A 29-year-old man comes to the office with right eye pain, redness, and blurry vision for the past 2 days. Physical examination findings are shown below. No discharge is present.

Which of the following is the most likely diagnosis?

Question

A 29-year-old man comes to the office with right eye pain, redness, and blurry vision for the past 2 days.  Physical examination findings are shown below.  No discharge is present.

Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec193a_989b_aefa_853d_a99b1411e433_MD0002_00 This patient has acute anterior uveitis (iritis), which is characterized by a unilateral painful, red eye and photophobia. Inflammation can affect both the anterior (iris, ciliary body) and posterior (choroid) uveal tract in addition to adjacent structures such as the retina and vitreous humor. Most cases are idiopathic, but common secondary causes may include: Infections (eg, toxoplasmosis, cytomegalovirus, syphilis)Autoimmune diseases (eg, ankylosing spondylitis, sarcoidosis, Behçet's disease)Medications (eg, rifabutin, cidofovir) Infections (eg, toxoplasmosis, cytomegalovirus, syphilis) Autoimmune diseases (eg, ankylosing spondylitis, sarcoidosis, Behçet's disease) Medications (eg, rifabutin, cidofovir) Gross examination may show a ciliary flush (marked erythema ringing the iris) and hypopyon (leukocytic exudate in the anterior chamber). The presence of leukocytes in the anterior chamber is diagnostic of anterior uveitis and differentiates it from other causes of red eye. Anterior chamber flare is another common manifestation and is created by extravasated protein that causes dispersal of light on slit lamp examination. Patients with suspected uveitis warrant expedited ophthalmology consultation. Topical corticosteroids are the treatment of choice for noninfectious uveitis. (Choice A) Acute angle-closure glaucoma presents in a similar manner with monocular blurry vision and pain, but it is more likely to be accompanied by headache, nausea, and vomiting. Examination would not show leukocytes in the anterior chamber. Acute angle-closure glaucoma (Choice C) Bacterial conjunctivitis presents with erythema and thick, purulent discharge that typically continues throughout the day. (Choice D) Episcleritis does not commonly present with pain but rather with erythema and tearing. Vision remains unimpaired. Episcleritis (Choice E) Hordeolum is the acute obstruction of the meibomian gland, eyelash follicle, or lid-margin tear gland, with associated inflammation and possible Staphylococcus aureus infection. It does not result in inflammation of the globe itself. Hordeolum Educational objective: Anterior uveitis is characterized by a unilateral painful, red eye and photophobia. Diagnosis is confirmed by identifying leukocytic exudate in the anterior chamber. Noninfectious etiologies are treated with topical corticosteroids. __________ References: A systematic approach to emergencies in uveitis. (http://www.ncbi.nlm.nih.gov/pubmed/25100911) Diagnosis and management of red eye in primary care. (http://www.ncbi.nlm.nih.gov/pubmed/20082509)

A 29-Year-Old Man Comes to the Office with Right Eye