Aqueous humour analysis can help identify a viral aetiology in hypertensive anterior uveitis
October 26, 2026

Aqueous humour analysis can help identify a viral aetiology in hypertensive anterior uveitis

Herpes simplex virus, varicella-zoster virus, cytomegalovirus (CMV) and rubella virus are increasingly recognised causes of hypertensive anterior uveitis. Identifying the virus matters for management, yet indications for aqueous humour sampling remain poorly standardised.1 In observational series of CMV-positive eyes, higher aqueous viral load has been correlated with higher intraocular pressure, more recurrences and a greater number of glaucoma medications2, and early anti-CMV treatment has been associated with fewer relapses and less need for glaucoma surgery3. Entities once considered idiopathic have also been linked to specific viruses, in particular: CMV to Posner-Schlossman syndrome, and rubella to Fuchs uveitis.4,5 Diagnostic yield is highest when sampling is performed during an active episode, before antiviral therapy is initiated. Combining PCR with intraocular antibody detection improves sensitivity, but a negative result does not exclude viral involvement. In experienced hands, anterior chamber paracentesis has been shown to be safe, with mostly minor complications, although rare sight-threatening events have been reported. Sampling should be considered in unilateral, recurrent hypertensive anterior uveitis, particularly when IOP is disproportionate to inflammation or when diffuse stellate keratic precipitates, endotheliitis or sectoral iris atrophy are present. Further studies are needed to define who and when to sample and the optimal duration of antiviral treatment.


References

  1. Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, et al.; TITAN consensus guidelines group. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2-global current practice patterns for the management of Cytomegalovirus anterior uveitis. Eye (Lond). 2024 Jan;38(1):68-75. doi: 10.1038/s41433-023-02631-8. Epub 2023 Jul 7. PMID: 37419958; PMCID: PMC10764804.
  2. Kandori M, Miyazaki D, Yakura K, Komatsu N, Touge C, Ishikura R, et al. Relationship between the number of cytomegalovirus in anterior chamber and severity of anterior segment inflammation. Jpn J Ophthalmol. 2013 Nov;57(6):497-502. doi: 10.1007/s10384-013-0268-2. Epub 2013 Aug 9. PMID: 23928983.
  3. Touhami S, Qu L, Angi M, Bojanova M, Touitou V, Lehoang P, et al. Cytomegalovirus Anterior Uveitis: Clinical Characteristics and Long-term Outcomes in a French Series. Am J Ophthalmol. 2018 Oct;194:134-142. doi: 10.1016/j.ajo.2018.07.021. Epub 2018 Jul 26. PMID: 30055154.
  4. Megaw R, Agarwal PK. Posner-Schlossman syndrome. Surv Ophthalmol. 2017 May-Jun;62(3):277-285. doi: 10.1016/j.survophthal.2016.12.005. Epub 2016 Dec 22. PMID: 28012873.
  5. Sun Y, Ji Y. A literature review on Fuchs uveitis syndrome: An update. Surv Ophthalmol. 2020 Mar-Apr;65(2):133-143. doi: 10.1016/j.survophthal.2019.10.003. Epub 2019 Oct 14. PMID: 31622627.


Contributor: Cristina Ginés Gallego, MD, FEBO, FEBOS-GL, Glaucoma specialist, Institut Clínic d’Oftalmologia. Hospital Clínic Barcelona, Barcelona, Spain

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