WHEN INFLAMMATION MASKS ANATOMY: BILATERAL ACUTE UVEITIS REVEALING PLATEAU IRIS SYNDROME WITH SEVERE OCULAR HYPERTENSION

Background: Ocular hypertension in the context of acute uveitis is a common but complex condition, often attributed to inflammatory mechanisms. However, underlying anatomical abnormalities such as plateau iris syndrome may coexist and complicate both diagnosis and management. The association between acute uveitis and plateau iris syndrome is rare and has been only scarcely reported in the literature. Case presentation: We report the case of a 50-year-old man with a history of ocular hypertension who presented with bilateral acute anterior uveitis associated with severe ocular hypertension (48 mmHg). Clinical examination revealed marked anterior segment inflammation with granulomatous keratic precipitates, severe anterior chamber reaction, and extensive posterior synechiae. Fundus examination showed advanced glaucomatous optic neuropathy.Fluorescein angiography demonstrated peripheral retinal periphlebitis and optic disc leakage. Optical coherence tomography confirmed severe nerve fiber layer loss. Ultrasound biomicroscopy revealed bilateral plateau iris configuration, which had not been previously diagnosed.