Clinical approach to Uveitis

Clinical approach to Uveitis

✅ Symptoms in Clinical approach to Uveitis:

• Anterior: photophobia,redness,watering,pain,dropped VA,
may be asymptomatic

• Intermediate: 
floaters,photopsia,dropped VA ,may be asymptomatic .

• Posterior: 
dropped VA,photopsia,Floaters,scotomata

✅ ASk patient for Clinical approach to Uveitis

• Previous episodes or any investigations done before or any surgery or trauma

✅ Exclude any systemic illness for Clinical approach to Uveitis

• Arthropathies (ankylosing spondylitis)

• chronic infections (HSV, TB)

• Sarcoid, Behcet’s disease

✅ Exclude Family members with Uveitis or related diseases

✅ Asking for travel or residence abroad
Contact to animals , IV drugs, sexual history in Clinical approach to Uveitis

✅ check for Clinical approach to Uveitis

• VA Best corrected/pinhole

• RAPD, colour vision

• Conjunctiva Circumcorneal injection

• Comea Band keratopathy, KPs (distribution, size, pigment)

• AC Flare/cells, hypopyon

• Gonioscopy PAS (consider if high IOP)

• Iris transillumination defects/sectoral atrophy, miosis, PS, heterochromia, Koeppe or Busacca nodules

• Lens Cataract, aphakia/pseudophakia

• Tonometry( low or high)

• Dilated fundoscopy (Non-contact handheld lens ± indirect/indenting)

• Vitreous Haze, cells, snowballs, opacities, subhyaloid precipitates (KP-like but on posterior vitreous face)

• Optic disc disc swelling, glaucomatous changes, atrophy

• Vessels Inflammation (sheathing, leakage), ischaemia/occlusion (BRAO, B/CRVO, retinal oedema)

• Retina CME, uni-/multifocal retinitis , atrophy, or pigmentation.

• Choroid Uni-/multifocal choroiditis (deeper yellow-white lesions) ± associated RD

Rapid Systemic review which may provide clues to underlying disease

✅ CVS in Clinical approach to Uveitis

• Chest pain+pericarditis 
( TB, Sarcoidosis,SLE)

• Chest pain+myocarditis
(Syphilis)

• Palpitations
(Sarcoidosis, ankylosing spondylitis, Syphilis, RA, SLE, HIV)

• Oedema+cardiac failure 
(TB, sarcoidosis, Syphilis, RA, SLE, HIV)

• Oedema+inferior vena cava (IVC) obstruction
( behcet’s)

✅ Respiratory system in Clinical approach to Uveitis

• Cough
(TB, sarcoidosis, GPA, HIV, Toxocariasis)

• Haemoptysis
(TB, GPA, HIV, RA, SLE, Sarcoidosis)

• Stridor
(Relapsing polychondritis)

• Chest pain+pleurisy 
(Sarcoidosis, TB, GPA, SLE, RA, lymphoma, HIV)

• Shortness of breath
(Sarcoidosis, TB, GPA, SLE, RA, HIV)

✅ GIT system in Clinical approach to Uveitis

• Diarrhoea
(IBD, Behcet’s, HIV)

• Blood/mucus in stools
(IBD, Behcet’s, HIV)

• Jaundice
(IBD (with cholangitis or hepatitis) toxoplasmosis, HIV)

✅ GU system in Clinical approach to Uveitis

• dysuria/discharge
(Reiter’s, Syphilis, TB)

• Hematuria
(GPA, IgA nephropathy, tubulointerstitial nephritis and uveitis (TINU), SLE, TB)

• Genital ulcers
(Behcet’s, Syphilis, HLA-B27-related disease)

• Testicular pain
(Behcet’s, HLA-B27-related disease)

✅ ENT system in Clinical approach to Uveitis

• Deafness/tinnitus
(VKH, sympathetic ophthalmia, GPA)

• Earlobe pain/swelling oral ulcers
(Relapsing polychondritis)

• Sinus problems Recurrent epistaxis
(Behcet’s, HSV, HLA-B27-related disease, SLE
GPA)

✅ Musculoskeletal System in Clinical approach to Uveitis

• Joint pain,swelling or stiffness
(HLA-B27-related arthropathies, JIA, sarcoidosis, RA, SLE, Behcet’s, relapsing polychondritis, GPA, lyme )

• Lower back pain
(HLA-B27-related arthropathies, TB)

✅ Skin Rash in Clinical approach to Uveitis

• Erythema nodosum
(Sarcoidosis, Behcet’s, TB, IBD)

• Vesicular rash 
(HSV, VZV)

• Other rash 
(Psoriasis, Syphilis, Lyme, SLE, Behcet’s)

• Photosensitivity
(Reiter’s, JIA, TB,SLE )

• Vitiligo
(SLE , VKH, sympathetic ophthalmia, leprosy)

• Alopecia
(SlE , VKH)

• Raynaud’s phenomenon
(SLE , RA)

✅ CNS in Clinical approach to Uveitis

• Headaches 
(Sarcoidosis, VKH, Behcet’s, TB, SLE , Lymphoma)

• Collapse or fits
(Sarcoidosis, VKH, Behcet’s, SLE , HIV, Toxoplasmosis, Lymphoma)

• Weakness
(MS, Sarcoidosis, Behcet’s, HIV, Leprosy, Syphilis, Toxoplasmosis, Lymphoma)

• Numbness/tingling 
(MS, sarcoidosis, Behcet’s, VKH, HIV, Syphilis, Lymphoma)

• Speech problems and behaviour change
(VKH, Sarcoidosis, Behcet’s, SLE , GPA, HIV, TB, Syphilis,Lymphoma)

✅ General in Clinical approach to Uveitis

• Fever/night sweats
(JIA, lymphoma, VKH, SLE , RA, IBD, Sarcoidosis, Kawasaki)

• Swollen glands
(Sarcoidosis, lymphoma, HIV, JIA, TB, RA, Syphilis, Toxoplasmosis)

Clinical approach to Uveitis Powerpoint presentation:

Uveitis Julie Jantzi, O.D. Mallory Cranmer, O.D. Neal Shastri, O.D. Noushin Ahmed, O.D. Seidenberg Protzko Eye Associates

Uveitis By Husain J. Patanwala 3rd year, B.Optom

Uveitis is an interesting disease of the with such a varied and diverse pathogenesis, various systemic causes and Dangerous complications in relation to the eye which makes it difficult and challenging to treat in a proper way. I hope this share will help.

Clinical approach to Uveitis Videos:

Clinical approach to Uveitis