BILATERAL EPISCLERITIS AS THE FIRST PRESENTING SIGN OF ANKYLOSING SPONDYLITIS

The aim of our case is to underline the importance of ocular manifestations in ankylosing spondylitis.

A 27 years old man presented with the complaint of bilateral eye redness, mild ocular discomfort, without visual acuity loss. He had no previous medical history but reported gradually progressive low back pain since 2 months before presenting to our department. Eye examination revealed a bilateral episcleritis without any other abnormality. 

A 27 years old man presented with the complaint of bilateral eye redness, mild ocular discomfort, without visual acuity loss. He had no previous medical history but reported gradually progressive low back pain since 2 months before presenting to our department. Eye examination revealed a bilateral episcleritis without any other abnormality. There was no inflammation in anterior and posterior segment. The visual acuity was conserved and a phenylephrin test was done to assess the diagnosis of bilateral episcleritis.

Lab tests revealed normochromic normocytic anaemia and an ESR -48mm/1st hour. The human leukocyte antigen (HLA) typing was positive for HLA B27. The diagnosis of ankylosing spondylitis was made according to the modified New York criteria.

Ankylosing spondylitis is a chronic inflammatory disease of insidious onset that usually begin with enthesis.The majority of episcleritis cases are idiopathic,but up to 36% of patients have an associated systemic disorder that is responsible for the pathological process and development of episcleritis.

It is important to insist on the anamnesis, especially among young adults presenting concomittant low back pain.