OP6.1 | Uveitis Classification and Iridocyclitis Recognition — Summary & Reflection

KEY TAKEAWAYS

Uveitis is inflammation of the uveal tract (iris, ciliary body, choroid), classified by the SUN Working Group into anterior (iridocyclitis — most common), intermediate (pars planitis), posterior (chorioretinitis), and panuveitis. Iridocyclitis presents with ciliary flush (not conjunctival), photophobia, miosis, posterior synechiae (irregular pupil), keratic precipitates on the corneal endothelium, aqueous cells and flare by slit-lamp, and characteristically LOW IOP. Granulomatous iridocyclitis shows mutton-fat KPs and iris nodules (Koeppe at pupillary margin, Busacca on iris stroma) and is associated with sarcoidosis, TB, and VKH; non-granulomatous disease shows fine stellate KPs, no nodules, acute onset, and is the most common type (HLA-B27 association). The acute red eye differential — angle-closure glaucoma (mid-dilated fixed pupil, very high IOP), keratitis (corneal ulcer), scleritis (scleral pain, non-blanching), conjunctivitis (discharge, normal vision) — is distinguished primarily by pupil state, IOP, corneal clarity, and presence/absence of discharge. First-line treatment: cycloplegia (atropine) FIRST to prevent synechiae, then topical corticosteroids.

REFLECT

You now understand that iridocyclitis is a medical emergency masquerading as a 'red eye.' Think about the 28-year-old man from the opening scenario — he has had low back pain for two years. What systemic workup would you arrange? How would you counsel him about the risk of recurrence and the need to seek early ophthalmology care if his eye becomes red again? Consider also: if a patient presents with bilateral, chronic iridocyclitis with mutton-fat KPs in your future practice, which systemic condition would you most urgently want to exclude, and why? Reflecting on the 'CAMP' mnemonic and the IOP differential — how will you incorporate a quick IOP check into your approach to every red eye?