GPAtlas🧭 When to suspect
Acute anterior uveitis (iritis) is inflammation of the iris and anterior ciliary body, and the commonest form of uveitis seen in UK primary care.
• The classic picture is an acute, usually unilateral, painful red eye with photophobia and blurred vision.
• The deep ache is often worse on reading, as accommodation tugs on the inflamed ciliary muscle.
• Discharge is unusual – its presence points towards conjunctivitis instead.
In general practice, aim for recognition and timely referral, not diagnosis or treatment.
• Anterior uveitis cannot be confirmed without a slit lamp.
• Topical steroids must never be started in primary care.
Two skills matter most:
• Separate uveitis from the benign red eye, and from the other sight-threatening causes.
• Then refer within 24 hours (same day if vision is threatened).
Around half of patients are HLA-B27 positive, and an episode may be the first clue to an undiagnosed spondyloarthropathy, inflammatory bowel disease or sarcoidosis.
| Painful red eye | Discriminating features |
|---|---|
| Anterior uveitis (iritis) | • Deep aching pain, marked photophobia (including consensual), blurred vision • Circumlimbal flush worst at the limbus • Small/irregular sluggish pupil • No discharge |
| Acute angle-closure glaucoma | • Severe pain with headache, nausea and vomiting, haloes • Fixed mid-dilated oval pupil, hazy cornea, hard eye – an emergency |
| Microbial keratitis | • Pain, photophobia, watering with a visible corneal infiltrate (white spot) or fluorescein-staining defect • Especially in contact-lens wearers – an emergency |
| Conjunctivitis | • Gritty or itchy rather than deep pain, no true photophobia, normal vision and pupil • Injection worst in the fornices (away from the limbus) • Discharge |
Source: College of Optometrists · BMJ
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