Uveitis does not have to be vexing. Here are some basic principles to make it easier for ophthalmologists to identify the disorder.
Other information that can assist with a uveitis diagnosis includes ocular comorbidities, response to treatment, ethnicity, medical conditions, family history, and travel or geography. Regarding geography, Dr. Dunn gave the example of a patient from Connecticut with uveitis in whom Lyme disease testing may be critical.
“However, if you’re in San Antonio, Texas, a Lyme titer probably won’t be helpful,” he said. When deciding on lab testing, Dr. Dunn urged physicians to think about the cost involved and how helpful the information actually may be.
For instance, a full autoimmune antibody panel might cost as much as $700. In another example he gave, the positive predictive value of a PPD test for tuberculosis in a patient with no risk factors for TB would only be 1%, rendering the test almost useless.
In his patients, Dr. Dunn usually orders a chest X-ray (or chest CT scan) and syphilis serology, because sarcoidosis and syphilis are almost always in the differential diagnosis of any type of uveitis. There are other tests that he will request but only in the appropriate context, such as HLA-B27, Lyme antibody testing, or interferon gamma releasing assay.
When he suspects infection, Dr. Dunn is more likely to order PCR testing from aqueous or vitreous specimens, as in acute retinal necrosis or ocular toxoplasmosis, because serologic testing lacks specificity. Not all physicians who work with uveitis take the same approach.
However, Dr. Dunn said that the rigorous use of the SUN criteria will improve the efficiency of uveitis workups.
JAMES PHILIP DUNN JR., MD
E: [email protected]
This article was adapted from Dr. Dunn’s presentation during Retina Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology
1. Jabs DA, Busingye J. Approach to the diagnosis of the uveitides. Am J Ophthalmol. 2013;156:228-236.
2. Jabs DA, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509-516.