A 31 year old female presents to the eye clinic after noticing some blurring in her right eye along with an increased amount of floaters for the past several weeks. She denies any pain or photophobia. She denies any fever or chills. She has negligible past medical history including ocular history. Visual acuity is 20/30 OD and 20/20 OS. IOP is 27 mmHg OD and 14 mmHg OS. Slit-lamp exam OD demonstrates fine, diffuse, stellate keratic precipitates coating the entire corneal endothelium, trace anterior chamber cell, and loss of the iris pupillary ruff. Dynamic gonioscopy reveals fine blood vessels bridging the trabecular meshwork in the right eye. Dilated fundus examination shows 1+ vitreous cells without active retinochoroidal lesions in the right eye; the left fundus is unremarkable. Which of the following is the most appropriate management strategy for this patient's intraocular inflammation?
A) High-dose topical prednisolone acetate 1% drops every hour
B) Periocular triamcinolone acetonide injection
C) Topical cyclopentolate 1% to prevent posterior synechiae formation
D) Observe the intraocular inflammation and treat the elevated intraocular pressure with topical hypotensive agents
E) Perform urgent laser peripheral iridotomy
Correct Answer: D) Observe the intraocular inflammation and treat the elevated intraocular pressure with topical hypotensive agents
In Fuchs Uveitic Syndrome (FUS), low-grade anterior chamber inflammation is chronic, asymptomatic, and steroid-resistant. Although it is still debated, most recent studies align with the infectious pathway, where chronic infection (possibly rubella) leads to chronic inflammation that manifests as uveitis. Long-term topical or periocular corticosteroids will not eliminate the cell/flare and significantly increase the risk of accelerating steroid-induced glaucoma and cataract formation. Treatment in FUS is directed exclusively at managing complications (elevated IOP with topical glaucoma drops, and phacoemulsification for visual loss due to cataracts).
A & B: Steroids can be used to clear anterior chamber cells. Steroids should be avoided for treating the baseline low-grade cell/flare in FUS due to resistance and high risk of IOP spikes/cataracts.
C: Mydriatics/cycloplegics are unnecessary because FUS does not produce posterior synechiae.
E: The abnormal angle vessels seen on gonioscopy (which cause the Amsler sign—filiform hemorrhage during paracentesis or applanation) cause open-angle glaucoma, not pupillary block or angle-closure glaucoma; LPI is not indicated. LPI is used to prevent angle-closure glaucoma.
Moshirfar M, Villarreal A, Ronquillo Y. Fuchs Uveitis Syndrome. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559148/