Uveitis and HLA B27
Carol Slight
Nurse Practitioner
Ophthalmology
May 2014
What is uveitis?
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Why is classification important?
Not a single disease
Encompasses entire range of inflammatory conditions of
the uveal tract (iris, ciliary body and choroid).
Classified as
1. Acute or chronic or recurrent
2. Unilateral or bilateral or alternating
3. Granulomatous or non granulomatous
4. Anterior, intermediate, posterior or pan uveitis
May 2014
HLA B27 uveitis
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Using the previous classification
1. Usually acute or recurrent
2. Usually unilateral or alternating
3. Non granulomatous
4. Usually anterior
May 2014
HLA B27 associated uveitis
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Gene located on short arm of chromosome 6
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Present in 1-8% of population
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Associated uveitis affects males more than females
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Often severe with fibrin and hypopyon
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Recurrent course can involve both eyes not usually
simultaneously
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HLA B27 diseases known as spondyloarthropathies
May 2014
Associated systemic HLA B27+ve diseases
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Ankylosing Spondylitis
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Reactive arthritis (Reiter
syndrome)
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Inflammatory bowel
disease
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Psoriatic arthritis
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Undifferentiated
spondyloarthropathy
May 2014
Symptoms
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Red eye
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Pt often described bruised feeling above affected eye
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Photophobia
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May or may not have decreased visual acuity
May 2014
Signs
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Circumcorneal injection
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Fine keratic precipitates
Circumcorneal
injection
(KP’s)
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Distortion of pupil with
Fine KP’s
Posterior synechiae
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Lower IOP
Posterior synechiae
May 2014
Signs
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White blood cells in
anterior chamber (AC)
Possible flare in AC
Possible hypopyon or fibrin
in AC
Inflammation in vitreous
spillover WBC
Usually does not involve
posterior segment
Cells
Flare
Hypopyon
Fibrin
May 2014
Treatment
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Gutt Pred forte intensively
Mydriatic TDS usually cyclopentolate
Oc maxidex nocte
½ hourly 1/7- hourly 5/7- 2 hourly 1/52
6 x day 1/52, QID 1/52, TDS 1/52, BD 1/52, daily 1/52
Fu dependent on severity and how well settling
Usually can discharge when drops minimal
Most pts are aware of symptoms and will return early
May 2014
Auckland’s HLA B27 uveitis
Num bers of HLA B27+ve by ethnicity
200
150
Series1
100
50
LA
A
M
E
In
di
an
As
ia
n
Ea
st
PI
M
ao
ri
0
au
ca
si
an
Caucasian 199 60.3%
► Maori 30 9.09%
► Polynesian 29 8.78%
► East Asian 43 13.03%
► Indian 26 7.87%
► Others 3 0.9%
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250
C
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From 1153 pts with uveitis
330 HLA B 27+ve 28.6%
Numbers from 330
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Ethnicity
Ethnicity percentages
Caucasian
Maori
PI
East Asian
Indian
MELAA
May 2014
Demographics
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HLA B27+ve uveitis
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Males 211 64%
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Females 119 36%
Uveitis numbers all causes 1153
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Males 620 53.8%
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Females 533 46.2 %
May 2014
Age at first diagnosis of
HLA B27+ve uveitis
Age at first diagnosis
120
Numbers
100
80
60
Series1
40
20
0
0-10
11-20 21-30 31-40 41-50 51-60 61-70 71-80
Decade range
May 2014
80+
Summary
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HLA B 27+ve uveitis can be associated with other systemic
conditions
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Can be HLA B27+ve with no other associations
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Usually follows a pattern of unilateral inflammation
although can alternate eyes
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Usually settles for period of time
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Less likely to get complications but still possible to develop
CMO, steroid induced OHT and posterior involvement
May 2014