On slit-lamp examination of a patient with chronic panuveitis, large greasy 'mutton-fat' (granulomatous) KPs are seen on the corneal endothelium, together with iris nodules (Koeppe and Busacca), and posterior synechiae. Chest X-ray shows bilateral hilar lymphadenopathy. What is the diagnosis?

• A Tuberculosis-related uveitis
• B Fuchs heterochromic cyclitis
• C Herpetic anterior uveitis
• D Sarcoid uveitis ✓

Explanation

Granulomatous uveitis (mutton-fat KPs, iris nodules — Koeppe at pupillary margin and Busacca in mid-iris stroma) combined with bilateral hilar lymphadenopathy on CXR strongly points to sarcoid uveitis. Sarcoidosis is a systemic granulomatous disease; ocular involvement occurs in 25-50% of cases. TB uveitis also causes granulomatous uveitis but typically without bilateral hilar adenopathy; it may show unilateral hilar or parenchymal disease. Serum ACE and calcium levels confirm sarcoidosis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.