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. 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. 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.
Lei et al. (Tue,) studied this question.