OP6.1-4 | Iris, Uvea and Anterior Chamber — Glossary

Grade IV total hyphema where the entire anterior chamber is filled with dark, clotted blood; the eye appears dark through the cornea; highest risk of corneal blood staining and secondary glaucoma.

Anti-TNF-α monoclonal antibody; the only biologic agent FDA-approved specifically for JIA-associated non-infectious uveitis in paediatric patients; used in refractory uveitis when steroids and methotrexate are insufficient.

An antifibrinolytic agent (inhibits fibrinolysis of the clot) used to reduce the risk of rebleed in traumatic hyphema; prevents premature dissolution of the clot before vessel healing.

A chronic HLA-B27-associated seronegative inflammatory arthritis primarily affecting the sacroiliac joints and spine; causes morning stiffness (improved by exercise), progressive spinal fusion (bamboo spine on X-ray), and acute non-granulomatous anterior uveitis in 25–40% of patients.

Standard four-drug regimen for tuberculosis (isoniazid, rifampicin, pyrazinamide, ethambutol for 2 months; then isoniazid and rifampicin for 4 months); used empirically in India for granulomatous uveitis with positive Mantoux/IGRA in the absence of other identified cause.

Visible scatter (Tyndall effect) of a slit-lamp beam passing through the anterior chamber due to elevated protein content from blood–aqueous barrier breakdown; graded 1+ to 4+.

Rapidly devastating endophthalmitis caused by Bacillus cereus, associated with ocular injury by organic material (soil, vegetable matter); produces exotoxins causing retinal necrosis within 12–24 hours; one of the most aggressive forms of post-traumatic endophthalmitis.

Calcium deposition in Bowman's layer and superficial corneal stroma in a horizontal band across the interpalpebral zone; a classical complication of JIA-associated chronic uveitis and hypercalcaemia; treated with EDTA chelation after superficial keratectomy.

A systemic vasculitis characterised by the classic triad of recurrent oral aphthous ulcers, genital ulcers, and ocular inflammation (uveitis with migratory hypopyon); most common along the 'Silk Road' (Turkey, Middle East, Central Asia, East Asia); male-predominant.

Functional barrier formed by tight junctions between iris capillary endothelial cells and non-pigmented ciliary epithelial cells; prevents protein and leucocytes from entering the aqueous under normal conditions; breaks down in anterior uveitis.

Iris nodules situated on the anterior iris stroma surface (not at the pupillary margin); found only in granulomatous uveitis.

Honest, evidence-based reassurance that acknowledges real risks while affirming a positive prognosis with adherent management; avoids both catastrophising and false reassurance; 'With proper treatment and follow-up, most patients with uveitis maintain good vision — but this requires regular check-ups and careful use of your medications.'

Circumcorneal brick-red injection of the deep episcleral/limbal vessels (anterior ciliary artery branches) that supply the ciliary body; characteristic of deep intraocular inflammation; does not blanch with topical phenylephrine.

Cytomegalovirus retinitis occurring in severely immunocompromised patients (HIV with CD4 count <50 cells/μL); characterised by full-thickness retinal necrosis with haemorrhage along vascular arcades ('pizza-pie' appearance); treated with ganciclovir/valganciclovir.

Posterior subcapsular lens opacity developing as a complication of chronic uveitis (from inflammation-induced lens metabolic disruption) or prolonged corticosteroid use; managed by phacoemulsification during a quiescent phase.

Permanent yellow-brown discolouration of the corneal stroma caused by haemoglobin breakdown products diffusing into the stroma; occurs when total (Grade IV) hyphema persists for >5 days with elevated IOP; may require corneal transplantation.

Paralysis of the ciliary muscle and iris sphincter using anticholinergic drops (atropine, homatropine); used in iridocyclitis to dilate the pupil, prevent posterior synechiae, and relieve ciliary spasm pain.

Accumulation of fluid in the outer plexiform and inner nuclear layers of the macula in a cystoid (flower-petal) pattern, due to breakdown of the perifoveal blood–retinal barrier; the leading cause of visual loss in chronic uveitis; diagnosed by OCT and FFA.

Serious intraocular infection involving the vitreous cavity; may be exogenous (post-operative, post-traumatic) or endogenous (haematogenous); presents with pain, reduced vision, hypopyon, and vitreous haze; requires immediate vitreous tap and intravitreal antibiotics.

A landmark randomised controlled trial that established the role of immediate vitrectomy (superior for hand-movement or worse vision) vs intravitreal antibiotics alone (equivalent for light perception or better) in post-operative bacterial endophthalmitis management.

The eye that has sustained penetrating injury or surgery and initiates the immunological sensitisation leading to sympathetic ophthalmia; the uveal antigens exposed at the wound site prime T-lymphocytes that then attack melanocyte-associated antigens in both eyes.

A chronic, unilateral, low-grade granulomatous uveitis characterised by fine stellate KPs distributed evenly across the entire endothelium, iris heterochromia (affected eye lighter), absence of posterior synechiae, and complicated cataract as the main complication.

Retinal vascular imaging technique using intravenous fluorescein dye; detects vascular leakage patterns in CMO (flower-petal petaloid staining), neovascularisation, and retinal vasculitis in posterior uveitis.

Uveitis characterised by mutton-fat KPs (large, greasy, composed of epithelioid macrophages) and iris nodules (Koeppe at pupillary margin; Busacca on iris stroma); associated with sarcoidosis, TB, VKH, leprosy.

Human leukocyte antigen associated with spondyloarthropathies (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD-related arthropathy); the strongest genetic risk factor for acute non-granulomatous anterior uveitis.

Presence of blood (red blood cells) in the anterior chamber of the eye; appears as a red/dark red horizontal level settling under gravity in the inferior AC; most commonly caused by blunt ocular trauma.

Layered collection of white cells in the inferior anterior chamber, visible as a white level; in iridocyclitis represents intense sterile inflammation; distinguished from infective endophthalmitis by context and other clinical features.

Antibiotics injected directly into the vitreous cavity for treatment of bacterial endophthalmitis; standard combination: vancomycin 1 mg/0.1 mL (gram-positive cover) + ceftazidime 2.25 mg/0.1 mL (gram-negative cover); given immediately following vitreous tap for culture.

Inflammation of the iris and ciliary body together; the most common form of anterior uveitis, presenting with ciliary flush, KPs, aqueous cells/flare, miosis, and risk of posterior synechiae.

Traumatic avulsion/separation of the iris root from the ciliary body, often associated with hyphema; appears as a dark crescentic defect at the peripheral iris; may cause monocular diplopia and is an indication for surgical repair.

Forward bowing of the peripheral iris caused by aqueous accumulation behind the closed pupil (seclusio pupillae); produces secondary angle-closure glaucoma as the peripheral iris contacts the trabecular meshwork.

Deposits of inflammatory cells, fibrin, and pigment on the corneal endothelium; seen at slit-lamp; morphology (fine vs mutton-fat) distinguishes non-granulomatous from granulomatous uveitis.

Iris nodules situated at the pupillary margin (pupillary ruff); seen in granulomatous uveitis (sarcoidosis, TB); distinguished from Busacca nodules (on the iris stroma).

Creation of a small hole in the peripheral iris using Nd:YAG or argon laser, bypassing the pupil to restore aqueous flow from posterior to anterior chamber; the definitive treatment for iris bombé from seclusio pupillae.

Antimetabolite (folate antagonist) used as a steroid-sparing immunosuppressant in chronic uveitis, particularly JIA-associated disease; given weekly (7.5–25 mg) with folate supplementation; requires LFT and FBC monitoring.

Large, greyish-white, greasy-appearing KPs composed of epithelioid macrophages and giant cells; pathognomonic of granulomatous uveitis; distributed broadly on the corneal endothelium.

More common type of anterior uveitis; fine stellate KPs in Arlt's triangle; no iris nodules; typically acute onset; strongly associated with HLA-B27-positive spondyloarthropathies.

Non-invasive, cross-sectional retinal imaging using near-infrared light; the investigation of choice for detecting and monitoring CMO, epiretinal membrane, and retinal thickness in uveitis; guides treatment response assessment.

Premature whitening of hair, eyelashes, or eyebrows due to melanocyte destruction; a dermatological feature of VKH syndrome alongside vitiligo and alopecia.

Adhesion between the posterior surface of the iris and the anterior lens capsule, caused by inflammatory exudate; irregular pupil on examination; widespread synechiae (360°) → seclusio pupillae → iris bombé → secondary angle-closure glaucoma.

The preferred topical corticosteroid for anterior uveitis due to its superior anterior chamber penetration compared to dexamethasone; instilled as frequently as hourly in severe active disease and tapered by reducing frequency (not concentration).

Class of IOP-lowering agents (latanoprost, bimatoprost, travoprost) that increase uveoscleral outflow; CONTRAINDICATED in active uveitis as they enhance prostaglandin-mediated intraocular inflammation.

HLA-B27-associated triad of urethritis/cervicitis + arthritis + conjunctivitis/uveitis occurring 1–4 weeks after a genitourinary (Chlamydia) or gastrointestinal (Salmonella, Shigella, Yersinia, Campylobacter) infection; formerly called Reiter's syndrome.

Secondary haemorrhage from a traumatic hyphema, typically occurring on days 2–5 post-injury as the initial clot undergoes fibrinolysis before the torn vessel has healed; produces a larger hyphema and worsens prognosis significantly.

Pathological neovascularisation of the iris (new blood vessel growth on the iris surface); occurs in ischaemic conditions (proliferative diabetic retinopathy, CRVO, ocular ischaemic syndrome); the fragile new vessels bleed spontaneously, causing non-traumatic hyphema.

Complete 360° posterior synechiae occluding the pupil, preventing aqueous flow from posterior to anterior chamber, leading to iris bombé and secondary angle-closure glaucoma.

IOP elevation caused by corticosteroid use (topical, periocular, or systemic) through increased trabecular meshwork resistance; occurs in approximately 30% of users (mild rise) and 4–6% (significant rise); requires IOP monitoring at every visit during steroid treatment.

Injection of corticosteroid (triamcinolone acetonide) into the sub-Tenon's space (between Tenon's capsule and sclera) at the superotemporal quadrant; delivers high local concentration to the posterior segment with reduced systemic absorption; used for posterior uveitis and CMO.

The Standardisation of Uveitis Nomenclature Working Group — an international expert group that established the current anatomical classification and grading standards for uveitis (published 2005).

A distinctive fundus appearance in the convalescent phase of VKH syndrome; diffuse depigmentation of the retinal pigment epithelium gives the fundus a reddish-orange (sunset) appearance; indicates chronic/burnt-out disease stage.

Bilateral granulomatous uveitis following penetrating injury or intraocular surgery; the injured eye is the exciting eye, the fellow uninjured eye is the sympathising eye; enucleation of the exciting eye within 2 weeks of injury can prevent sympathetic ophthalmia; after 2 weeks, enucleation does not reliably prevent it.

The fellow (uninjured) eye that develops bilateral granulomatous uveitis in sympathetic ophthalmia; the primary visual concern since the injured eye often has poor prognosis from the original trauma.

Sterile, non-infectious acute inflammation of the anterior segment following intraocular surgery, caused by toxic contamination of intraocular instruments or fluids; presents within 12–24 hours of surgery with hypopyon and corneal oedema; aqueous culture is negative; responds to topical corticosteroids.

A patient communication technique in which the clinician asks the patient to explain what they have just been told in their own words; used to verify understanding and identify gaps; 'Can you tell me in your own words how you will use these drops?'

The most common cause of posterior uveitis globally; caused by Toxoplasma gondii; presents as a focal pale necrotising active lesion adjacent to an old pigmented chorioretinal scar ('headlight in fog'); usually reactivation of congenital infection; treated with pyrimethamine + sulfadiazine + folinic acid.

Inflammation of the uveal tract (iris, ciliary body, and/or choroid); classified anatomically by the SUN Working Group into anterior, intermediate, posterior, and panuveitis based on the primary site of involvement.

Bilateral granulomatous panuveitis with exudative retinal detachment; associated with melanocyte-targeting immune attack producing neurological (meningism, tinnitus, CSF pleocytosis) and dermatological (vitiligo, alopecia, poliosis) features; more common in pigmented races; treated with high-dose systemic corticosteroids.