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MARCH 24, 2019

Uveitis

Clinical hints for your approach examining UVEITIS:

Anterior

photophobia, hyperaemia, epiphora, pain, floaters, posterior synechiae, KP, hypopyon, reduced best corrected visual acuity

Examination Hint: patient may be asymptomatic

 

 

 

 

 

 

 

Intermediate

floaters, photopsia, reduced best corrected visual acuity

Examination Hint: patient may be asymptomatic

 

Posterior

floaters, photopsia, reduced best corrected visual acuity, scotoma

Examination Hint: patient may be asymptomatic

 

TIP: Recommendation is to refer uveitis patients onto an ophthalmologist for assessment

 

HISTORY

Ask patient for:

Previous episodes or any previous investigations or any surgery or trauma

It is important to EXCLUDE:

Arthropathies (ankylosing spondylitis)

Chronic Infections (HSV, TB)

Sarcoid, Bechet's disease

Ask about family history:

Exclude family members with uveitis, similar or related diseases

Ask about:

Any travel or residence abroad

Animals

IV drug use

Sexual background history

Check

Best corrected visual acuity 

Pin hole visual acuity

RAPD

Colour Vision

Colour Desaturation

Slit Lamp Examination

Conjunctival: circumcorneal injection

Cornea band keratopathy, KPs (distribution, size, pigment)

AC: flare/cells, hypopyon

Gonioscop PAS (consider if IOP high)

Iris: transillumination,sectorial atrophy, miosis, posterior synechiae, Koeppe or Busacca nodules

Lens: cataract, aphakia/pseudophakia

Tonometry: Low or high

Dilated fundus examination

Vitreous: haze, cells, snowballs, opacities, subhyaloid precipitates 

Optic disc: swelling, glaucomatous changes, atrophy

Vessels: inflammation (sheathing, leakage), ischaemia/occlusion (BRAO, BRVO, CRVO, retinal oedema)

Retina: CMO, uni-/multifocal retinitis, atrophy, pigmentation

Choroid: Uni-/multifocal choroiditis (deeper yellow-white lesions), retinal detachement

Systemic Review

CVS

Chest pain and pericarditis (TB, Sarcoidosis, SLE)

Chest pain and myocarditis (syphillis)

Palpitation (sarcoidosis, ankylosing spondylitis, sypilis, RA, SLE, HIV)

Oedema and cardiac failure (TB, sarcoidosis, syphilis, RA, SLE, HIV)

Oedema and inferior vena cava (Bechet's)

GU:

Dysuria (Reiter's, Syphilis, TB)

Genital Ulcers and testicular pain (Bechet's, Syphilis, HLA-B27 related disease)

Musculoskeletal: (Joint pain, swelling or stiffness - HLA-B27, JIA, Sarcoidosis, RA, SLE, Bechets, Lyme)

Skin Rash: (erythema nodosum - Sarcoidosis, Bechet's, TB, IBD), Alopecia (VKH), Vesicular rash (HSV, VZV), Photosensitivity (Reiter's, JIA, TB, SLE),

CNS: Headaches (Sarcoidosis, VKH, Bechet's,TB, SLE, Lympoma)

Weakness and numbness/tingling (MS, Sarcoidosis, Bechet's, HIV, Leprosy, Syphilis, Toxoplasmosis, Lymphoma)

Speech and behaviour change (VKH, Sarcoidosis, Bechet's, SLE, HIV, TB, Syphilis, Lymphoma)

General: 

Fever/night sweats (JIA, Lymphoma, Sarcoidosis, KH, RA, IBD, SLE)*

*The above list is not a full and final list, but provides a starting guide for examination purposes, please refer to ophthalmologist for opinion