Diagnosis

Specific uveitic diagnoses are made on the basis of disease patterns. Careful history, ocular examination, and a general physical examination, along with selected laboratory and imaging studies, may contribute to making the diagnosis. History is useful for distinguishing acute from chronic uveitis. Ocular examination, including slit-lamp biomicroscopy and indirect ophthalmoscopy, establishes the location and pattern of inflammation. These two features help to differentiate the various diagnostic possibilities (Table 1). All patients with uveitis should undergo a chest radiograph and serological testing for syphilis. Serum levels of angiotensin converting enzyme (ACE) may be elevated in patients with sarcoidosis, but the cost effectiveness of ACE testing in this clinical setting is unclear. Fundus photography may be used as a point of reference for comparison with the findings on future exams. Other ocular imaging studies, such as fluorescein angiography, indocyanine green angiography, ultrasound, and optical coherence tomography, may be warranted depending on the clinical picture (1,7,14). Vitrectomy coupled by analysis of the intraocular material by cytology, culture, immunophenotyping of cells, and polymerase chain reaction (PCR) for microbial pathogens may aid in the diagnosis of lymphoma and certain infections (14).

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