Cytomegalovirus anterior uveitis: how does it compare to the characteristics of other anterior uveitides to provide unique management opportunities

Abstract

Anterior uveitis (AU) is the commonest type of uveitis [1,2]. Most cases (48–70%) are considered idiopathic. HLA-B27-associated spondyloarthritis is the most common systemic disease associated with adult AU. It was reported in 18–32% of patients with AU in Western countries and in 6–13% of patients with AU in Asia [3]. AU in children is also frequently associated with juvenile idiopathic arthritis. Several other causes of AU have been described in the literature including herpes family virus, syphilis, tuberculosis, sarcoidosis, tubulointerstitial nephritis and uveitis syndrome, and Adamantiades–Bechet’s disease (ABD) [4]. In terms of disease duration, AU has been divided into acute, recurrent, and chronic. A chronic course is defined as episode duration over 3 months or relapses within less than 3 months of treatment cessation [5]. Chronic AU has been linked to an increased risk for loss of vision from serious complications such as glaucoma, cataract, band keratopathy, cystoid macular edema, and phthisis bulbi [4]. Prompt identification of possible infectious causes or systemic associations may prevent complications and loss of vision and can positively affect the overall visual prognosis and the patient’s quality of life [6]. For example, in patients with juvenile idiopathic arthritis (JIA)-associated chronic AU, the use of immunosuppression reduces the risk of vision loss by ~ 40% [7] and an early identification of herpetic AU may significantly reduce the risk of glaucoma and cataract formation [8].