Uveitis-induced posterior synechiae

Abstract

An 81-year-old man presented at the Miami Veterans Affairs eye clinic with redness and pain in his left eye. On examination, a small nasal pterygium was noted along with mild bulbar injection and 2+ cell in the anterior chamber (AC). He was diagnosed with acute anterior uveitis of the left eye and started on prednisolone acetate 1% eye drops four times daily. On return visit 1 week later, new posterior synechiae (PS) were noted inferonasally (A, blue arrowhead), but the AC cell had improved. The frequency of prednisolone was increased to eight times daily for 1 week then four times daily until the next visit. Cyclopentolate 1% was added twice daily. Three weeks later, no AC cells were noted, and prednisolone was tapered weekly, and cyclopentolate was discontinued. Three months later, the PS had broken, with separation of the pupillary margin from the iris forming a ropelike structure nasally (B, black arrowhead), with remnants of pigment on the anterior lens capsule (orange arrowhead). PS can be a sequela of inflammatory conditions such as uveitis. Prompt treatment of inflammation can reverse PS formation but does not typically lead to detachment of the pupillary margin from the iris, as noted in this case.