Board Certified Ophthalmologist Uveitis and Ocular Inflammation 1 — Questions and Answers
Question 1: A 25-year-old male presents with acute anterior uveitis and lower back pain. HLA-B27 testing is positive. Which condition is most likely associated with this presentation?
- Sarcoidosis
- Ankylosing spondylitis (Correct answer)
- Behçet disease
- Vogt-Koyanagi-Harada syndrome
Correct answer: Ankylosing spondylitis
HLA-B27-positive acute anterior uveitis with sacroiliitis or lower back pain is classically associated with ankylosing spondylitis, a seronegative spondyloarthropathy.
Question 2: What is the classic appearance of keratic precipitates (KPs) in granulomatous uveitis?
- Fine, stellate KPs scattered across the entire cornea
- Large, greasy 'mutton-fat' KPs in the inferior cornea (Correct answer)
- Small punctate KPs in the superior cornea
- Pigmented KPs along the pupillary margin
Correct answer: Large, greasy 'mutton-fat' KPs in the inferior cornea
Granulomatous uveitis is characterized by large, greasy 'mutton-fat' KPs that accumulate in the inferior cornea due to aqueous convection currents.
Question 3: A patient with intermediate uveitis shows 'snowballs' in the vitreous and 'snowbanking' over the pars plana. Which condition is most likely?
- Behçet disease
- Pars planitis (Correct answer)
- Sympathetic ophthalmia
- Vogt-Koyanagi-Harada syndrome
Correct answer: Pars planitis
Pars planitis is a form of idiopathic intermediate uveitis characterized by vitreous snowballs and snowbank (exudate) formation overlying the pars plana.
Question 4: Which class of medication is the first-line treatment for non-infectious uveitis?
- Antimetabolites (methotrexate)
- Calcineurin inhibitors (cyclosporine)
- Corticosteroids (Correct answer)
- Anti-TNF biologics (adalimumab)
Correct answer: Corticosteroids
Corticosteroids—topical, periocular, or systemic—are the first-line agents for non-infectious uveitis due to their potent and rapid anti-inflammatory effect.
Question 5: A patient presents with bilateral granulomatous panuveitis, sunset glow fundus, vitiligo, poliosis, and alopecia. What is the most likely diagnosis?
- Sympathetic ophthalmia
- Sarcoidosis
- Vogt-Koyanagi-Harada syndrome (Correct answer)
- Behçet disease
Correct answer: Vogt-Koyanagi-Harada syndrome
VKH syndrome is characterized by bilateral granulomatous uveitis, sunset glow fundus from choroidal depigmentation, and extraocular findings including vitiligo, poliosis, and alopecia.
Question 6: Weeks after penetrating trauma to the right eye, a patient develops inflammation in the uninjured left eye. What is the diagnosis?
- Bacterial endophthalmitis
- Sympathetic ophthalmia (Correct answer)
- Phacoanaphylactic uveitis
- Posner-Schlossman syndrome
Correct answer: Sympathetic ophthalmia
Sympathetic ophthalmia is a bilateral granulomatous panuveitis arising after penetrating trauma or surgery to one eye (the exciting eye), affecting the fellow sympathizing eye via autoimmune sensitization to uveal antigens.
Question 7: A patient presents with recurrent hypopyon uveitis, painful oral ulcers, and genital ulcers. What is the most likely diagnosis?
- Reactive arthritis (Reiter syndrome)
- Behçet disease (Correct answer)
- Ankylosing spondylitis
- Crohn's disease
Correct answer: Behçet disease
Behçet disease classically presents with the triad of recurrent oral ulcers, genital ulcers, and uveitis (often with hypopyon), and is more severe in patients of Middle Eastern or Asian descent.
