Chief Complaint: Eye Pain
A. History: Located Deep within the Eye
| Next Pivotal Assessment | Finding |
|---|---|
Further History |
Chronic: May require long-term immunosuppression and closer monitoring for complications like glaucoma or cataracts.
Recurrent: Requires a plan for flare management and systemic disease control.
Recurrent acute anterior uveitis = think HLA-B27-associated spondyloarthropathies
Chronic anterior uveitis in children = screen for juvenile idiopathic arthritis
Chronic posterior uveitis = consider sarcoidosis, TB, syphilis
Treatment planning
Identifying systemic associations
Prognostication
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Laterality: Unilateral or bilateral
Symptoms:
Eye pain
Redness
Photophobia
Blurred vision
Floaters
Systemic clues:
Joint pain (e.g., ankylosing spondylitis)
Skin rashes (e.g., psoriasis, lupus)
GI symptoms (e.g., IBD)
Respiratory symptoms (e.g., sarcoidosis, TB)
Past infections (e.g., herpes, syphilis)
Performed by an ophthalmologist:
Visual acuity check
Slit-lamp examination:
Anterior chamber cells/flare (for anterior uveitis)
Keratic precipitates on corneal endothelium
Hypopyon (layering of WBCs)
Posterior synechiae
Fundoscopy:
Vitreous haze or cells (intermediate/posterior uveitis)
Retinal vasculitis
Choroidal lesions
Optic disc edema
Not all patients need all tests — directed based on systemic findings:
Infectious causes:
Syphilis serology (VDRL, FTA-ABS)
TB testing (Quantiferon, TST, CXR)
Toxoplasmosis (IgG, IgM)
Viral PCR (HSV, VZV, CMV)
Autoimmune/systemic:
HLA-B27 (if spondyloarthropathy suspected)
ANA, RF, anti-CCP (SLE, RA)
ACE, lysozyme (sarcoidosis)
ANCA (vasculitis)
Imaging:
Chest X-ray or CT (sarcoidosis, TB)
MRI brain/orbits (if CNS involvement)
By location:
Anterior: iris/ciliary body
Intermediate: vitreous
Posterior: retina/choroid
Panuveitis: all layers
By onset/duration:
Acute (<6 weeks), chronic (>6 weeks), recurrent
Uveitis is complex — referral to an ophthalmologist, often with input from a rheumatologist or infectious disease specialist, is crucial.
Let me know if you want a quick diagnostic algorithm or printable summary.
Differential Diagnosis
Uveitis (inflammation of the uvea), glaucoma, or retinal issues.
| Pivotal Assessment | Finding |
|---|---|
Further History |