This case illustrates the diagnostic challenge of tubulointerstitial nephritis and uveitis (TINU) syndrome, particularly when ocular symptoms are subtle or attributed to other causes. It emphasises the optometrist’s key role in recognising red flags for systemic disease in patients presenting with uveitis, the importance of a thorough systemic history and the value of early multidisciplinary collaboration to prevent irreversible renal and ocular complications.

Matthew Chan, Optometrist and Senior Lecturer, medical retina, uveitis and emergency ophthalmology specialist at Bristol Eye Hospital and independent practice. Senior Lecturer at Cardiff University, leading The College of Optometrists’ accredited Medical Retina Higher Certificate programme.

Visit 1: initial presentation 

A 39-year-old Afro-Caribbean woman presented to the eye emergency department with a one-day history of right-eye pain, redness and photophobia. She used monthly contact lenses (CLs) twice weekly for 12 hours, last worn three days earlier. She recalled a similar “red, painful eye” during a previous nephritis admission, saying, “This feels like the same problem.” She also reported fatigue and new sciatica after completing a prednisolone course for nephritis. Her last routine eye exam was two years earlier.