# Uveitis > Uveitis for FMGE Ophthalmology: anterior uveitis signs, HLA-B27, granulomatous KPs, VKH, sympathetic ophthalmia, intermediate and posterior uveitis treatment. - Canonical URL: https://prepelephant.com/topics/fmge/ophthalmology/uveitis-fmge - Exam / course: FMGE · Subject: Ophthalmology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Uveitis", PrepElephant, https://prepelephant.com/topics/fmge/ophthalmology/uveitis-fmge ## Direct answer Uveitis is inflammation of the iris, ciliary body or choroid, and the anterior form presents with a painful, photophobic, red eye in which the flush is deepest around the limbus, the pupil is small and irregular, and keratic precipitates clutter the corneal endothelium. Classification is anatomical — anterior, intermediate, posterior or panuveitis — and each pattern carries its own cause list, from HLA-B27-associated ankylosing spondylitis to tuberculosis, sarcoidosis, syphilis and Behçet disease in the Indian clinic. Treatment pairs a cycloplegic such as homatropine or atropine (to break pain and prevent posterior synechiae) with steroids delivered topically, periocularly or systemically, guided by the cause. The two special examinations favourites, Vogt-Koyanagi-Harada disease and sympathetic ophthalmia, are both bilateral granulomatous panuveitides. ## What you must remember - Anterior uveitis triad: ciliary limbal flush, miosis with a sluggish pupil, keratic precipitates; cells and flare in the anterior chamber on slit lamp. - Granulomatous uveitis shows mutton-fat keratic precipitates, Koeppe and Busacca iris nodules and posterior synechiae; non-granulomatous disease shows fine KPs and aqueous flare. - HLA-B27 associates with acute recurrent anterior uveitis in ankylosing spondylitis, reactive arthritis and inflammatory bowel disease — young men with a stiff, painful back and a red eye. - Behçet disease: recurrent hypopyon uveitis with oral and genital ulceration and skin pathology; VKH: bilateral granulomatous panuveitis with meningism, tinnitus, dysacousia, alopecia, poliosis and vitiligo, giving a sunset-glow fundus. - Sympathetic ophthalmia is bilateral granulomatous panuveitis following penetrating injury or surgery to one eye, usually appearing two weeks to three months later; prevention is enucleation of a hopelessly blind, badly disrupted globe within about 14 days. - Intermediate uveitis (pars planitis) affects young people with floaters and snowball or snowbank exudates over the pars plana; macular oedema is the threat to vision. - Toxoplasma retinochoroiditis produces a fluffy white retinitis next to an old pigmented scar — the "headlight in the fog" — treated with antiparasitics plus steroids (steroids never alone). - Never start steroids without cycloplegia and, where possible, a work-up: chest radiograph, Mantoux, syphilis serology, HLA-B27 and sarcoid markers are the Indian standard panel. ## A unilateral red eye in a young man, worked through A 27-year-old presents with right eye pain, photophobia and blurred vision for three days; he mentions early-morning low-back stiffness that responds to exercise. Vision is 6/18; the eye shows deep limbal injection, a small irregular pupil and fine keratic precipitates, with two-plus cells and flare in the anterior chamber. The pattern is acute non-granulomatous anterior uveitis, and the back story flags ankylosing spondylitis: order HLA-B27, inflammatory markers and a sacroiliac radiograph, but do not wait for results to treat. Start homatropine 2 per cent twice daily to immobilise the ciliary body and prevent posterior synechiae, and prednisolone acetate 1 per cent hourly, tapered over weeks against the cell count. Review at 48 hours: falling cells and a dilated round pupil mean response; a fibrin-filled pupil or rising pressure means escalation to oral steroids and a glaucoma review. Had the KPs been mutton-fat with iris nodules, the pathway would widen to granulomatous causes — tuberculosis, sarcoidosis, VKH — before any steroid plan. Had the patient returned after eye surgery with a quiet partner eye turning granulomatous, sympathetic ophthalmia would top the list. The discipline is the same each time: characterise the inflammation, treat early with cycloplegia plus steroids, and chase the cause in parallel. ## Where candidates slip Three marks are lost predictably. One: treating uveitis with antibiotics — most cases are non-infective or immunological, and the emergency is suppression of inflammation, not antimicrobial cover. Two: forgetting the fellow eye and the systemic cause; an examiner who asks about oral ulcers, vitiligo or back pain is handing the diagnosis over. Three: the sympathetic ophthalmia timeline — any granulomatous inflammation in the fellow eye weeks to months after penetrating trauma or surgery is sympathetic ophthalmia until proven otherwise, and steroids or immunosuppression must start immediately; the enucleation-of-the-injured-eye rule applies only within the first two weeks of a devastating injury. ## Frequently asked questions ### What distinguishes granulomatous from non-granulomatous uveitis? Mutton-fat keratic precipitates, iris nodules (Koeppe and Busacca) and dense posterior synechiae in granulomatous disease, versus fine KPs and aqueous flare in non-granulomatous inflammation. ### Which conditions link HLA-B27 with anterior uveitis? Ankylosing spondylitis, reactive arthritis, inflammatory bowel disease and psoriatic arthritis — typically acute, recurrent, unilateral anterior uveitis in young men. ### What is sympathetic ophthalmia and how is it prevented? Bilateral granulomatous panuveitis following penetrating injury or surgery to the other eye, mostly within two weeks to three months; prevented by enucleating a hopelessly injured eye within about 14 days. ### Why are cycloplegics mandatory in anterior uveitis? They relieve ciliary spasm and pain and keep the pupil moving, preventing posterior synechiae, secondary angle closure and a fixed small pupil. ### What are the systemic features of VKH syndrome? Meningism, tinnitus and dysacousia, alopecia, poliosis and vitiligo accompanying bilateral granulomatous panuveitis with a sunset-glow fundus. ### How does toxoplasma retinochoroiditis appear? A fluffy white focal retinitis adjacent to an old pigmented scar, the headlight in the fog, treated with antiparasitic drugs covered by steroids.