Spontaneous Amsler’s sign

Fuchs' uveitis syndrome has a characteristic clinical appearance but is frequently overlooked when heterochromia is subtle or absent. In this series of 54 patients, additional features of this syndrome are described, including absent or reversed heterochromia, occasional peripheral anterior synechia, spontaneous hyphema, rubeosis, venous sheathing, and corneal edema. Cataracts and glaucoma were more frequent and associated with a poorer prognosis than previously reported. Topical applications of corticosteroids are occasionally useful, but the patients later become refractory.

A patient had Fuchs heterochromic iridocyclitis of approximately 17 years' duration. Histologically, keratic precipitates, iris atrophy, rubeosis iridis, discontinuous rubeosis of the anterior chamber angle, a chronic nongranulomatous iridocyclitis, and trabeculitis were noted. The cause of the glaucoma probably is a combination of rubeosis of the anterior chamber angle and trabeculitis.

Anterior uveitis is the most common group of uveitis worldwide, with a diverse spectrum ranging from autoimmune and infectious to masquerade etiologies. Elucidation of the underlying etiology may be challenging, but it remains important, especially for recurrent uveitis. Multimodal imaging has improved our understanding and management of many posterior uveitis and panuveitis. Similarly, a wide variety of anterior segment ophthalmic imaging techniques are available to allow the monitoring of the structural changes that may develop during anterior uveitis. These include anterior segment photography, specular microscopy, in vivo confocal microscopy, anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), laser flare photometry, and less commonly used techniques such as anterior segment fluorescein and indocyanine green angiography, iris autofluorescence, and infrared imaging. This review recapitulates the past and recent application of these ophthalmic imaging modalities to the diagnosis and management of anterior uveitis.