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

Disease History

Details gained in the medical history are crucial for obtaining the overall picture of the disease process and help classify the inflammation according to the Standardization of Uveitis Nomenclature (SUN) Working Group definitions (Box 1).[15] Pattern recognition is significant in making a specific uveitis diagnosis. Questions that cohesively elucidate course, characteristics and associated signs and symptoms are key. For example, a patient may present with symptoms of acute anterior uveitis (AAU) with photophobia and a red, painful eye. A detailed review of systems may reveal systemic findings such as pulmonary symptoms, arthritis, neurologic symptoms,[3,16] or oral ulcers, greatly narrowing the differential diagnosis.[8,17–21] Evolution of symptoms and the patient's perception of disease severity may also alter the diagnostic and therapeutic approach.

The history must be targeted to both help to define the disease and identify associated etiologies (Box 2). First, is this the first episode or has the patient had multiple episodes in the past? If this is the first episode, is it unilateral or bilateral? What has been the time course of disease, is it acute or has it been chronic, sudden or insidious onset, or even found incidentally on examination. If this is recurrent, has it always been in one eye or has the inflammation occurred in both eyes either sequentially or simultaneously? What therapy was previously used and was there a therapeutic clinical response? What diagnostic testing was previously performed and what were the results? Second, ask for specific associated symptoms including headache, hearing loss, paresthesias or numbness, vitiligo, poliosis, skin lesions, oral or genital ulcers, abdominal symptoms, arthritis and sinus disease. Third, identify any systemic diseases that could potentially be associated with the ocular disease. Determine whether the patient is known to have multiple sclerosis, sarcoidosis, inflammatory bowel disease (IBD), ankylosing spondylitis or other specific arthritis syndromes and any history of malignancy or infection. Has the patient received recent surgery or had an indwelling line for any reason? Fourth, take a medication history. Fifth, define any ocular or systemic disease in close blood relatives. Sixth, is there a travel history that may have exposed the patient to potential infectious disease? Finally, identify the demographics of the affected patient, including age, ethnicity and occupation, and ask about intravenous drug use, as the answers to these questions may help narrow the diagnostic possibilities. It is important to emphasize that interpretation of test results is linked in part to the clinical presentation and the probability of a patient having a specific disease syndrome. The answers to these questions in conjunction with the clinical examination will help to define a targeted differential diagnosis that may be further explored using diagnostic testing.

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