A 34-year-old man presents with his third episode of unilateral anterior uveitis. Each episode features moderate anterior chamber cells, markedly raised intraocular pressure despite a shallow-looking anterior chamber, and patchy stromal iris atrophy in the superior quadrant on transillumination. The most likely etiology is:

• A HLA-B27 associated autoimmune uveitis
• B Tubercular anterior uveitis
• C Fuchs heterochromic iridocyclitis
• D Herpes simplex virus infection of the iris ✓

Explanation

Raised intraocular pressure during an episode of anterior uveitis plus focal, sectoral iris stromal atrophy with transillumination defects is the signature combination of herpetic anterior uveitis caused by HSV or VZV. Viral infection produces a neurotrophic trabeculitis that elevates pressure and damages iris stroma in a sectoral pattern. HLA-D27 uveitis runs low pressure from ciliary body shutdown, and Fuchs heterochromic iridocyclitis shows diffuse rather than sectoral atrophy with low pressure.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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