Correspondence Address:
Dr. Sudha K Ganesh
Department of Uvea, Medical Research Foundation, Sankara Nethralaya 18, College Road, Chennai - 600 006, Tamil Nadu
India

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A 35-year-old male presented with acute onset of pain, redness, watering, and diminution of vision in the left eye (OS) for the last 20 days. His right eye was normal. He was already on multiple antiglaucoma medications in OS given by a local ophthalmologist.

On examination, visual acuity was hand movement in the OS. Slit lamp examination revealed that cornea was clear, severe fibrinous anterior uveitis (AU) with posterior synechiae with intraocular pressure (IOP) of 22 mmHg. Following therapy with hourly topical steroids and cycloplegics, vision improved to 20/50, AU subsided, and IOP was controlled. Fundus examination showed blurring of disc margins with retinal hemorrhage in the inferonasal quadrant [Figure 1]. Viral hypertensive AU with inflammatory disc edema of OS was considered as a possible diagnosis. A complete laboratory uveitis workup, including aqueous polymerase chain reaction (PCR) for herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV), were all negative.{Figure 1}

On review at 3 months, we noted new-onset diffuse iris atrophy arising at the pupillary border and extending 2 mm into the iris tissue, all around the pupillary margin with dense posterior synechiae [Figure 2]. The IOP with maximum medical therapy was 25 mmHg. Empirical oral antiviral therapy was started. The patient underwent trabeculectomy with mitomycin-C. Repeat nested PCR from aqueous, trabeculectomy, and iris tissues were negative for all viruses. On follow-up at 6 months, vision was 20/20, with no AU, controlled IOP and temporal disc pallor [Figure 3].{Figure 2}{Figure 3}

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