Ophthalmology KFP 1.5 – Barry has a painful red eye

by | Jan 14, 2018

Barry is a 35-year-old man presented with sudden onset of a right red eye, severe eye pain in right eye only, worse when trying to read, tearing, photophobia, and headache. He has a history of back pain for the last year which he has not sought treatment for.

What is the most likely diagnosis in this presentation? (1)

  1. Anterior Uveitis

What are the differentials in this presentation? (5)

  1. Acute Angle Closure Glaucoma
  2. Acute Anterior Uveitis
  3. GCA
  4. Scleritis
  5. Episcleritis
  6. Conjunctivitis

What are the features of history in Anterior Uveitis? (8)

  1. Eye Pain
  2. Eye Redness
  3. Photophobia are typical
  4. Eye pain worse on reading
  5. Progressive over hours/days
  6. Blurred vision
  7. Watery eyes
  8. Headache

What are the features of examination in Anterior Uveitis? (8)

  1. Painful red eye
  2. Synechiae or iris nodules – irregular iris
  3. Pupil may react sluggishly
  4. Photophobia
  5. VA may be reduced
  6. Tearing
  7. Lid puffiness
  8. Eyelid drooping
  9. Keratic Precipitate
  10. Ciliary flush
  11. Corneal oedema
  12. Hypopyon
  13. Inflammatory cells in the vitreous
  14. Disc inflammation
  15. IOP is most often decreased

What are the most common categories of pathology causing of anterior uveitis? (3)

  1. Idiopathic
  2. Infections
  3. Autoimmune

What are the most common infections causing uveitis? (3)

  1. TB
  2. Syphilis
  3. HSV
  4. Varicella Zoster

What are the most common autoimmune causes of Uveitis? (5)

  1. Seronegative spondyloarthropathies
  2. Ankylosing spondylitis
  3. Acute anterior uveitis
  4. Psoriatic arthritis
  5. Reiters syndrome
  6. Inflammatory Bowel Disease
  7. Juvenile Rheumatic Arthritis

What initial investigations might you perform to ascertain the cause of this patient’s symptoms? (8)

  1. FBC
  2. LFT
  3. UEC
  4. ESR
  5. CRP
  6. ANA
  7. Rheumatoid factor
  8. Anti-CCP
  9. ENA
  10. Faecal Calprotectin
  11. HLA-B27 typing
  12. Sacroiliac Xray
  13. Spinal Xray

What are the most important initial steps in management? (2)

  1. Refer to an ophthalmologist
  2. Do not initiate treatment for recurrent uveitis in primary care

What are the most common complications of this presentation? (2)

  1. Cystoid macular oedema
  2. Secondary cataract

References

  1. patient.info
  2. Murtaghs
  3. Colour Atlas of Family Medicine
  4. Dynamed