## Granulomatous Anterior Uveitis — Infectious Causes **Key Point:** Mycobacterium tuberculosis is the most common infectious cause of granulomatous anterior uveitis in India, reflecting the high prevalence of tuberculosis in the Indian subcontinent. ### Granulomatous vs Non-Granulomatous Uveitis | Feature | Granulomatous | Non-Granulomatous | |---------|---------------|-------------------| | **Presentation** | Insidious onset, mild symptoms | Acute, marked photophobia, pain | | **KP (Keratic Precipitates)** | Large, greasy, "mutton fat" | Small, fine, "dust-like" | | **Anterior Chamber** | Granules on iris, ciliary body | Diffuse inflammation | | **Common Causes** | TB, syphilis, sarcoidosis, toxo | Acute bacterial, viral, HLA-B27 | ### Infectious Causes of Granulomatous Uveitis 1. **Mycobacterium tuberculosis** — most common in endemic areas (India, Southeast Asia) - Often associated with choroidal tubercles, miliary TB - Systemic screening essential 2. **Treponema pallidum** — secondary syphilis - Anterior uveitis with iris papules - Serology (RPR/VDRL, FTA-ABS) confirmatory 3. **Toxoplasma gondii** — primarily posterior uveitis - Focal retinochoroiditis ("headlight in the fog") - Anterior uveitis less common 4. **Candida albicans** — rare, usually in immunocompromised - Endophthalmitis pattern - Not a typical anterior uveitis pathogen **High-Yield:** In an Indian patient with granulomatous anterior uveitis, TB must be ruled out first — chest X-ray, tuberculin skin test (TST), and/or GeneXpert MTB/RIF are standard investigations [cite:Parson's Diseases of the Eye 22e Ch 8]. **Clinical Pearl:** TB-associated uveitis may present with "snowball" opacities in the vitreous (posterior involvement) or iris nodules, and systemic anti-TB therapy is often required alongside topical steroids. 
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