Anterior Segment Changes

Anterior uveitis may be the only ocular manifestation in BD patients. Anterior uveitis is an inflammation, which is limited to the iris and the vitreous. The synonym of anterior uveitis is iridocyclitis. In the literature, the classic finding in BD patients is an anterior uveitis described as occurring together with hypopyon (Fig. i2.4) in 30 % of cases [ii, 2i, 96]. Nowadays, iridocyclitis occurs mostly in isolation, which is probably due to earlier and more aggressive treatment, resulting in dampening inflammatory responses.

The inflammatory response in the anterior chamber in BD is of nongranulomatous nature. The patients often complain of redness, periorbital pain, photophobia, and blurred vision. Slit-lamp biomicroscopy examination reveals conjunctival injection, ciliary flash in the peril-imbal region, cells and flare in the anterior chamber, and fine keratic precipitates [i35, i56].

In eyes with severe iridocyclitis, in which hypopyon is not seen by direct slit-lamp examination, a small layering of leucocytes can be observed in the angle by gonioscopy. This is termed angle hypopyon [i56].

The anterior uveitis may resolve spontaneously over 2-3 weeks even if therapy is not instituted. It is explosive in nature, appearing very rapidly. Some patients with BD may change from feeling perfect one moment to having severe inflammation 2 h later. However, this anterior segment inflammation may not be accompanied by posterior segment involvement [i35, i56].

Structural changes of the anterior portion of the eye, including posterior synechiae, iris atrophy, and peripheral anterior synechiae, may develop during the course of repeated ocular inflammatory attacks. The presence of peripheral anterior synechiae or iris bombe from pupillary seclusion may lead to secondary glaucoma.

Fig. 12.4. Acute iridocyclitis with hypopyon in a BD patient

Neovascularization of the iris can occur as a result of posterior segment involvement [156].

Uncommon anterior segment findings are conjunctivitis with or without subconjunctival haemorrhage, episcleritis or scleritis, keratitis, and, rarely, extraocular muscle paralysis [21, 156].

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