Idiopathic chronic anterior uveitis remains the most common uveitis diagnosis

This study reports on the epidemiology of the chronic anterior uveitis cases seen at one tertiary uveitis center during a 35-year period. The authors found a small but statistically significant decrease in the relative frequency of idiopathic disease. This may be related to an increase in the diagnosis of cases associated with HLA-B27 positivity, inflammatory bowel disease (including family history) and multiple sclerosis, they say. However, despite the medical advances of the past 35 years, idiopathic disease still comprises at least 39 percent of the medical center's annual load of chronic anterior uveitis patients.

Of the 5970 patients seen at the center between 1973 and 2007, 1855 (31 percent) were diagnosed with chronic anterior uveitis. The authors retrospectively reviewed these records, finding that the most frequent cause of chronic anterior uveitis was idiopathic (54 percent; range 39 to 72 percent annually), followed by sarcoidosis (14 percent; range 2 to 20 percent annually), Fuchs' heterochromic iridocyclitis (12 percent; range 4 to 22 percent annually), juvenile idiopathic arthritis (6 percent; range 2 to 13 percent annually), spondyloarthropathies, syphilis, multiple sclerosis, inflammatory bowel disease and herpetic uveitis.

Idiopathic chronic anterior uveitis showed a dramatic 9 percent decrease in frequency of diagnosis, with a more pronounced drop of approximately 13 percent in the adult population. However, the frequency of Fuchs' heterochromic iridocyclitis, juvenile idiopathic arthritis or sarcoidosis diagnosis did not change significantly. HLA-B27-associated chronic anterior uveitis diagnosis was more common between 1995 and 2004 than between 1975 and 1984. Diagnosis of infectious causes, such as syphilis, decreased 4.1 percent during the 35-year study period, while diagnosis of chronic anterior uveitis secondary to herpetic disease did not change dramatically. The increase found in diagnosis of HLA-B27 related disease, multiple sclerosis or inflammatory bowel disease among chronic anterior uveitis patients may be due to diagnostic improvements.

The study's results indicate that chronic anterior uveitis remains a challenging clinical diagnosis, and patients with the condition should be studied in order to discover the underlying etiology.