Viral Aetiology in Anterior Uveitis – The Tip of an Iceberg?

Identification of an infectious cause in intraocular inflammation is of crucial importance since their treatment and prognosis differ from non-infectious aetiologies. Herpes simplex and varicella-zoster viruses are well known causes of anterior uveitis. Furthermore, cytomegalovirus (CMV) and rubella virus (RV) are also detected in a significant number of patients. Despite their different aetiology, viral anterior uveitis may have similar features and often presents with unilateral diffuse, fine, stellate keratic precipitates, iris atrophy or ocular hypertension. Viruses are increasingly recognised as aetiology of anterior uveitis that has previously been referred as idiopathic. RV, for example, causes a distinct clinical spectrum of ocular signs and symptoms presenting as Fuch’s uveitis syndrome (FUS) in Europe, strongly suggesting a role in its pathogenesis. Interestingly, CMV may also be involved in the pathogenesis of both FUS and Posner–Schlossman syndrome in particular in the Asian population.