13th February 2025

Viral causes of uveitis

Herpes simplex virus anterior uveitis

Herpes simplex-associated uveitis can occur in the presence of keratitis or in isolation, but there will often be a history of cold sores, keratitis or genital lesions. Patchy iris atrophy may be seen on slit lamp examination, and the affected pupil may be slightly larger. Keratic precipitates (cellular inflammatory deposits on the corneal endothelium) may be present, and IOP may be raised. It is usually treated with a combination of topical steroids, topical cycloplegic (paralyses the ciliary muscles, preventing accommodation) and an oral antiviral.

Varicella zoster virus anterior uveitis

Anterior uveitis can occur in around half of patients affected by herpes zoster ophthalmicus and usually occurs 1-3 weeks after the rash. In immunocompromised patients, infection with primary varicella zoster infection (chickenpox) may also lead to uveitis. Management is with topical steroids, mydriatics and systemic antivirals such as aciclovir.

Cytomegalovirus

Infection with cytomegalovirus (CMV) is more likely to be clinically significant in immunocompromised patients. Uveitis associated with CMV is usually unilateral. The mainstay of treatment is with antivirals such as ganciclovir and valganciclovir.