Chronic Anterior Uveitis

History of Present Illness (HPI)

A 46-year-old woman with a history of anterior uveitis in the left eye (OS) associated with HLA-B27 presents to you from an outside ophthalmologist for a second opinion. She had her first episode of iritis 7 years ago. She responded well to drops and did not recur for almost a year. In the last 1 to 2 years, her flares have become more frequent and difficult to control. She is currently being treated for her third flare this year and has grown tired of the recurrences and frequent trips to the ophthalmologist’s office. She has had extensive testing for an underlying cause and only HLA-B27 was positive.

She is 3 weeks into this current flare. Her symptoms have subsided, and she has just started tapering her drops as per the usual routine.

Ocular medications:

• Prednisolone acetate 1% three times a day (TID) OS

Questions to Ask

• Do you have any other manifestations of HLA-B27-associated disease, like low back pain?

• What is the longest period you have gone without drops in the last year?

• Have you ever had high eye pressure from using steroid drops?

The patient denies any low back pain or other joint problems. She has not gone any longer than 5 weeks without topical therapy this year. She recalls once having eye pressures in the 20s when she was using the corticosteroid drop every hour for a while, but it came down once she was using the drop less frequently.