Determining the Cause

Chief Complaint: Eye Pain

A. History: Located Deep within the Eye

B. Further History:

Diagnosing uveitis, which is inflammation of the uveal tract (iris, ciliary body, and choroid), requires a detailed clinical evaluation.

Great question — the onset of uveitis (whether it's acute, chronic, or recurrent) provides critical diagnostic and prognostic clues. Here's why it matters:

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🕰️ 1. Helps Narrow Down the Cause

Different etiologies tend to present with specific patterns:

Onset	Typical Duration	Common Causes
Acute	Sudden, <6 weeks	HLA-B27 diseases (e.g., ankylosing spondylitis), infections (e.g., HSV, toxoplasmosis)
Chronic	Gradual, >6 weeks	Sarcoidosis, tuberculosis, juvenile idiopathic arthritis (JIA), idiopathic
Recurrent	Repeated episodes	Behçet's disease, HLA-B27-associated uveitis, herpes viruses

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🔄 2. Guides Treatment and Monitoring

• Acute: Often responds quickly to topical steroids; short course may suffice.

• 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.

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🧠 3. Points Toward Systemic Disease

• 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

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🧩 In Summary:

Knowing the onset helps with:

• Etiologic differentiation

• Treatment planning

• Identifying systemic associations

• Prognostication

Want me to send a table summarizing uveitis types with onset, symptoms, and typical causes?++++++++++++++++++++

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🔍 1. Clinical History

Ask about:

• Onset: Acute vs. chronic

• 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)

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👁️ 2. Ocular Examination

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

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🧪 3. Laboratory Work-up (guided by clinical suspicion)

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)

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🧠 4. Classification

• By location:

  • Anterior: iris/ciliary body

  • Intermediate: vitreous

  • Posterior: retina/choroid

  • Panuveitis: all layers

• By onset/duration:

  • Acute (<6 weeks), chronic (>6 weeks), recurrent

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🧑‍⚕️ Referral

Uveitis is complex — referral to an ophthalmologist, often with input from a rheumatologist or infectious disease specialist, is crucial.

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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

 

Determining the Cause