Difference between revisions of "HLA-B27 Associated Acute Anterior Uveitis"

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|Assigned editor=Jessica.Shantha
|Assigned editor=Jessica.Shantha
|Date reviewed=February 11, 2019
|Date reviewed=May 27, 2019
|Article status=Update Pending
|Article status=Update Pending
|Meta description=Approximately 50% of acute anterior uveitis (AAU) cases are associated with the allele Human Leukocyte Antigen B27 (HLA-B27)
|Meta description=Approximately 50% of acute anterior uveitis (AAU) cases are associated with the allele Human Leukocyte Antigen B27 (HLA-B27)

Revision as of 23:51, May 27, 2019

Uveitis is a common form of intraocular inflammation of the iris, ciliary body, or choroid, which presents predominantly as anterior uveitis (80-85%). Approximately 50% of acute anterior uveitis (AAU) cases are associated with the allele Human Leukocyte Antigen B27 (HLA-B27).


The HLA-B locus encodes a class I Major Histocompatibility Complex surface antigen which presents antigens to CD8+ T-cells.


  • changes amino acids in the antigen-binding cleft
  • highly polymorphic
  • 105 subtypes, 132 genetic alleles


HLA-B27 Prevalence:

  • Varies between ethnic populations
    • Pawaia tribe of Papua New Guinea (53%)
    • Haida natives of western Canada (50%)
    • Chukotka Eskimos of eastern Russia (40%)
    • Northern Scandinavia (14-16%)
    • Caucasians (8-10%)
  • HLA-B27 Prevalence in the United States:
    • 7.5% in non-Hispanic whites
    • 4.6% in Mexican-Americans
    • 2-4% in African-Americans

Clinical Presentation

  • Age of onset: 20-40 years
  • Males 1.5-2.5 times more likely than women
  • Systemic associations: Psoriasis, Ankylosing Spondylitis, Inflammatory Bowel Disease, and Reactive Arthritis
  • Frequency:
    • Recurrent, sometimes in contralateral eye but rarely in both
    • Common episodes of inflammation alternate between eyes
    • Usually resolves within two months
    • Recurrence may become less frequent with longer duration
  • Unilateral
    • Sudden onset
    • Photophobia
    • Ocular pain
    • Eye redness
    • Non-granulomatous
    • Severe inflammation potentially resulting in:
      • Hypopyon
      • Anterior chamber fibrin

Potential Ocular Complications

  • Posterior synechiae
  • Ocular hypertension or glaucoma
  • Posterior subcapsular cataract
  • Epiretinal membrane
  • Less commonly:
    • Cystoid macular edema
    • Band keratopathy
    • Ocular hypotony
  • Mixed results whether complication rates differ between HLA-B27 and other uveitis etiologies

Diagnostic Testing

  • Careful ocular and systemic evaluation
  • HLA-B27 typing
  • Chest x-ray
  • Syphilis serology
  • Angiotensin Converting Enzyme


  • Corticosteroids (topical drops, periocular/intraocular injection, oral)
  • Adalimumab approved only for AAU patients with spondyloarthropathy
    • FDA approval for non-infectious posterior or panuveitis (not anterior uveitis)


  1. Seve P, Cacoub P, Bodaghi B, Trad S, Sellam J, Bellocq D, Bielefeld P, Sene D, Kaplanski G, Monnet D, Brezin A, Weber M, Saadoun D, Chiquet C, Kodjikian L. Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev. 2017;16:1254-1264.
  2. Rosenbaum JT. New developments in uveitis associated with HLA B27. Curr Opin Rheumatol. 2017;29:298-303.
  3. Kopplin LJ, Mount G, Suhler EB. Review for Disease of the Year: Epidemiology of HLA-B27 Associated Ocular Disorders. Ocul Immunol Inflamm. 2016;24:470-5.
  4. Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 2005;50:364-88.
  5. Wakefield D. Management of HLA-B27 acute anterior uveitis. American Academy of Ophthalmology. https://www.aao.org/current-insight/management-of-hlab27-acute-anterior-uveitis. August 7, 2009. Accessed December 30, 2017.