7.1 Acute Anterior Uveitis

eyes.nhs.scot/
Eyecare Guidelines/
Section 7 - Uvea/
7.1 Acute Anterior Uveitis

Date of last review:

19/12/2025

Date of next review:

19/12/2027

Date of publication:

19/1/2026

This is a GOS Specialist Supplementary condition and should be managed by community optometrists in line with national guidance⁽⁸⁾. This guideline should be read in conjunction with ‘Supporting information’ guidance [link to Supporting Information page]

Differential diagnosis ⁽¹⁾

Acute angle-closure glaucoma
Other causes of acute red eye,g. Endophthalmitis
Lens-induced uveitis
Intraocular foreign body
Other uveitis types: intermediate, posterior, panuveitis
Rare: intraocular lymphoma

Possible management by optometrist

Advice ⁽¹⁾

Advise sunglasses for photophobia and near addition for cycloplegia
Instruct patients to report worsening symptoms immediately

Optometrist Advice

Take a thorough medical history, asking about signs of inflammatory pain, specifically back pain
- e.g. chronic lower back pain beginning <45 years of age, duration > 3 months, early morning stiffness, risk of autoimmune disease such as spondyloarthritis. Consider referral to GP/Rheumatology ^(1,7)
Measure intraocular pressure (IOP) and continue to monitor for any complications, especially elevated IOP ⁽¹⁾
Perform a dilated examination of the posterior segment in both eyes to assess for signs such as vitreous cells, snowballs/snowbanking, cystoid macular oedema or posterior uveitis ⁽¹⁾
Do not initiate treatment without specialist input if the patient has a known history of steroid-induced ocular hypertension or hypertensive uveitis ⁽¹⁾

Treatment

First Episode:

Topical steroids: prednisolone acetate 1% eye dops or dexamethasone 0.1% eye dops ⁽¹⁾
Cycloplegia: cyclopentolate 1% eye dops (after ruling out risk of angle closure) ⁽¹⁾
Review within 48 hours (where possible) and taper steroids over ≥6 weeks⁽⁷⁾

Recurrent Episodes:

Reinstate treatment ⁽¹⁾
Consider referral to ophthalmologist for systemic work-up and possible rheumatology referral ⁽⁷⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Cyclopentolate hydrochloride 1% eye drops ^(1,5) (POM): One drop up to 3 times daily, consider reducing (or stopping) as condition improves ^(6,7) (consult local guidance as they may vary on timescales⁽⁷⁾)
Prednisolone acetate 1% eye dops ^(1,5) (POM): One drop ⁽⁷⁾ every 1–2 waking hours until inflammation is controlled, then reduce frequency.^(2,3)
Dexamethasone 0.1% eye drops ^(1,5) (POM): One drop ⁽⁷⁾ four to six times daily until inflammation is controlled, then reduce frequency. In severe cases, treatment may be started with one drop every hour, but dosage should be reduced to one drop every 4 hours when a favourable response is observed ^(2,3).
Suggested tapering schedule once inflammation under control ⁽⁷⁾
- One drop ⁽⁷⁾ every second waking hour for 1 week
- One drop ⁽⁷⁾ six times daily for 1 week
- One drop ⁽⁷⁾ four times daily for 1 week
- One drop ⁽⁷⁾ three times daily for 1 week
- One drop ⁽⁷⁾ twice daily for 1 week
- One drop ⁽⁷⁾ once daily for one week then stop
Monitor inflammatory response to steroid and measure IOP regularly during tapering schedule and on completion ^(1,7)

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and local/national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

GOS Specialist Supplementary Stage 1 to establish presence of anterior uveitis* ⁽⁸⁾
If required, GOS Specialist Supplementary Stage 2* treatment should be provided by a local IP optometrist/OMP who is registered and qualified to carry out GOS Specialist Supplementary Stage 2 management; intra-referral (practice to practice) should take place to facilitate this ⁽⁸⁾

If treating:

First Episode – Initiate pharmacological therapy, no referral needed if ⁽¹⁾:
- Non-granulomatous, unilateral
- No systemic or infectious cause
- No posterior segment involvement
Initiate pharmacological therapy and then urgent referral if ⁽¹⁾:
- No improvement after 1 week
- Granulomatous features, hypopyon, fibrin
- Bilateral disease
- Posterior synechiae not broken
- Vitreous or posterior segment involvement
- Inadequate pupil dilation
- Systemic symptoms suggestive of underlying disease
For all practitioners: Emergency Referral (same day) if ⁽¹⁾:
- Severe pain
- Significant vision loss
- Markedly raised IOP
Specific Syndromes – Urgent Referral ⁽¹⁾:
- Fuchs heterochromic cyclitis
- Posner-Schlossman syndrome
Second or subsequent episode:
- Begin treatment and consider urgent referral to ophthalmology ⁽¹⁾.
- After the underlying cause has been investigated, future episodes may be managed in community (under GOS Specialist Supplementary Stage 2*) or in collaboration with ophthalmology ^(1,8). Consult any available local guidance or enhanced schemes, as appropriate ⁽⁷⁾
Treatment may be provided within available locally enhanced schemes, or by community IP Optometrists/OMPs, as appropriate (outwith GOS Specialist Supplementary) ⁽⁷⁾

*Treatment should be provided in line with “Annex C of the Statement” ⁽⁸⁾https://www.eyes.nhs.scot/for-professionals/legislation/

Possible management in secondary care or local/community pathways where available ^(1,8)

See Further management options
Investigation of systemic causes (rheumatology, immunology, infectious disease)
Antimicrobial therapy in cases with infectious aetiology
Treatment of secondary glaucoma
Consideration of:
- Sub-Tenon’s steroid injection
- Sub-conjunctival mydriatic
- Systemic immunosuppressants

College of Optometrists Clinical Management Guideline⁽¹⁾

Uveitis (anterior) - College of Optometrists *

*With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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