Features
• Painful red eye
• Photophobia
• Blurred vision
• Small, irregular (constricted) pupil (due to posterior synechiae)
• Ciliary flush (perilimbal injection)
• Cells and flare seen on slit-lamp
Associations
• HLA-B27 diseases: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, IBD
• Sarcoidosis
• Juvenile idiopathic arthritis
• Herpetic infections
Management
• Cycloplegic agents (e.g., atropine) to prevent synechiae
• Topical steroids (under ophthalmology guidance)
Features
• Floaters
• Blurred vision
• Less pain than anterior uveitis
Causes
• Toxoplasmosis (most common infectious cause)
• CMV (especially HIV/AIDS, CD4 <50)
• Syphilis
• TB
• Sarcoidosis
Management
• Systemic and/or local steroids
• Antimicrobial therapy if infectious cause
Features
• Severe, deep, boring eye pain, may radiate to jaw or forehead
• Worse with eye movements
• Diffuse or nodular redness involving deep scleral vessels
• May lead to scleral thinning, perforation
Associations
• Rheumatoid arthritis (most common)
• Granulomatosis with polyangiitis
• SLE
Management
• Systemic NSAIDs or steroids
• Urgent ophthalmology referral
Features
• Mild discomfort
• Localised or diffuse redness
• No vision loss, minimal or no pain
• Blanches with topical phenylephrine (distinguishes from scleritis)
Associations
• Often idiopathic
• May be associated with systemic rheumatological disease
Management
• Usually self-limiting
• Artificial tears, topical NSAIDs if needed
Condition Pain Visual Loss Other Clues
Acute angle-closure glaucoma Severe Yes Halos, mid-dilated pupil, hard eye
Anterior uveitis Moderate Variable Photophobia, small irregular pupil
Scleritis Severe Possible Deep pain, systemic disease
Keratitis Severe Yes Corneal opacity, contact lens use
Endophthalmitis Severe Yes Post-surgery, hypopyon
Extra Revision Pearls
• Photophobia clue → intraocular inflammation (uveitis, keratitis)
• Pain with eye movement clue → scleritis (not episcleritis)
• Synechiae clue → anterior uveitis complication
• Posterior uveitis clue → floaters predominant
• Red eye that blanches with phenylephrine clue → episcleritis
• Deep blue sclera clue → scleritis or osteogenesis imperfecta
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
