Internal Medicine

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

1504 Uveitis

➣Antinuclear antibodies (ANAs) in juvenile idiopathic arthritis

■Other lab tests as dictated by associated systemic disease

Imaging

■US (A-, B-) of eye to exclude retinal detachment if small pupil,

cataract, or vitreous hemorrhage prevents visualization of retina

■CT of eye w/ penetrating trauma

Ocular Biopsy

■Not routine

■Anterior chamber paracentesis (to remove aqueous humor), vitreous

paracentesis (to remove vitreous), or retinal biopsy for diagnostic

culture, PCR & light/electron microscopy

differential diagnosis

■Viral conjunctivitis may mimic red, painful, photophobic eye; fre-

quently associated w/ cold & swollen preauricular lymph nodes

■Intraocular infection after trauma (blunt, penetrating, surgical)

immediately suspect; institute aggressive diagnosis & therapy

■Intraocular malignancy (retinoblastoma in childhood, lymphoma in

elderly) may present as uveitis

management

What to Do First

■Determine if uveitis localized to anterior segment, posterior seg-

ment, or both.

■Assess cause of decreased vision (cataract, macular edema).

General Measures

■Use history, physical, & lab tests to determine cause: most com-

mon causes of acute anterior uveitis are seronegative spondy-

loarthropathies (look for HLA-B27 and perform sacroiliac films).

Most common cause of chronic anterior uveitis is juvenile rheuma-

toid arthritis (look for ANAs). Most common causes of posterior

uveitis are infections such as toxoplasmosis, toxocariasis, syphilis,

TB (perform antibody titer tests).

■If intraocular infection suspected, refer to ophthalmologist as emer-

gency.

■Use eyeshield for blunt & penetrating trauma; refer immediately to

ophthalmologist for diagnosis and treatment.