Lipemic anterior chamber mimicking uveitis in severe hypertriglyceridemia: a case report and literature review.

BACKGROUND

Diffuse milky-white exudation (lipemic aqueous humor) in the anterior chamber is a rare ocular manifestation associated with metabolic disease-related microvascular dysfunction. Early-onset type 2 diabetes mellitus is characterized by severe metabolic disturbances (e.g., dyslipidemia) and early microvascular injury. We report a young female with poorly controlled hyperglycemia/hyperlipidemia presenting with pseudouveitis and marked milky-white anterior chamber exudation (lipemic aqueous humor), initially mimicking a corneal disorder.

CASE PRESENTATION: A 33-year-old woman with 5-year type 2 diabetes (poor glycemic control), dyslipidemia, chronic sleep disturbances, and a high-fat/high-sugar diet developed acute left-eye pain, photophobia, and decreased vision during menstruation following travel-related fatigue. Slit-lamp examination showed massive homogeneous milky-white anterior chamber exudation (corneal porcelain-like appearance), and B-scan ultrasonography was unremarkable. Fasting blood tests revealed markedly elevated fasting glucose, triglycerides, and total cholesterol. She was diagnosed with pseudouveitis with anterior chamber lipid-protein exudation, and symptoms improved rapidly within 12 h of intensive topical/periocular corticosteroid therapy; intraocular inflammation largely resolved by day 6, with residual posterior synechiae.

CONCLUSIONS

Early-onset type 2 diabetes patients are prone to metabolic dysregulation under physiological/metabolic stress. Persistent hyperglycemia/hyperlipidemia may compromise microvascular integrity and increase permeability, potentially leading to lipid-protein leakage into the anterior chamber (lipemic aqueous humor)-a hypothetical association due to lack of aqueous humor biochemical analysis. This milky exudate is easily misdiagnosed as infectious keratitis, especially with normal B-scan findings. Meticulous slit-lamp examination, adjunctive AS-OCT/UBM, and systemic metabolic evaluation are crucial for accurate diagnosis. Clinicians should promptly assess serum glucose/lipid levels in young patients with milky anterior chamber opacities to avoid misdiagnosis and unnecessary interventions.