A 39-year-old man, complained about a 3-day history of bilateral blurred vision. He had a past medical history of kidney transplantation 5 years ago and was receiving systemic immunosuppressive therapy. The patient was hospitalized for chickenpox and was treated with systemic antivirals 3 weeks prior to ocular symptoms onset. On ophthalmic examination, the patient’s best corrected visual acuity (BCVA) was 20/200 in the right eye (RE) and 20/25 in the left eye (LE). Slit-lamp examination showed stromal keratitis and few fine keratic precipitates in the RE (Fig. ) and 1+ anterior chamber cells in both eyes. Intraocular pressure was 22 mmHg in the RE and 20 mmHg in the LE. There were no vitreous cells, and results of dilated fundus examination were unremarkable in both eyes. The patient was diagnosed with keratouveitis in the RE and acute anterior uveitis in the LE secondary to chickenpox. He was treated with topical acyclovir five times a day, dexamethasone six times a day, beta blockers, and atropine 1% twice daily. He was lost to follow-up. One year later, he presented with a 1-week history of blurry vision bilaterally. On ophthalmic examination, BCVA was 20/200 in the RE and 20/30 in the LE. Slit-lamp examination showed “mutton-fat” pigmented keratic precipitates (Fig. ), 1+ anterior chamber cells, corneal scars, patchy iris atrophy with circumscribed depigmented spots of the iris, and distorted pupil (Fig. ) in both eyes. Intraocular pressure was 27 mmHg in the RE and 24 mmHg in the LE. Assessment of posterior segments revealed no abnormalities in both eyes. A diagnosis of recurrent granulomatous anterior uveitis was made. The patient was treated with topical dexamethasone six times a day, topical acyclovir five times a day, beta blockers, and atropine 1% twice daily. Intraocular inflammation gradually resolved, and visual acuity improved. Topical steroids and acyclovir were slowly tapered. Visual acuity improved to 20/25 in both eyes one month after presentation. No recurrence of intraocular inflammation was observed over a follow-up period of 24 months.
A 42-year-old otherwise healthy man experienced redness and blurred vision in the LE 3 weeks after the onset of chickenpox. On examination, BCVA was 20/20 in the RE and 20/25 in the LE. His left pupil was small but reactive with no relative afferent pupillary defect. There were perilimbal injection, few fine keratic precipitates inferiorly, and 1+ anterior chamber cells in the LE. Intraocular pressure was 16 mmHg. There was no vitritis, and dilated fundus findings were normal. Examination results of the RE were normal. A diagnosis of unilateral acute non-granulomatous anterior uveitis secondary to varicella was made. The patient was treated by topical acyclovir five times a day, dexamethasone six times a day, and cycloplegic agent twice daily. The uveitis resolved within 2 weeks, and visual acuity improved to 20/20 in the LE. No recurrence of uveitis was observed over a follow-up period of 24 months.