Targeted Medical History and Diagnostic Testing in Uveitis

Abstract

Uveitis is a collective term for a variety of different intraocular inflammations. The underlying etiologies vary greatly depending on the uveitis subtype, and in particular the anatomical focus. The most common forms of anterior uveitis are acute fibrinous unilateral uveitis, often associated with the HLA-B27 haplotype, and granulomatous inflammation, typically associated with sarcoidosis or herpes infections. Intermediate uveitis is usually idiopathic in nature but can also be associated with multiple sclerosis or sarcoidosis, while vitreoretinal lymphoma must also be considered as a masquerade syndrome in patients aged over 45. Posterior uveitis, on the other hand, as well as retinal vasculitis and panuveitis, have a very broad variety of etiologies; these can, however, be narrowed down through a similar findings-centered approach. Retinitis, for example, is often associated with infections (Toxoplasma gondii and viruses of the herpes group), whereas chorioditis is frequently idiopathic, although infections such as tuberculosis may occur. Therefore, the medical history and laboratory diagnosis should be tailored in patients with uveitis based on the anatomic focus of inflammation (anterior, intermediate, or posterior uveitis, or panuveitis) and the clinical picture (e.g., granulomatous versus nongranulomatous).

Key words

uveitis - medical history - diagnostics - laboratory analysis - workup

Publication History

Received: 22 November 2021

Accepted: 23 December 2021

Article published online:
23 March 2022

• References/Literatur

• 1 Grajewski RS, Caramoy A, Frank KF. et al. Spectrum of Uveitis in A German Tertiary Center: Review of 474 Consecutive Patients. Ocul Immunol Inflamm 2015; 23: 346-352
• 2 Jakob E, Reuland MS, Mackensen F. et al. Uveitis subtypes in a German interdisciplinary uveitis center–analysis of 1916 patients. J Rheumatol 2009; 36: 127-136
• 3 Jabs DA, Nussenblatt RB, Rosenbaum JT. et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516
• 4 Rathinam SR, Babu M. Algorithmic approach in the diagnosis of uveitis. Indian J Ophthalmol 2013; 61: 255-262
• 5 Sève P, Cacoub P, Bodaghi B. et al. Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev 2017; 16: 1254-1264
• 6 Berufsverband der Augenärzte Deutschlands e.V. (BVA), Deutsche Ophthalmologische Gesellschaft (DOG). Leitlinie Nr. 14: Uveitis anterior. Stand: 11.10.2010. Im Internet (Stand: 22.02.2022): https://augeninfo.de/leit/leit14.pdf
• 7 Berufsverband der Augenärzte Deutschlands e.V. (BVA), Deutsche Ophthalmologische Gesellschaft (DOG). Leitlinie Nr. 24a: intermediäre Uveitis. Ophthalmologe 2021; 118 (Suppl. 01) S16-S30
• 8 Berufsverband der Augenärzte Deutschlands e.V. (BVA), Deutsche Ophthalmologische Gesellschaft (DOG). Leitlinie Nr. 24b: Nichtinfektiöse Uveitis posterior. Stand: August 2017. Im Internet (Stand: 22.02.2022): https://augeninfo.de/leit/leit24b.pdf
• 9 Wang MY, Asanad S, Asanad K. et al. Value of medical history in ophthalmology: A study of diagnostic accuracy. J Curr Ophthalmol 2018; 30: 359-364
• 10 Rosenbaum JT. New developments in uveitis associated with HLA B27. Curr Opin Rheumatol 2017; 29: 298-303
• 11 Reddy SC, Rao UR. Ocular complications of adult rheumatoid arthritis. Rheumatol Int 1996; 16: 49-52
• 12 Yang P, Du L, Ye Z. How To Deal With Uveitis Patients. Curr Mol Med 2018; 17: 468-470
• 13 Yang P. History-Taking in Uveitis Patients. In: Yang P. ed. Atlas of Uveitis. Singapore: Springer; 2021: 13-17
• 14 Oliver GF, Stathis RM, Furtado JM. et al. Current ophthalmology practice patterns for syphilitic uveitis. Br J Ophthalmol 2019; 103: 1645-1649
• 15 Majumder PD, Sudharshan S, Biswas J. Laboratory support in the diagnosis of uveitis. Indian J Ophthalmol 2013; 61: 269-276
• 16 Grajewski RS, Boelke AC, Adler W. et al. Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis. Eye (Lond) 2016; 30: 1415-1423
• 17 Grajewski RS, Adler W, Frank KF. et al. Predictive value of serum markers for pulmonary involvement in ocular sarcoidosis. Acta Ophthalmol 2014; 92: e250-e251
• 18 Kopplin LJ, Mount G, Suhler EB. Review for Disease of the Year: Epidemiology of HLA-B27 Associated Ocular Disorders. Ocul Immunol Inflamm 2016; 24: 470-475
• 19 Caplash S, Gangaputra S, Kesav N. et al. Usefulness of Routine Lyme Screening in Patients with Uveitis. Ophthalmology 2019; 126: 1726-1728
• 20 Garweg JG, de Groot-Mijnes JD, Montoya JG. Diagnostic approach to ocular toxoplasmosis. Ocul Immunol Inflamm 2011; 19: 255-261