Uveitis and Ocular Inflammation
This domain tests classification, systemic associations, targeted workup, and treatment of intraocular inflammation. The exam rewards pattern recognition and avoids indiscriminate testing.
Core uveitis
- Anatomic classification: anterior, intermediate, posterior, panuveitis. Granulomatous disease includes sarcoidosis, TB, VKH, and sympathetic ophthalmia.
- Common associations: HLA-B27 with ankylosing spondylitis; Behçet with hypopyon and oral/genital ulcers; toxoplasmosis with focal retinochoroiditis; sarcoidosis with mutton-fat KPs and iris nodules.
- Workup is targeted; not every anterior uveitis needs a full systemic screen.
- Treatment: topical steroids and cycloplegics for anterior disease; periocular or systemic steroids; immunosuppressants such as methotrexate or azathioprine; biologics such as adalimumab.
- Masquerade syndromes: intraocular lymphoma, melanoma, and retained lens material.
Worked example
A 28-year-old man has recurrent unilateral anterior uveitis, HLA-B27 positivity, and low back pain. Reasoning: the combination suggests ankylosing spondylitis. Refer to rheumatology and treat the eye with topical steroid plus cycloplegic.
Traps
Steroids alone in herpetic uveitis can cause harm. Posterior synechiae need dilation. A hypopyon can be Behçet or infection, not always bacterial.