- A 43-year-old male presented with redness and pain in both eyes for 3 months and decreasing vision in both eyes for 1 month. - Examination found hazy corneas, anterior uveitis, and absent foveal reflex in both eyes. - The probable diagnosis was recurrent bilateral granulomatous anterior uveitis. Differential diagnoses included tuberculosis, sarcoidosis, leprosy, syphilis, VKH, and toxoplasmosis. - Treatment with topical and oral steroids was started along with additional tests to determine the underlying cause.

1. CASE PRESENTATION
PRESENTER- Dr SADYAJA SMITA
UNDER GUIDANCE OF- DR. ABHA SHUKLA

2. PATIENT DETAILS
• Name: Ramwaran s/o Roopkishor
• Age/Sex: 43 years/Male
• Address: BHIND,Gwalior
• Occupation: Shopkeeper

3. PRESENTING COMPLAINTS
• C/o redness and pain in both eye 3 months back
• C/o Dimunition of vision in both eyes since 1 month

4. HISTORY OF PRESENTING ILLNESS
• The patient presented in our opd with redness in both eye 3 months back
which was acute in onset and gradually progressive in nature associated
with watering in both eye which was relieved on medication.
• The patient developed diminution of vision in both eyes since 1 month
which is insidious in onset, gradually progressive and not associated with
floaters, micropsia, macropsia, metamorphopsia, photopsia,
dyschromatopsia, or nyctalopia.

5. PAST HISTORY
• h/o rta 6 yrs back when he underwent surgery for right tibia fracture
• c/o back stiffness since 4 years
• No c/o flu like illness, chronic cough, shortness of breath, oral or
genital ulceration, burning micturition, skin lesions, significant
weight loss, chronic diarrhea, tinnitus, or vertigo.
• The patient did not give any history of previous ocular trauma,
ocular surgery, or any history of intake of immunosuppressants, or
i/v drug abuse.

6. MEDICAL HISTORY
• Not a k/c/o hypertension, diabetes mellitus, tuberculosis, bronchial
asthma, epilepsy.
PERSONAL HISTORY
• The patient denied any history of close contact with animals, bathing in the
river, or consuming uncooked meat.
FAMILY HISTORY
• No history of similar illness in the family.

7. On Examination
• The patient was well oriented to time, place and
person; had average built and stature with normal
appearance.
• All the vitals of the patient were within normal
limits.
• No signs of pallor, icterus, cyanosis, clubbing,
lymphadenopathy, pedal edema

8. RIGHT EYE LEFT EYE
VA 6/36 PH 6/12 6/24 PH 6/12
Orbit Normal Normal
Lids Normal Normal
Position Primary Primary
Movements of the globe Full Range Full range
Conjunctiva Normal NASAL PTERYGIUM GRADE 2
Sclera White White
Cornea MILD HAZY, sensations normal MILD HAZY, sensations normal
AC NID NID,
Pupil CCRL+ CCRL+
Lens Opacity 1+ Opacity1+
IOP BE 16 mm Hg with GAT (10/07/20 at 10 AM)

9. SLIT LAMP EXAMINATION
• BE- MULTIPLE MUTTON FAT KPs in arlt’s
triangle
• AC cells grade 2
• Aqueous flare grade 1
• Koeppes nodule on pupillary border

10. OD OS

11. FUNDUS EXAMINATION
BOTH EYE- Red glow seen. Media mild hazy(vitreous haze
grade 2), Disc- size, shape, colour - normal, margins normal,
general fundus –mild tessalation, vessels in general fundus-
normal Foveal reflex absent.

12. Probable Diagnosis- RECURRENT BILATERAL
GRANULAMATOUS ANTERIOR UVEITIS
DIFFERENTIAL DIAGONOSIS
TUBERCULOSIS
SARCOIDOSIS
LEPROSY
SYPHILLIS
VKH
TOXOPLASMOSIS

13. TREATMENT GIVEN
• E/D MOXIFLOXACIN+DEXAMETHASONE 6 TIMES A DAY
• E/D HOMATROPINE TWO TIMES A DAY
• E/D CMC 4 TIMES A DAY
• TAB prednisolone 40mg tapered in 5 days
• TAB MVBC ONCE A DAY

14. Investigations
• Blood investigations- CBC, ESR, CRP,RA FACTOR
• SEROLGY- VDRL, SEUM ANCA, SEUM ACE
• MONTOUX TEST, CBNAAT , INTERFERON GAMMA ESSAY
• Radiological investigations-CHEST XRAY, SACRO-ILIAC JOINT XRAY
• Immunoassay/HLA- HLA-B27 TYPING