Uveitis

Last reviewed: 3 Nov 2022
Last updated: 10 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain (anterior uveitis)
  • decreased vision
  • synechiae
  • flare
  • keratic precipitates
More key diagnostic factors

Other diagnostic factors

  • tearing
  • photophobia
  • floaters
  • eye redness without discharge
  • constricted or non-reactive pupil
  • decreased intra-ocular pressure
  • retinal exudates and oedema, optic nerve oedema
  • retinal vascular sheathing
  • macular oedema
  • optic disc swelling
  • retinal haemorrhages
  • ciliary flush
  • corneal oedema
  • cataract
Other diagnostic factors

Risk factors

  • inflammatory diseases of the joints, bowel, or skin
  • human leukocyte antigen (HLA)-B27 positive
  • ocular trauma
  • age 30 to 40 years
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • FBC
  • erythrocyte sedimentation rate
  • CRP
  • fluorescent treponemal antibody (FTA-ABS), Venereal Disease Research Laboratory (VDRL), and rapid plasma reagin (RPR)
  • serum ACE
  • antinuclear antibodies
  • HLA-B27
  • Lyme titre
  • purified protein derivative (PPD) skin test
  • cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)
  • perinuclear antineutrophil cytoplasmic antibodies (p-ANCA)
  • C3 and C4
  • antidouble-stranded DNA antibody (anti-dsDNA)
  • rheumatoid factor
  • anticyclic citrullinated peptide (anti-CCP) antibodies
  • Bartonella henselae titre
  • toxoplasma serological titre
  • other HLA antigens
  • chemistry screen
  • CXR
  • polymerase chain reaction (PCR)
More investigations to consider

Emerging tests

  • vitreous biopsy

Treatment algorithm

ACUTE

non-infectious, initial presentation: not pregnant

non-infectious, initial presentation: pregnant

infectious

ONGOING

non-infectious, after immediate control of inflammation: not pregnant

non-infectious, after immediate control of inflammation: pregnant

Contributors

Authors

John J. Huang, MD

President

Connecticut Uveitis Foundation

Associate Clinical Professor

Yale University

New Haven

New England Retina Associates

Hamden

CT

Disclosures

JJH declares that he has no competing interests.

Maxwell Elia, MD

Uveitis and Retina Specialist

Medical Eye Center of New Hampshire

Manchester

NH

Disclosures

ME declares that he has no competing interests.

Acknowledgements

Dr John J. Huang and Dr Maxwell Elia would like to gratefully acknowledge Dr Richard Gale, Dr Zsolt Varga, Dr Victor L. Perez, and Dr Carlos A. Medina, the previous contributors to this topic.

Disclosures

RG, ZV, VLP, and CAM declare that they have no competing interests.

Peer reviewers

Jessica Ackert, MD

Assistant Professor

Ophthalmology

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that she has no competing interests.

Anthony J. Hall, MD, FRANZCO

Director of Ophthalmology

Alfred Hospital

Melbourne

Australia

Disclosures

AJH has been reimbursed by Novartis, the manufacturer of Lucentis, for lecture fees. AJH's employer, the Alfred Hospital, has received research funding from Novartis, the manufacturer of Lucentis, and from Bayer, the manufacturer of Eylea.

Daniel A. Johnson, MD

Chairman

Department of Ophthalmology

The University of Texas Health Science Center at San Antonio

San Antonio

TX

Disclosures

DAJ declares that he has no competing interests.

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