Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Uveitis 1503

➣Nonimmunocompromised: spondyloarthropathies, TB, syp-

hilis, sarcoidosis, autoimmune diseases, other infectious dis-

eases

Signs & Symptoms

■Ocular pain, redness, photophobia

■Blurring of vision, floaters

■Red eye (conjunctival/ciliary injection) w/ excessive tearing & lid

closure or quiet, white eye

■Cataract (posterior subcapsular cataract)

■Intraocular inflammation (anterior chamber &/or vitreous body)

■Macular edema

➣Intraocular pressure (IOP) should be measured. IOP is most

frequently decreased, although occasionally it may be incre-

ased.

The diagnosis requires slit-lamp examination to identify inflamma-

tory cells floating in the aqueous humor or deposited on the corneal

endothelium (keratic precipitates) in anterior uveitis. Intermediate,

posterior, and panuveitis are diagnosed by observing inflammation in

the vitreous, retina or choroid. They are more likely than anterior uveitis

to be associated with an identifiable systemic disease.

tests

Basic Blood Tests

■CBC w/ differential

■VDRL, if sexually active; if positive, confirm w/ FTA

Other Basic Tests

■CXR (PA, lateral) to exclude sarcoidosis, TB

Specific Diagnostic Tests

■HLA B-27: w/ juvenile RA, spondyloarthropathy, unilateral acute

anterior uveitis

■HLA A-29: w/ birdshot chorioretinopathy

➣HLA B-51: w/Bechet disease

■Sacroiliac joint x-ray: w/ back pain, ankylosing spondylitis

Other Tests

■Serum antibody titers for suspected disease; eg, toxoplasmosis,

Lyme, cat-scratch disease, AIDS

■ACE, gallium scan, biopsy of conjunctival or lid nodule, DTH

(mumps, Candida, PPD intermediate): sarcoidosis