Etiology of hypopyon in patients presenting acutely to the emergency eye department and characteristics of hypopyon uveitis

Abstract

ObjectiveTo examine the etiology of undifferentiated hypopyon presenting acutely and to better characterize hypopyon uveitis. MethodsPatients with hypopyon were retrospectively identified from presentations to the emergency eye department between January 2015 and 2022 and also from a uveitis database of 3,925 patients seen between January 2008 and January 2022. A total of 426 episodes of hypopyon occurred in 375 eyes in 359 patients, and medical records were reviewed for each patient. ResultsIn all, 222 hypopyon episodes were due to uveitis, and 204 were due to nonuveitic causes. The most common cause of hypopyon was HLA-B27-associated uveitis in 146 patients (34.3%). The next most common causes were infectious keratitis in 125 patients (29.3%) and endophthalmitis in 63 patients (14.8%). Compared with those presenting with nonuveitic hypopyon, patients with uveitis tended to present younger (p < 0.001), were more likely to be male (p < 0.0001), had better initial and final visual acuities (p < 0.001), and had lower intraocular pressures (p = 0.030). ConclusionAbout half of the cases of hypopyon were secondary to uveitis, most of them being associated with HLA-B27 conditions with a good prognosis, and the other half were secondary to infectious keratitis and endophthalmitis with a poor prognosis.