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HLA-B27 Anterior Uveitis — RACP Adult Medicine MCQ

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HardRheumatologyHLA-B27 Anterior UveitisRACP Adult Medicine

A 30-year-old with HLA-B27 axial spondyloarthritis develops a third episode of unilateral acute anterior uveitis: pain, photophobia, ciliary injection, cells and flare, without posterior involvement or infection. What is the best immediate ocular regimen?

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Correct answer: A — Urgent ophthalmology-directed potent topical corticosteroid plus a cycloplegic–mydriatic

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

A is correct. Non-infectious acute anterior uveitis is treated promptly with a potent topical corticosteroid to suppress inflammation and a cycloplegic–mydriatic to relieve ciliary spasm and reduce posterior-synechiae risk, under ophthalmic follow-up for response and pressure. B is too slow and does not treat the acute eye. C is inadequate and reverses the synechiae rationale. D treats a different posterior-segment vascular problem. E exposes the whole body while omitting the standard local regimen and monitoring. Recurrent episodes justify coordinated rheumatology–ophthalmology discussion of systemic disease control, but that longer-term decision does not replace immediate topical therapy.

Reference: RANZCO: Uveitis: https://ranzco.edu/wp-content/uploads/2019/06/OPA-RANZCO-Uveitis-ed2-1.pdf