ObjectivesTo evaluate the long term complications and vision loss in HLA-B27 uveitis.MethodsRetrospective review of subjects with HLA-B27 uveitis in a public tertiary centre between January 2008 and 2020.Results562 HLA-B27-positive subjects (834 eyes) had mean follow-up of 9.8 years (8173.2 eye-years). Median visual acuity at ten years was 0.1 logMAR (IQR 0.0–0.1). Complications occurred in 404 eyes (48.4%): posterior synechiae (39.7%), cataract (22.1%), elevated intraocular pressure (15.5%), cystoid macular oedema (6.0%). Permanent moderate vision loss ( ≤ 0.4 logMAR) due to uveitis occurred in 14 eyes (1.7%) and severe vision loss (≤ 1.0 logMAR) in 7 eyes (0.8%). Complications were more common with older age (OR 1.017p= 0.016), chronic inflammation (OR 5.272p< 0.001) and intermediate uveitis (OR 5.982p< 0.001).ConclusionsComplications are frequent in HLA-B27 uveitis, especially in older subjects, chronic inflammation and intermediate uveitis. Despite this, the majority of subjects maintain good visual prognosis.