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Acute anterior uveitis in axSpA — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesAcute anterior uveitis in axSpASCE Rheumatology

A 29-year-old woman with axial spondyloarthritis develops an acutely painful red eye, photophobia and blurred vision. Examination shows circumcorneal injection and reduced visual acuity, with no purulent discharge. Her axial symptoms are stable. What is the most appropriate next step?

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Correct answer: E — Arrange immediate same-day ophthalmological assessment

The correct answer is E. Acute ocular pain, photophobia, blurred vision and circumcorneal injection in a patient with axial spondyloarthritis strongly suggest acute anterior uveitis. NICE recommends immediate same-day ophthalmological assessment because slit-lamp confirmation and prompt treatment are needed to limit complications such as posterior synechiae and visual impairment. A review within 2 weeks is too slow. Chloramphenicol is inappropriate because bacterial conjunctivitis more typically causes discharge and does not usually cause marked photophobia or reduced vision. Although topical corticosteroids and cycloplegics are commonly used for anterior uveitis, corticosteroids should not be initiated without ophthalmological assessment because infection and other important causes of a painful red eye must first be excluded. Stable axial symptoms do not alter the urgency of eye assessment or justify immediate escalation of rheumatological therapy.

Reference: National Institute for Health and Care Excellence. NG65, Spondyloarthritis in over 16s: diagnosis and management, recommendation 1.1.12, 2017. https://www.nice.org.uk/guidance/ng65/chapter/Recommendations