A patient with recurrent HLA-B27-associated anterior uveitis presents with a red painful eye. Slit-lamp shows a hypopyon and keratic precipitates (KPs). The KPs in this case are most likely:

• A Large, greasy, mutton-fat KPs distributed across entire endothelium
• B Fine, stellate, small KPs concentrated in the inferior corneal endothelium (Arlt's triangle) ✓
• C Large, pigmented KPs at the pupillary margin (Koeppe nodules)
• D Diffuse fine KPs over the entire corneal endothelium equally distributed

Explanation

HLA-B27 anterior uveitis (as in ankylosing spondylitis, reactive arthritis) is a fibrinous, non-granulomatous acute anterior uveitis characterized by small fine cellular KPs concentrated in the inferior corneal endothelium (Arlt's triangle) by gravity. Large 'mutton-fat' KPs (aggregated macrophages/epithelioid cells) with iris nodules (Busacca and Koeppe nodules) are characteristic of granulomatous uveitis (sarcoidosis, TB, Vogt-Koyanagi-Harada). Hypopyon with fine KPs and fibrin strands is classic for HLA-B27 anterior uveitis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.