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Diagnostic Testing in Uveitis

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Uveitis

Part of the book series: Current Practices in Ophthalmology ((CUPROP))

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Abstract

Introduction: The diagnostic workup upon the discovery of uveitis is challenging even for experienced ophthalmologists. This chapter gives a basic strategic overview when investigating the underlying cause of uveitis.

Diagnostic Strategy: There is no perfect diagnostic algorithm in uveitis. Rather, a detailed history and clinical exam provides clues that guide a more directed evaluation for an underlying cause, limiting the use of low positive predictive value (PPV) testing. Classifying the type of uveitis (laterality, granulomatous vs. nongranulomatous, location of inflammation) is an important step in developing an efficient diagnostic approach. Age, gender, race, and travel history are other important considerations.

Extraocular Imaging: Non-ocular imaging can be useful when determining a cause of uveitis. Chest radiography is frequently ordered during the initial workup in cases of unknown uveitis to evaluate for signs of tuberculosis and sarcoidosis. Chest X-ray is a safe and inexpensive first-line method, while chest computed tomography (CT) is more sensitive and specific in certain patient groups.

Infectious Testing: Samples of ocular fluid can be used to investigate specific pathogens in cases where infectious uveitis cannot be excluded. Polymerase chain reaction (PCR) is a directed method for which specific pathogens are investigated. Metagenomic deep sequencing is a novel unbiased sequencing technique capable of interrogating many pathogens at once that offers possible utility in the future. Tuberculosis and syphilis can mimic many types of uveitis and their testing should therefore be included in most initial uveitis workups.

Noninfectious Testing: Uveitis is frequently noninfectious in nature. Autoantibody testing, including antinuclear antibody (ANA) and rheumatoid factor (RF), is generally low yield. Human leukocyte antigen (HLA) testing can be useful in classifying certain uveitic entities, in particular birdshot chorioretinopathy and seronegative spondyloarthropathies. Urine beta-2 microglobulin and serum creatinine are important when evaluating a young patient for tubulointerstitial nephritis and uveitis syndrome (TINU). Tissue biopsy paired with histopathology, cytopathology, and immunohistochemistry are useful techniques when evaluating a patient for entities such as ocular sarcoidosis and primary vitreoretinal lymphoma.

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Authors and Affiliations

  1. Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA

    Ashlin Joye

  2. Department of Ophthalmology, Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA

    John Gonzales

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  1. Casey Eye Institute Oregon Health & Science University, Portland, OR, USA

    Phoebe Lin

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Joye, A., Gonzales, J. (2020). Diagnostic Testing in Uveitis. In: Lin, P. (eds) Uveitis . Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-15-0331-3_5

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