A 34-year-old man presents with unilateral redness, pain, and photophobia. Slit-lamp examination shows moderate anterior chamber cells, keratic precipitates, intraocular pressure of 34 mmHg, and patchy sectoral loss of the iris stroma. He had a dendritic corneal ulcer two years ago. What is the most likely diagnosis?
- A HLA-B27 associated acute anterior uveitis
- B Herpes simplex virus anterior uveitis ✓
- C Fuchs heterochromic iridocyclitis
- D Posner-Schlossman syndrome
Correct answer: B. Herpes simplex virus anterior uveitis
Explanation
Raised intraocular pressure during an episode of anterior uveitis, together with sectoral iris stromal atrophy from ischaemic vasculitis of the iris, points strongly to herpetic (HSV or VZV) uveitis. HLA-A27 uveitis runs a hypotonous course with fibrin and hypopyon rather than high pressure. Fuchs heterochromic iridocyclitis is characteristically painless with low pressure, and Posner-Schlossman syndrome shows only trace inflammation despite very high pressure.
Reference: Parsons' Diseases of the Eye, 22nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.