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. 2022 Dec 27;36(4):356-364.
doi: 10.4103/sjopt.sjopt_80_22. eCollection 2022 Oct-Dec.

Viral anterior uveitis

Fabrizio Gozzi  1 , Pietro Gentile  2 , Luca De Simone  1 , Elena Bolletta  1 , Federica Alessandrello  3 , Lucia Belloni  4 , Martina Bonacini  4 , Stefania Croci  4 , Alessandro Zerbini  4 , Luca Cimino  1   5
Affiliations

Viral anterior uveitis

Fabrizio Gozzi et al. Saudi J Ophthalmol. .

Abstract

Anterior uveitis has various causes, but the majority of cases are viral induced. The most common viral anterior uveitis etiology includes double-stranded DNA viruses of the Herpesviridae family, including Alpha herpes virinae (herpes simplex 1 and 2 and varicella zoster virus), Beta herpesvirinae (cytomegalovirus), and less frequently, Gamma herpesvirinae (Epstein-Barr virus). In the last few decades, a growing body of evidence has correlated Fuchs uveitis etiology to the rubella virus from the Matonaviridae family, which has a single-stranded RNA genome. The clinical presentation of each of these uveitis is hypertensive granulomatous anterior uveitis; however, the very slight differences between them, which often overlap, make differential diagnosis sometimes difficult. Therefore, diagnostic laboratory tests such as polymerase chain reaction and antibody index or Goldmann-Witmer coefficient analyses on the aqueous humor help to identify the etiology in doubtful cases and thus to plan targeted treatment.

Keywords: Antibody index; herpes virus; polymerase chain reaction; rubella virus; viral anterior uveitis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Herpes simplex virus anterior uveitis. (a) Sectoral iris atrophy visible on slit lamp retroillumination. (b) Mutton-fat keratic precipitates typically distributed in a wedge-shaped region on the inferior corneal endothelium, known as Arlt's triangle
Figure 2
Figure 2
Varicellazoster virus anterior uveitis. Sectoral iris atrophy visible on slit lamp retroillumination (more extended and defined than herpes simplex virus uveitis)
Figure 3
Figure 3
Cytomegalovirus anterior uveitis. (a) Coin-shaped keratic precipitates, (b) Same precipitates at higher magnification
Figure 4
Figure 4
Fuchs uveitis. (a) Stellate keratic precipitates throughout the corneal area, (b) Koeppe nodules localized at the pupillary margin (white arrow) and normal radial iris vessels that become visible because of iris atrophy (black arrows), (c) Anterior vitreous cells
Figure 5
Figure 5
Fuchs uveitis heterochromia. (a) The affected eye is a hypochromic light-blue color, (b) Unaffected eye
Figure 6
Figure 6
Diagnostic algorithm for doubtful cases of viral anterior uveitis
See this image and copyright information in PMC

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