A 35-year-old male presented with redness, pain, and blurred vision in OD for the past 10 days. He was diagnosed with ankylosing spondylitis (AS) 4 years back when he had acute anterior uveitis in his left eye and was tested positive for HLA-B27. He gave a history of similar episodes and lower backache for the past 8–10 years and was advised systemic medications by a rheumatologist that he did not start. He neither gave any history of trauma or any other systemic disease nor was he on any systemic medications.
His BCVA was hand movement in OD and 6/9 in OS. Slit lamp examination of OD revealed circumciliary congestion, corneal edema, 4 +cells with fibrin, dispersed hem, and hyphema with an IOP of 10 mmHg [Figure 1a]. Ultrasonography B scan of OD documented attached retina with few vitreous echoes. He was started on frequent topical corticosteroid and cycloplegic. Considering severity of the inflammation; oral corticosteroid was added. He was reviewed on day 2 [Figure 1b] and 4 [Figure 1c], and at 2-week follow-up, his BCVA in OD improved to 6/9, and anterior segment was quiet with no neovascularization of iris/angle [Figure 1d]. Fundus examination revealed resolving hemorrhage in anterior hyaloid face in OD and a normal attached retina in OU. The patient is under regular follow-up with us.
Figure 1.
Slit-lamp photographs of the right eye showing hyphema on (a) day 1, (b) day 2, and (c) day 4, and (d) quiet anterior chamber after 2 weeks
Ocular or systemic causes may cause spontaneous hyphema. Our patient denied any history of trauma, and there is no evidence of any mass lesion. He was a known case of AS and lacked other signs which helped us to exclude the differentials.[1]
Spontaneous hyphema in a case of uveitis is secondary to breakdown of blood–aqueous barrier and corresponds to the severity of inflammation[2] and has been reported with AS.[3,4,5] Serial photographic documentation and favorable response with the conventional therapy may help in creating awareness on this extremely rare manifestation of the most common cause of acute anterior uveitis.
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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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