tuberculosis can involve both the anterior and posterior meshwork by inflammatory cells, protein particles, debris or

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Volume 03 Issue 01 January 2018, ISSN No. - 2455-8737
Available online at - www.ijirms.in

fibrinous material release from disruption of blood-aqueous [11] Rathinam SR, Namperumalsamy P. Global
barrier. In chronic cases scarring and obliteration of variation and pattern changes in epidemiology of
trabecular meshwork may lead to secondary open angle uveitis. Indian J Ophthalmol. 2007; 55:173–83.
glaucoma in uveitis. Secondary angle closure glaucoma can [12] Dogra M, Singh R, Agarwal A, Sharma A, Singh
resulted from various mechanisms such as pupillary block, SR, Gautam N, Yangzes S, Samanta R, Sharma M,
360 degree of posterior synechial closer of angle, and Aggarwal K, Sharma A, Sharma K, Bansal R,
neovascularization in angle. Secondary glaucoma managed Gupta A, Gupta V. Epidemiology of Uveitis in a
with topical anti-glaucoma medicine and none of patient Tertiary-care Referral Institute in North India. Ocul
required filtration surgery. Immunol Inflamm. 2017;25(sup1):S46-S53
[13] Singh R, Gupta V, Gupta A. Pattern of uveitis in a
Conclusion referral eye clinic in North India. Indian J
Ophthalmol. 2004;52:121–5
In this study, there was higher incidence of uveitis in 40-50
[14] Gautam N, Singh R, Agarwal A, Yangzes S, Dogra
year of age. Idiopathic type of anterior uveitis is common in
M, Sharma A, Bansal R, Gupta V, Dogra MR,
the Rewa district of Madhya Pradesh. Granulomatous type
Gupta A. Pattern of Pediatric Uveitis at a Tertiary
of uveitis secondary to tuberculosis and syphilis also kept in
Referral Institute in North India. Ocul Immunol
mind during dealing a patient of anterior uveitis in the
Inflamm. 2016 Oct 21:1-7.
Rewa, district of Madhya Pradesh.
[15] Das D, Biswas J, Ganesh SK. Pattern of uveitis in a
referral uveitis clinic in India. Indian J Ophthalmol.
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