A 28-year-old HLA-B27-positive man presents with recurrent acute anterior uveitis. The current episode shows 3+ cell and flare, hypopyon, and posterior synechiae. He also has bilateral sacroiliac joint tenderness. Which condition is he most likely to have, and which pattern of uveitis does it typically produce?

• A Ankylosing spondylitis — bilateral simultaneous anterior uveitis
• B Ankylosing spondylitis — unilateral alternating acute anterior uveitis ✓
• C Sarcoidosis — bilateral chronic granulomatous anterior uveitis
• D Juvenile idiopathic arthritis — bilateral acute non-granulomatous uveitis

Explanation

HLA-B27-associated uveitis in ankylosing spondylitis characteristically presents as unilateral, alternating, acute non-granulomatous anterior uveitis — each episode affects one eye and recurrences often alternate between eyes. The episodes are intense (hypopyon, posterior synechiae) but respond well to topical steroids and cycloplegics. Bilateral simultaneous involvement is not the typical pattern. Sarcoidosis causes bilateral chronic granulomatous uveitis with mutton-fat KPs and Koeppe/Busacca nodules, not hypopyon. JIA-associated uveitis is typically bilateral chronic anterior uveitis in young girls that is often asymptomatic (white eye uveitis).

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.