Demystifying viral anterior uveitis: A review

Abstract

A viral aetiology should be suspected when anterior uveitis is accompanied by ocular hypertension, diffuse stellate keratic precipitates or the presence of iris atrophy. The most common viruses associated with anterior uveitis include herpes simplex virus, varicella‐zoster virus, cytomegalovirus and rubella virus. They may present as the following: Firstly, granulomatous cluster of small and medium‐sized keratic precipitates in Arlt's triangle, with or without corneal scars, suggestive of herpes simplex or varicella‐zoster virus infection. Secondly, Posner‐Schlossman syndrome with few medium‐sized keratic precipitates, minimal anterior chamber cells and extremely high intraocular pressure; this is mainly associated with cytomegalovirus. Thirdly, Fuchs uveitis syndrome, with fine stellate keratic precipitates diffusely distributed over the corneal endothelium, with diffuse iris stromal atrophy but without posterior synechiae, is associated mainly with rubella or cytomegalovirus infection. In rubella, the onset is in the second to third decade. It presents with posterior subcapsular cataract, may have iris heterochromia and often develops vitritis without macular oedema. Cytomegalovirus affects predominantly Asian males in the fifth to seventh decade, the keratic precipitates may be pigmented or appear in coin‐like pattern or develop nodular endothelial lesions, but rarely vitritis. Eyes with cytomegalovirus tend to have lower endothelial cell counts than the fellow eye. As their ocular manifestations are variable and may overlap considerably, viral AU can pose a diagnostic dilemma. Thus, quantitative polymerase chain reaction or Goldmann‐Witmer coefficient assay from aqueous humour samples are preferred to confirm the aetiology and determine the disease severity as this impacts the treatment.

Varicella Zoster Virus Anterior Uveitis Complicated by Thalamic Stroke

“…Anterior uveitis is deemed to be idiopathic in approximately 50% of cases and often does not require extensive workup, particularly for the rst episode of anterior uveitis; however, a viral etiology (i.e. varicella zoster, herpes simplex, cytomegalovirus, or rubella) should be strongly considered in the differential diagnosis when uveitis is accompanied by ocular hypertension or iris atrophy, both of which were observed in our patient's case [2].…”

Increased incidence of glaucoma medication usage in middle-aged Australian males taking antiretroviral medication – a population-based study

“…However, hypertensive uveitis in HIV/AIDS is uncommon, with the reported incidence of uveitis in HIV/AIDS ranging from 0.8 to 5.0% [ 45 – 47 ]. It is typically associated with viral infections such as varicella zoster, herpes simplex and CMV anterior uveitis [ 48 , 49 ], as well as other infections such as toxoplasmosis and syphilis [ 50 ]. While HIV is a risk factor for the development of herpes zoster ophthalmicus (HZO) which can cause a hypertensive uveitis in up to 56% of HZO cases [ 51 – 56 ], the overall incidence of HZO in HIV/AIDS patients is low [ 57 ].…”

Flow Cytometric Analysis of T Lymphocytes and Cytokines in Aqueous Humor of Patients with Varicella Zoster Virus-mediated Acute Retinal Necrosis

“…It keeps di cult to nd out the cause of uveitis at early stage for clinicians [1]. However, more and more evidence showed that viruses may be the causes for some uveitis with unknown causes previously, such as Posner-Schlossman syndrome [2][3][4] and Fuchs uveitis syndrome [5,6]. Since the intraocular cytokine environment and molecular mechanisms and the in ltrating intraocular in ammatory cells or cytokines varied remarkably between viral infectious uveitis and non-viral infectious uveitis [7], it may be a potential way to analyzing the intraocular in ammatory cells and cytokines for clinicians to partially con rm the presumed viral-induced uveitis, even when the PCR of speci c viruses is negative.…”