A 32-year-old woman presents with sudden onset photophobia, pain, and blurred vision in the right eye. Slit-lamp examination reveals fine keratic precipitates, anterior chamber cells (3+), and fibrin. Posterior segment examination is unremarkable. Which of the following is NOT a recognized cause of this pattern of anterior uveitis?

Explanation

## Differential Diagnosis of Anterior Uveitis **Key Point:** Acute angle-closure glaucoma is a medical emergency presenting with pain, photophobia, and blurred vision, but it is NOT a cause of uveitis. It is a primary angle-closure attack due to pupillary block or plateau iris, NOT inflammation of the uveal tract. ### Recognized Causes of Anterior Uveitis | Cause | Keratic Precipitates | AC Cells | Clinical Context | |-------|----------------------|----------|------------------| | **Sarcoidosis** | Granulomatous (mutton-fat) | 2–4+ | Bilateral, chronic; systemic symptoms | | **Tuberculosis** | Granulomatous | 2–4+ | Granulomatous pattern; history of TB exposure | | **Behçet disease** | Non-granulomatous or granulomatous | 3–4+ | Recurrent; oral/genital ulcers; posterior segment involvement | | **Acute angle-closure** | ABSENT | ABSENT | Shallow AC; elevated IOP; NOT inflammation | **High-Yield:** Acute angle-closure glaucoma mimics anterior uveitis clinically (pain, photophobia, redness, blurred vision) but has: - **No keratic precipitates** (no inflammatory cells) - **No anterior chamber reaction** (no cells or flare) - **Shallow anterior chamber** on gonioscopy - **Markedly elevated IOP** (often >40 mmHg) - **Mid-dilated, non-reactive pupil** **Clinical Pearl:** The presence of keratic precipitates and anterior chamber cells definitively excludes angle-closure glaucoma and confirms uveitis. Angle-closure is a mechanical/pressure problem, not an inflammatory one. **Warning:** Do not confuse the symptom overlap (pain, photophobia) with pathophysiology. Angle-closure is a surgical emergency requiring laser peripheral iridotomy; uveitis requires anti-inflammatory therapy.