Lens and Anterior Uvea

This chapter illustrates photos of clinical signs seen in uveitis and interesting cases of lens pathologies. Anterior uveitis is the inflammation of the iris and the ciliary body. Anterior uveitis can be idiopathic, isolated, or associated with systemic diseases. The clinical findings observed in anterior uveitis include keratic precipitates, inflammatory cells and flare in anterior chamber, hypopyon, rarely hyphema, miosis, iris nodules and atrophy, synechiae, and band keratopathy in chronic cases (shown in corneal degenerations chapter). The inflammation in anterior uveitis is almost always immune. Treatment includes steroid eye drops, cycloplegic drops, sub-Tenon steroid injections when cystoid macular edema is present. Chronic macular edema can be treated with intravitreal Triamcinolone injection and Dexamethasone implants. In cases of refractory anterior uveitis or associated immune systemic diseases, immunomodulatory treatment or biologic agents are prescribed.

Epstein-Barr virus uveitis after intravitreal triamcinolone injection

Purpose: To report a case of Epstein-Barr virus (EBV) uveitis after intravitreal triamcinolone injection. Methods: Observational case report. Results: A 66-year-old male presented with bilateral intermediate uveitis, left macular branch retinal vein occlusion, and left macular edema 3 months following acute infectious mononucleosis. He received systemic prednisolone, methotrexate, and intravitreal bevacizumab with partial response. Intravitreal triamcinolone was given for recurrent macular edema, which led to the development of severe panuveitis with positive EBV PCR in aqueous humour. This was successfully treated with high-dose systemic valaciclovir and topical prednisolone. Conclusion: Non-infectious uveitis may become infectious following intravitreal steroid administration triggering intraocular viral replication. Intraocular fluid should be tested in cases which are suspicious for infection and EBV should be considered a differential diagnosis, particularly if PCR is negative for more common viral etiologies.