What diagnosis should you consider in a patient with acute eye pain and redness and a history of ankylosing spondylitis?

In a patient with acute eye pain and redness, combined with a history of ankylosing spondylitis, the diagnosis of anterior uveitis should be strongly considered. Ankylosing spondylitis is associated with various extra-articular manifestations, one of which is anterior uveitis (also known as iritis). Anterior uveitis typically presents with symptoms such as eye pain, redness, photophobia, and blurred vision, and is characterized by inflammation of the iris and ciliary body.

The link between ankylosing spondylitis and anterior uveitis stems from underlying autoimmune mechanisms. Many patients with ankylosing spondylitis are positive for the HLA-B27 antigen, which is also a risk factor for developing anterior uveitis. Therefore, when encountering a patient with both acute eye symptoms and a background of ankylosing spondylitis, anterior uveitis becomes a plausible and likely diagnosis requiring timely intervention to prevent complications like vision loss.

Other potential conditions, such as open-angle glaucoma, retinal detachment, or vitreous hemorrhage, may present with eye pain or changes in vision but do not have the same strong association with ankylosing spondylitis, making anterior uveitis