I have just examined a 32-year-old female patient who is new to the practice. She had good visual acuity in each eye with a low prescription for myopia. She was interested in using contact lenses. During slit lamp examination of the anterior eye I noticed some white-yellow greasy deposits on the rear surface of both corneas. About six months ago she had one episode of blurred vision, mild eye pain, tearing, and mild sensitivity to light. She took paracetamol and after a week things improved. What is going on?

This sounds and looks like granulomatous uveitis. The white-yellowish greasy deposits on the rear surface of both corneas are keratic precipitates (KPs); these are clusters of white blood cells. They are usually located over the lower half of the cornea.

Granulomatous uveitis can be associated with some serious systemic diseases:

Sarcoidosis- abnormal collections of inflammatory cells that form lumps

Syphilis

Multiple sclerosis

Lyme disease-bacterial infection

Tuberculosis

Herpes zoster

Even though your patient seems to have good visual acuity and the eyes are quiet at the moment, attempts need to be made to discover the underlying cause of the episode of uveitis. A referral to a medical specialist would be clinically warranted in this case.

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