Practical Diagnostic Approach to Uveitis

Anthony Grillo; Ralph D Levinson; Lynn K Gordon

Disclosures

Expert Rev Ophthalmol. 2011;6(4):449-459. 

In This Article

Expert Commentary

Uveitis is a set of heterogeneous diseases that share the feature of intraocular inflammation. This inflammation can involve any part of or the entire uveal tract, including the anterior segment, vitreous and posterior segment. The etiologies of disease include idiopathic autoimmune disease, defined autoimmune syndromes and infections from bacteria, fungi and viruses. The most important concept is to follow the patient, see how they respond to therapy and be alert for masquerade syndromes, especially if the clinical response to therapy is poor. Masquerade syndromes, including malignancies, may present in a manner similar to idiopathic uveitis, but the underlying etiology must be recognized and diagnosed in order to prevent increased morbidity or even disease-related mortality.

Despite many years of investigations, uveitis is still largely diagnosed using descriptive terminology and categorized by the primary site of inflammation and the chronicity of inflammatory disease, along with associated information from the history of present illness as well as exposure history, travel history and systemic symptoms and diseases. Laboratory analysis is required, in particular, to identify treatable conditions that require specific pharmacologic intervention or in order to provide the patient with prognostic information. It is also important to remember to keep an open mind about the diagnosis of uveitis. It is not expected or necessary to remember all the uveitis syndromes, but it is critical to the patient that one be persistent in appropriately evaluating the response to therapy. Therapy for uveitis was not discussed in the paper, but may also be a useful diagnostic tool. For example, a good clinical response following therapy using an anti-infective in a suspected viral retinitis or anti-inflammatory in the setting of suspected autoimmunity may provide supporting evidence for disease pathophysiology. However, therapy is increasingly complex as the use of targeted biologic immunotherapeutics is expanding in the treatment of autoimmune disease. One of the most important points to remember is that when diagnosing uveitis, do not be afraid to ask for expert help and opinions. There are many options ranging from online forums to referral to uveitis specialists at tertiary care centers and sometimes, especially in infectious cases, early diagnosis is crucial to preventing permanent morbidity.

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