In HLA-B27-associated acute anterior uveitis (AAU), which slit-lamp finding, if present, favors sarcoid or Fuchs heterochromic iridocyclitis rather than HLA-B27 AAU?

• A Small, non-granulomatous keratic precipitates (KPs) in inferior cornea
• B Fibrinous exudate in anterior chamber
• C Posterior synechiae with occlusio pupillae
• D Mutton-fat KPs (large stellate KPs) with iris nodules (Busacca nodules) ✓

Explanation

Mutton-fat KPs (large, greasy, stellate keratic precipitates on the endothelium) with iris nodules (Koeppe at pupillary margin, Busacca on iris stroma) are the hallmarks of granulomatous anterior uveitis — seen in sarcoidosis, sympathetic ophthalmia, VKH, and tuberculosis. HLA-B27 AAU characteristically produces non-granulomatous inflammation with fine or medium KPs, fibrinous exudate, and posterior synechiae. Fuchs heterochromic iridocyclitis also shows fine stellate (not mutton-fat) KPs distributed across the entire endothelium and characteristically does not develop posterior synechiae.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.