A 28-year-old man with HLA-B27-positive ankylosing spondylitis presents with acute pain, redness, photophobia, and miosis in the right eye. Slit-lamp examination shows fine keratic precipitates (KPs), 3+ cells and flare in the anterior chamber, and a fibrin exudate. This is best classified as:

• A Granulomatous anterior uveitis
• B Intermediate uveitis
• C Fuchs heterochromic iridocyclitis
• D Non-granulomatous acute anterior uveitis ✓

Explanation

HLA-B27-associated anterior uveitis is the classic form of non-granulomatous acute anterior uveitis—characterised by small, fine keratic precipitates (stellate or fine KPs), intense anterior chamber reaction, and acute painful onset; it tends to be unilateral and recurrent. Granulomatous uveitis (as in sarcoidosis or TB) produces large mutton-fat KPs, iris nodules (Koeppe/Busacca), and a more chronic course. Fine KPs with acute onset in an HLA-B27-positive spondyloarthropathy patient is the hallmark presentation.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.