A 32-year-old woman presents with recurrent episodes of painful red eye, photophobia, and blurred vision. Slit-lamp shows fine keratic precipitates (KPs) in a triangular distribution (Arlt triangle) on the inferior corneal endothelium, cells and flare in the anterior chamber, and a small posterior synechia. Systemic workup reveals bilateral hilar lymphadenopathy on chest X-ray. The most likely diagnosis is:

• A Ankylosing spondylitis-associated uveitis
• B HLA-B27-associated acute anterior uveitis
• C Herpes simplex keratouveitis
• D Sarcoidosis-associated uveitis ✓

Explanation

Sarcoidosis is a systemic granulomatous disease that commonly involves the eye, causing chronic granulomatous anterior uveitis with mutton-fat (large greasy) KPs, iris Koeppe and Busacca nodules, and posterior synechiae. The presence of bilateral hilar lymphadenopathy on CXR strongly suggests sarcoidosis. Fine KPs in Arlt triangle (inferior cornea) are typical of granulomatous uveitis. HLA-B27-associated uveitis tends to be acute, unilateral, non-granulomatous, with large fibrinous exudates.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.