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.
The key point is that the GP's role is recognition and timely referral, not diagnosis or treatment. Anterior uveitis cannot be confirmed without a slit lamp, and 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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