A 23-year-old man notices new low back pain, stiffness, and left eye discomfort. Sunlight also bothers his eyes. The back pain is worse at night and described as a dull ache in the back and buttock area. On physical examination, there is paravertebral muscle, iliac crest, and ischial tuberosity tenderness with limited flexion of the lumbar spine. His eye is inflamed and the pupil is constricted. Pelvic x-rays show sacroiliitis. Which of the following is the most likely diagnosis for his eye symptoms (it is the most common extra-articular manifestation of this condition)?
High-Yield Explanation
Acute anterior uveitis is the most common extra-articular manifestation of ankylosing spondylitis (AS). Pain, photophobia, and increased lacrimation are the usual symptoms. Attacks are unilateral and tend to recur, often in the other eye. Cataracts and secondary glaucoma are not uncommon sequelae. The iritis is usually managed with local glucocorticoid administration in association with a mydriatic agent.