Conditions

What is HLA-B27 anterior uveitis?

HLA-B27 anterior uveitis is a common form of inflammation affecting the anterior part of the eye in patients presenting with a specific gene, the allele human leukocyte antigen B27.

The disease is more frequent in 20-40 years old people with male predominance.

HLA-B27 anterior uveitis manifests with recurrent episodes of unilateral acute anterior uveitis, often alternating between the eyes, characterized by sudden onset, ocular pain, redness and light sensitivity (photophobia).

The inflammation is often severe potentially resulting in the formation of hypopion, an exudate rich in inflammatory cells lying at the bottom of the anterior chamber, and posterior synechiae, an adhesion between the iris and the crystalline lens capsule, resulting in an irregular shape of the pupil and preventing its complete dilation.

The back of the eye can be affected too due to a spill over of the inflammation and can manifest with macular oedema or optic disc swelling.

HLA-B27 uveitis may occur as isolated anterior uveitis or in association with systemic conditions, including:

Some patients may first present with ocular symptoms and develop systemic manifestations later. Because of this, a detailed medical history and a focussed systemic examination to look for joint, skin or bowel involvement is mandatory.

What causes HLA-B27 anterior uveitis?

HLA-B27 anterior uveitis is an inflammatory condition driven by an abnormal immune response that occurs in genetically predisposed individuals. Patients present a marker in their white blood cells known as HLA-B27.

The disease cannot be passed on to other people or from parent to child, but the presence of HLA-B27 has been linked to an increased risk of developing anterior uveitis and other systemic inflammatory conditions. Environmental factors may be important and occurrence of the disease in family members is more likely to be connected to exposure to these factors.

What are the symptoms?

Symptoms include

Diagnosis

The diagnostic suspicion is raised based on clinical manifestations and is confirmed by HLA-B27 testing.

All patients with recurrent anterior uveitis in the absence of another clear etiologic agent, should be tested for HLA-B27 because of its prognostic implications.

Treatment

The intention of therapy is to control inflammation and prevent damage to ocular tissues. Treatment of acute uveitis includes topical steroids and cycloplegics, for comfort and preventing the formation of posterior synechiae.

Inflammation associated with HLA-B27 usually responds well to the treatment with steroid eye drops. However, the disease is characterized by recurrences and the more frequent they are, the higher the complication rate is. In some cases, when recurrence become very frequent, the use of additional immunosuppressive drugs to allow long term control of the condition and minimize the side effects of long term topical steroid use may be necessary. This may also be needed for the treatment of a systemic association.

Complications and Prognosis

If not well controlled, HLA-B27 uveitis can result in ocular tissue damage.

Common complications include persistent posterior synechiae, glaucoma and cataract. All these complications can affect the quality of vision.

HLA-B27 associated acute anterior uveitis with diffuse conjunctival hyperaemia (redness), hypopion and posterior synechiae, resulting in an irregular shape of the pupil.

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