A patient with Behcet's disease presents with a hypopyon in the right eye. Which distinctive feature of Behcet's uveitis distinguishes it from other causes of hypopyon?

• A Hypopyon in Behcet's is fibrinous and does not shift with gravity
• B Behcet's hypopyon is associated with corneal ulceration and descemetocele
• C Behcet's hypopyon is typically mobile (shifting with changes in head position), occurs with recurrent oral and genital ulcers, and shows occlusive vasculitis on FFA ✓
• D Behcet's produces a small non-reactive hypopyon with scleritis

Explanation

Behcet's disease produces a shifting (mobile) hypopyon that moves with gravity as the patient tilts their head—this is in contrast to HLA-B27 uveitis where the hypopyon may be more fibrinous. The clinical triad of oral aphthous ulcers, genital ulcers, and uveitis is diagnostic; the pathergy test is positive in Middle Eastern and Japanese populations. Fundus fluorescein angiography shows an occlusive vasculitis affecting both arteries and veins, with perivascular leakage. Recurrent severe attacks cause cumulative visual damage; systemic immunosuppression (azathioprine, cyclosporin, TNF inhibitors like infliximab) is required.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.