Title : Blood sugar measurement in acute anterior uveitis a life saving link
Abstract:
Introduction: To explore the correlation between acute anterior uveitis (AAU) and undiagnosed or poorly controlled diabetes mellitus (DM), and to emphasise the importance blood sugar testing in Eye Emergency in case of Uveitis
Case series: This case series describes four patients who presented with acute anterior uveitis (AAU) and were subsequently found to have either undiagnosed diabetes mellitus (DM) or poorly controlled disease.
Case 1: An 11-year-old girl presented with bilateral AAU and was newly diagnosed with Type 1 DM, requiring hospitalisation in ICU for diabetic ketoacidosis.
Case 2: A 68-year-old woman with recurrent AAU was found to have previously undiagnosed Type 2 DM, along with ketonuria, hypertension, and atrial fibrillation requiring urgent attention.
Case 3: A 36-year-old man with recurrent AAU was diagnosed with latent autoimmune diabetes in adults (LADA) and later developed diabetic retinopathy requiring laser and intravitreal treatment.
Case 4: A 42-year-old man with known Type 2 DM and recurrent AAU exhibited poor glycaemic control (HbA1c 124 mmol/mol), linked to non-compliance with treatment.
Management: These cases highlight the important but often overlooked association between AAU and systemic conditions, particularly diabetes. Suspecting and detecting altered blood sugar early was life-saving in two of our cases, which needed urgent emergency intervention. Ketoacidosis as a trigger and consequence of ongoing inflammation in the human body which can not only present as AAU but can be life threatening needing urgent intervention as seen in two of our cases. Raised blood sugar is also associated with frequent relapses in known diabetics and higher chances of developing retinopathy at a later stage
Conclusion: Presentations in the eye emergency are mostly acute and severe and associated with very high blood sugar levels and higher susceptibility to complications. Early detection and management of metabolic abnormalities through such screening may prevent life-threatening complications and preserve vision.
Learning point: Incorporating routine blood glucose and HbA1c checks into the assessment of AAU can reveal hidden diabetes, improve disease control, and even save lives. Eye emergency services are uniquely positioned to act as gateways for broader systemic health screening, making every encounter count.
