Rheumatoid arthritis is a chronic auto-immune disease that leads to persistent symmetrical polyarthri- tis mainly affecting the hands and feet. Significant extra-articular involvements can occur including the eyes. However, most extra-articular manifestations usually occur in the presence of joints changes or symptoms. We report an interesting case of a 62-year-old Malay lady who was referred severe ocular presentation, peripheral ulcerative keratitis that led to the diagnosis of rheumatoid arthritis. Interest- ingly, she had typical changes of rheumatoid arthritis in the hand but was not troubled by them.

A 55-year-old man presented with a five-day history of blurring of vision, pain and redness in the right eye. He had no significant past ocular or medical history, and gave no history of trauma. Ophthalmologic examination is shown above (Panel). What is the diagnosis? Answer: refer to page 235

(Refer to page 207) Answer: Hypopyon In this case, hypopyon is seen in the anterior chamber and posterior synaechiae can also be seen at the pupil margin. Hypopyon can be defined as layering of white blood cells in the anterior chamber of the eye following acute, subacute and chronic inflammatory reactions involving the aqueous humor and anatomical structures adjacent to it. It appears as a white milky layer at the bottom of the anterior chamber.