Clinical Features of CMV-Associated Anterior Uveitis

Abstract

Cytomegalovirus (CMV) anterior uveitis is the most common ocular manifestation of CMV disease in immunocompetent individuals. It is thought to be due to a local reactivation of latent CMV and is usually unilateral. The acute form presents as Posner-Schlossman Syndrome, a recurrent hypertensive anterior uveitis with few granulomatous keratic precipitates. There are geographic differences in the chronic form of CMV anterior uveitis. Asian patients commonly present as Fuchs Uveitis Syndrome with diffuse stellate keratic precipitates, while the European patients present with a chronic hypertensive anterior uveitis with fewer keratic precipitates that are brown in color and located inferiorly. Characteristic features of CMV anterior uveitis include mild anterior chamber inflammation, elevated intraocular pressure, stromal iris atrophy. Synechiae, macular edema and retinitis are typically absent. CMV disease may also be associated with the development of corneal endotheliitis with a reduced endothelial cell count. Long-term complications include glaucomatous optic neuropathy and cataract formation.

Demystifying viral anterior uveitis: A review

“…CMV was not identified as a cause of FUS until in recent years when it was reported more frequently in Asia. The clinical signs of CMV‐associated FUS therefore differ in some aspects from those in RV‐associated FUS (see Table ) …”

“…Ocular discomfort and blurring of vision are the usual presenting symptoms in chronic CMV AU. Interestingly, there are geographic differences in the manifestations of chronic CMV AU . In Asian patients, CMV commonly presents as FUS with mild ocular injection, mild‐to‐moderate anterior chamber activity and fine stellate uniformly‐distributed KPs.…”

“…Unlike Asian patients who present similarly to FUS or PSS, patients in the West often present with less distinct syndromes, or an overlap of features from both syndromes, manifesting as a mild unilateral recurrent or chronic iridocyclitis …”

“…The clinical signs of CMV-associated FUS therefore differ in some aspects from those in RV-associated FUS (see Table 1). 17 Heterochromia is more apparent in light-coloured irides and may be noticed by the patient decades before visual symptoms develop. The affected eye is usually hypochromic due to diffuse pigment loss, 18,19 but may be hyperchromic when anterior stromal atrophy exposes the darker iris pigmented epithelium ( Figure 1).…”

“…Interestingly, there are geographic differences in the manifestations of chronic CMV AU. 17 In Asian patients, CMV commonly presents as FUS with mild ocular injection, mild-to-moderate anterior chamber activity and fine stellate uniformly-distributed KPs. In European patients, there are fewer pigmented KPs (Figure 3) located inferiorly and minimal flare.…”