Last week I met three people with iridocyclitis caused by ankylosing spondylitis, which is related with the gene of HLA-B27. Those patients were complaining the ocular pain, red eye, weeping, photophobia and mild vision decrease. The most common cause of hypopyon uveitis in north America and Europe is HLA-B27-associated uveitis, whereas the most common cause of hypopyon uveitis in Asia is Behcet’s disease.

Up to 50% ankylosing spondylitis patients develop anterior uveitis. Especial for men. The uveitis can vary in severity from mild to severe and often produces pain, photophobia, and blurred vision. Limbal injection is often present. Keratic precipitates are never granulomatous, and iris nodules don’t occur. Complications are posterior synechiae, peripheral anterior synechiae, cataracts and glaucoma.When the inflammation is severe and spills over to invole the vitreous, the macular edema occurs. Bilateral eyes simultaneous involvement is uncommon. 50% of patients with HLA -B27 positive will experience a nonocular complication of ankylosing spondylitis but also psoriatic arthritis, Reiter’s disease and inflammatory bowel disease.

you have to use hormones, such as dexamethasone 10mg for at least one week. Then ask patient to return visit every three days. Local glucocorticoid eye drops, non-steroidal anti-inflammatory drugs, dilation drugs is also necessary. Fundus examination was also a routine. Important are to exclude eye injury with intraocular foreign body and general uveitis diseases. If necessary, fluorescence fundus angiography is performed to exclude vascular disease. Acute iridocyclitis and endophthalmitis when sometimes are difficult to be distinguished.