6 Diagnosis and Management of Uveitis

A) Subjective: diagnose by the classic history

1) Acute iritis or uveitis causes a red painful photophobic eye

2) Ask, “Is it an itchy scratchy pain (cornea or external disease), or deep and achy (uveitis)?”

3) Acute uveitis pain is invariably deep and achy, usually intense and debilitating

4) The affected eye has a photophobic reaction when light is shone in the contralateral eye

5) Chronic smoldering uveitis may have no pain and a white eye

6) Juvenile uveitis is more likely to be severe and chronic

B) Objective

1) VA (corrected) and pinhole VA if necessary (grade II+ – IV+ cells may cause complaints of hazy vision)

2) Pupils: may be miotic from ciliary spasm. R/O APD

3) External: blepharospasm and deep conjunctival injection (red-purple color) and ciliary flush. Look for herpes simplex or zoster vesicles. Look for subtle sarcoid nodules in the lid margin and on the conjunctiva

4) Slit lamp: use a good slit lamp

a) Cornea

1) Epithelium: use stain to R/O any HSV dendrite or bacterial ulcer as a precipitating factor. Remember we will be using steroids

2) Stroma: clear and compact unless other problems

3) Endothelium: look for KPs

a) Draw: note

1) Number

2) Size

3) Distribution: (superior KPs usually are herpes simplex)

b) Type

1) Granulomatous (mutton fat) KPs

2) Non-granulomatous

3) Fine dusting: (too fine to see except in retroillumination)

c) Age (difficult judgment)

1) New: appears wet or cheesy

2) Old: dry, dusty, pigmented, involuted

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Edited by Clay E Moore
Last revised on March 25, 2008