Which physical findings are characteristic of ophthalmologic manifestations of ankylosing spondylitis?

Updated: May 15, 2020
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Patients suspected of having ankylosing spondylitis should undergo a thorough physical examination, preferably by a rheumatologist.

A complete ophthalmic examination should be performed, with special emphasis on the following:

  • Best-corrected distance and near acuity

  • Pupil examination

  • Slit-lamp examination

  • Intraocular pressure - Often low during acute exacerbations, secondary glaucoma, hypotony, phthisis

  • Gonioscopy - Peripheral anterior synechiae can form and cause secondary angle closure

  • Dilated fundus examination - Vitreitis, CME, retinal vasculitis, epiretinal membrane

Slit-lamp examination may reveal the following:

  • Conjunctiva and sclera - Conjunctival injection, watery discharge, no follicles or papillae

  • Cornea - Small to medium keratic precipitates

  • Anterior chamber - Cells and flare, fibrin, and/or hypopyon not uncommon

  • Iris - Posterior synechiae, peripheral anterior synechiae, pupillary membrane, no nodules

  • Lens - Posterior subcapsular cataract

  • Vitreous - Anterior vitreous cells, vitreitis


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