Clinical Approach to Uveitis

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Presentation transcript:

Clinical Approach to Uveitis

The SUN Working Group Anatomical Classification of Uveitis Anterior uveitis Iritis Iridocyclitis Anterior cyclitis Intermediate uveitis Pars planitis Posterior cyclitis Posterior uveitis Focal, multifocal, or diffuse choroiditis Chorioretinitis Retinochoroiditis Retinitis Neuroretinitis Panuveitis

The SUN Working Group Descriptors in Uveitis Onset Insidious Sudden Duration Limited Persistent Course Acute Recurrent Chronic

Symptoms of Uveitis Redness Pain Photophobia Epiphora Visual disturbances Scotoma (central or peripheral) Floaters

Signs of Uveitis Vitiligo Nodules

Conjunctiva Ciliary flush Conjuctival nodules

Cornea

Anterior chamber reaction

Iris

Iris

Glucoma

Vitreous cells

Snow balls

Vascular sheathing & vasculitis

Choroiditis & retinitis

Optic disk edema

Neovascularization

Retinal detachment

Historical Factors 1. Course of disease 2.Unilateral or bilateral 3.Age 4.Sex 5.Race 6. Trauma history 7.Medication 8.Travel history 9.Social history

Review of the Patient's Health 1.GENERAL HEALTH Chills –Fever-Night sweats-Fatigue -Poor appetite- Unexplained weight loss 2. HEAD Headaches -Fainting -Numbness or tingling in body-Paralysis in parts of body-Seizures 3. EARS Deafness-Frequent ear infections-Painful or swollen earlobes

4. NOSE AND THROAT Sore in nose or mouth-nosebleeds-Frequent sneezing-Sinus trouble-hoarseness-Tooth or gum infections 5. SKIN Rashes-Skin –Vitiligo-Alopesia-Tick or insect bites 6. RESPIRATORY Severe or frequent colds-Coughing-Hemoptysis-Recent flu or viral infection-Wheezing or asthma attacks-Dyspnea 7. GASTROI NTESTI NAL Trouble swallowing-Diarrhea-Bloody stools-Stomach ulcers-Jaundice or yellow skin

8. BONES AND JOINTS Stiff joints-Stiff lower back-Back pain while sleeping or awakening-Muscle aches 9. GENITOURINARY Kidney problems-Bladder trouble-Blood in urine-Urinary discharge-Genital sores or ulcers-Prostatitis-Testicular pain

Laboratory and Medical Evaluation There is no one standardized battery of tests that needs to be ordered for all patients with uveitis. 1.CBC 2.ESR 4.ACE-lyzozyme 5.Syphlis serology 7.CXR 8.Risk factor :TB and Lyme

Fluorescein angiography Indocyanine green angiography Ultrasonography Optical coherence tomography Anterior chamber paracentesis Vitreous biopsy Chorioretinal biopsy