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CLINICAL IMAGE
Year :   |  Volume :   |  Issue :   |  Page :  

Acute anterior uveitis with hyphema in ankylosing spondylitis


1 Department of Uvea Services, Aditya Jyot Eye Hospital Pvt. Ltd, Mumbai, Maharashtra, India
2 Department of Vitreoretina, Aditya Jyot Eye Hospital Pvt. Ltd, Mumbai, Maharashtra, India
3 Department of Uvea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission10-Aug-2021
Date of Decision27-Sep-2021
Date of Acceptance17-Oct-2021
Date of Web Publication16-Sep-2022

Correspondence Address:
Hitesh R Sharma,
Aditya Jyot Eye Hospital Pvt. Ltd, 153, Road No 9, Major Parmeshwaran Road, Opp. S.I.W.S. College Gate No. 3, Wadala, Mumbai - 400 031, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.ojo_239_21

   Abstract 


Keywords: Acute Anterior Uveitis, hyphaema, HLA B27



How to cite this URL:
Sharma HR, Walinjkar JA, Sundaram N, Majumder PD. Acute anterior uveitis with hyphema in ankylosing spondylitis. Oman J Ophthalmol [Epub ahead of print] [cited 2022 Oct 4]. Available from: https://www.ojoonline.org/preprintarticle.asp?id=356256



A 35-year-old male presented with redness, pain, and blurred vision in OD for the past 10 days. He was diagnosed with ankylosing spondylitis (AS) 4 years back when he had acute anterior uveitis in his left eye and was tested positive for HLA-B27. He gave a history of similar episodes and lower backache for the past 8–10 years and was advised systemic medications by a rheumatologist that he did not start. He neither gave any history of trauma or any other systemic disease nor was he on any systemic medications.

His BCVA was hand movement in OD and 6/9 in OS. Slit lamp examination of OD revealed circumciliary congestion, corneal edema, 4 +cells with fibrin, dispersed hem, and hyphema with an IOP of 10 mmHg [Figure 1]a. Ultrasonography B scan of OD documented attached retina with few vitreous echoes. He was started on frequent topical corticosteroid and cycloplegic. Considering severity of the inflammation; oral corticosteroid was added. He was reviewed on day 2 [Figure 1]b and 4 [Figure 1]c, and at 2-week follow-up, his BCVA in OD improved to 6/9, and anterior segment was quiet with no neovascularization of iris/angle [Figure 1]d. Fundus examination revealed resolving hemorrhage in anterior hyaloid face in OD and a normal attached retina in OU. The patient is under regular follow-up with us.
Figure 1: Slit-lamp photographs of the right eye showing hyphema on (a) day 1, (b) day 2, and (c) day 4, and (d) quiet anterior chamber after 2 weeks

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Ocular or systemic causes may cause spontaneous hyphema. Our patient denied any history of trauma, and there is no evidence of any mass lesion. He was a known case of AS and lacked other signs which helped us to exclude the differentials.[1]

Spontaneous hyphema in a case of uveitis is secondary to breakdown of blood–aqueous barrier and corresponds to the severity of inflammation[2] and has been reported with AS.[3],[4],[5] Serial photographic documentation and favorable response with the conventional therapy may help in creating awareness on this extremely rare manifestation of the most common cause of acute anterior uveitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bonfioli AA, Curi AL, Orefice F. Fuchs' heterochromic cyclitis. Semin Ophthalmol 20:143-6.  Back to cited text no. 1
    
2.
Pathanapitoon K, Dodds EM, Cunningham ET Jr., Rothova A. Clinical spectrum of HLA-B27-associated ocular inflammation. Ocul Immunol Inflamm 2017;25:569-76.  Back to cited text no. 2
    
3.
Fong DS, Raizman MB. Spontaneous hyphema associated with anterior uveitis. Br J Ophthalmol 1993;77:635-8.  Back to cited text no. 3
    
4.
Jones NP. Spontaneous hyphema associated with anterior uveitis. Br J Ophthalmol 1994;78:420.  Back to cited text no. 4
    
5.
Klemperer I, Yassur Y, David R. Spontaneous hyphema: An unusual complication of uveitis associated with ankylosing spondylitis. Ann Ophthalmol 1992;24:177-9.  Back to cited text no. 5
    


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