Uveitis physical examination: Difference between revisions
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== Overview == | == Overview == | ||
A complete [[medical history]] and comprehensive [[eye examination]] must be performed by an [[optometrist]] or [[ophthalmologist]] to properly diagnosis uveitis. Eye examination of patients with uveitis is usually remarkable for [[eye redness]] and increased or decreased [[intraocular pressure]]. Depending on the affected anatomy of the uvea, "snowbanking" or [[optic disc]] edema may be seen on [[dilated fundus exam]], and mutton fat keratic precipitates on [[slit lamp test]] may also be appreciated.<ref name=patientinfouveitis>Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet</ref><ref name=>{{Citation | |||
| last1 = Wyngaarden | first1 = James B. | |||
| last2 = Smith Jr. | first2 = Lloyd H. | |||
| title = [[Cecil Textbook Of Medicine]] | |||
| place = Philadelphia, PA | |||
| publisher = W.B. Saunders Company | |||
|pages = 2293-2294 | |||
| date = 1988 | |||
| isbn = 0-7216-1850-2 }}</ref> A complete physical examination can provide insight into the cause, and associated underlying conditions. | |||
== Physical examination == | == Physical examination == | ||
A complete [[medical history]] and comprehensive [[eye examination]] must be performed by an [[optometrist]] or [[ophthalmologist]] to properly diagnosis uveitis. A thorough physical examination can provide insight into the cause, and associated underlying conditions. The following findings may be found on physical examination:<ref name="pmid19147614">{{cite journal| author=Sieper J, van der Heijde D, Landewé R, Brandt J, Burgos-Vagas R, Collantes-Estevez E et al.| title=New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). | journal=Ann Rheum Dis | year= 2009 | volume= 68 | issue= 6 | pages= 784-8 | pmid=19147614 | doi=10.1136/ard.2008.101501 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19147614 }} </ref><ref name="pmid23083751">{{cite journal| author=Weisman MH| title=Inflammatory back pain: the United States perspective. | journal=Rheum Dis Clin North Am | year= 2012 | volume= 38 | issue= 3 | pages= 501-12 | pmid=23083751 | doi=10.1016/j.rdc.2012.09.002 | pmc=3501982 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23083751 }} </ref><ref name=nhlbiuveitis>National Heart, Lung, and Blood Institute - National Institiute of Health (2013)www.nhlbi.nih.gov/health/health-topics/sarc/signs</ref><ref name="pmid16546057">{{cite journal| author=Wallace CA| title=Current management of juvenile idiopathic arthritis. | journal=Best Pract Res Clin Rheumatol | year= 2006 | volume= 20 | issue= 2 | pages= 279-300 | pmid=16546057 | doi=10.1016/j.berh.2005.11.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16546057 }} </ref><ref name="pmid17936170">{{cite journal| author=Sullivan KE| title=Inflammation in juvenile idiopathic arthritis. | journal=Rheum Dis Clin North Am | year= 2007 | volume= 33 | issue= 3 | pages= 365-88 | pmid=17936170 | doi=10.1016/j.rdc.2007.07.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17936170 }} </ref><ref name="pmid4176988">{{cite journal| author=Baldwin DS, Levine BB, McCluskey RT, Gallo GR| title=Renal failure and interstitial nephritis due to penicillin and methicillin. | journal=N Engl J Med | year= 1968 | volume= 279 | issue= 23 | pages= 1245-52 | pmid=4176988 | doi=10.1056/NEJM196812052792302 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4176988 }} </ref><ref name="pmid17474563">{{cite journal| author=Koike K, Lida S, Usui M, Matsumoto Y, Fukami K, Ueda S et al.| title=Adult-onset acute tubulointerstitial nephritis and uveitis with Fanconi syndrome. Case report and review of the literature. | journal=Clin Nephrol | year= 2007 | volume= 67 | issue= 4 | pages= 255-9 | pmid=17474563 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17474563 }} </ref><ref name="pmid1482643">{{cite journal| author=Igarashi T, Kawato H, Kamoshita S, Nosaka K, Seiya K, Hayakawa H| title=Acute tubulointerstitial nephritis with uveitis syndrome presenting as multiple tubular dysfunction including Fanconi's syndrome. | journal=Pediatr Nephrol | year= 1992 | volume= 6 | issue= 6 | pages= 547-9 | pmid=1482643 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1482643 }} </ref><ref name="pmid381094">{{cite journal| author=Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK| title=Clinical features and natural history of Crohn's disease. | journal=Gastroenterology | year= 1979 | volume= 77 | issue= 4 Pt 2 | pages= 898-906 | pmid=381094 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=381094 }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue= | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544 }} </ref><ref name="pmid1123132">{{cite journal| author=Farmer RG, Hawk WA, Turnbull RB| title=Clinical patterns in Crohn's disease: a statistical study of 615 cases. | journal=Gastroenterology | year= 1975 | volume= 68 | issue= 4 Pt 1 | pages= 627-35 | pmid=1123132 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1123132 }} </ref><ref name="pmid14727454">{{cite journal| author=Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B et al.| title=Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece. | journal=Clin Exp Rheumatol | year= 2003 | volume= 21 | issue= 4 Suppl 30 | pages= S19-26 | pmid=14727454 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727454 }} </ref><ref name="pmid1464423">{{cite journal| author=Riethmüller G, Rieber EP, Kiefersauer S, Prinz J, van der Lubbe P, Meiser B et al.| title=From antilymphocyte serum to therapeutic monoclonal antibodies: first experiences with a chimeric CD4 antibody in the treatment of autoimmune disease. | journal=Immunol Rev | year= 1992 | volume= 129 | issue= | pages= 81-104 | pmid=1464423 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1464423 }} </ref><ref name="pmid10449951">{{cite journal| author=Treudler R, Orfanos CE, Zouboulis CC| title=Twenty-eight cases of juvenile-onset Adamantiades-Behçet disease in Germany. | journal=Dermatology | year= 1999 | volume= 199 | issue= 1 | pages= 15-9 | pmid=10449951 | doi=18197 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10449951 }} </ref><ref name="pmid18045733">{{cite journal| author=Karincaoglu Y, Borlu M, Toker SC, Akman A, Onder M, Gunasti S et al.| title=Demographic and clinical properties of juvenile-onset Behçet's disease: A controlled multicenter study. | journal=J Am Acad Dermatol | year= 2008 | volume= 58 | issue= 4 | pages= 579-84 | pmid=18045733 | doi=10.1016/j.jaad.2007.10.452 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18045733 }} </ref><ref name=eyewikitbuveitis>American Academy of Ophthalmology EyeWiki TB Uveitis (2015)http://eyewiki.aao.org/Tuberculosis_Uveitis</ref><ref name=eyewikisyphuveitis>American Academy of Ophthalmology EyeWiki Syphilitic Uveitis (2015)http://eyewiki.aao.org/Syphilitic_Uveitis</ref><ref name="pmid9164318">{{cite journal| author=Jacobson MA, Zegans M, Pavan PR, O'Donnell JJ, Sattler F, Rao N et al.| title=Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy. | journal=Lancet | year= 1997 | volume= 349 | issue= 9063 | pages= 1443-5 | pmid=9164318 | doi=10.1016/S0140-6736(96)11431-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9164318 }} </ref><ref name="pmid15234132">{{cite journal| author=Hodge WG, Boivin JF, Shapiro SH, Lalonde RG, Shah KC, Murphy BD et al.| title=Clinical risk factors for cytomegalovirus retinitis in patients with AIDS. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 7 | pages= 1326-33 | pmid=15234132 | doi=10.1016/j.ophtha.2004.03.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234132 }} </ref> | |||
A complete [[medical history]] and comprehensive [[eye examination]] must be performed by an [[optometrist]] or [[ophthalmologist]] to properly diagnosis uveitis. | {| class="wikitable" style="border: 2; background: none;" | ||
! colspan="1" rowspan="1" style="border: 1; background: 1;"| Organ System | |||
! colspan="1" rowspan="1"| Findings | |||
! colspan="3" rowspan="1"| Suggestive of | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| General Appearance | |||
| Ill-appearing || [[Infectious]] or Inflammatory/[[Autoimmune]] etiology<br>Masquerade syndromes | |||
|- | |||
! rowspan="3" style="border: 1; background: none;"| Vital Signs | |||
| [[Fever]] || [[Infectious]] or Inflammatory/[[Autoimmune]] etiology | |||
|- | |||
| [[Tachycardia]] || [[Infectious]] or Inflammatory/[[Autoimmune]] etiology | |||
|- | |||
| [[Tachypnea]] || [[Infectious]] etiology | |||
|- | |||
! rowspan="2" style="border: 1; background: none;"| Skin | |||
| [[Pallor]] || [[Anemia of chronic disease]] from any [[Autoimmune|inflammatory condition]]<br>[[Iron deficiency anemia|Anemia of blood loss]] from [[inflammatory bowel disease]] | |||
|- | |||
| [[Skin lesions]]<br> (e.g., [[Erythema nodosum]], [[Rash]], etc.) || [[Sarcoidosis]]<br>TINU syndrome<br>[[Behcet's disease]]<br>[[Systemic Lupus Erythematosus]]<br>[[Juvenile Idiopathic Arthritis]] | |||
|- | |||
! rowspan="6" style="border: 1; background: none;"| Eyes | |||
| [[Eye redness]] || Anterior uveitis, Panuveitis | |||
|- | |||
| Increased [[intraocular pressure]] || Chronic anterior uveitis, Posterior, Intermediate or Panuveitis | |||
|- | |||
| Decreased [[intraocular pressure]] || Acute anterior uveitis | |||
|- | |||
| "Snowbanking" on [[dilated fundus exam]] || [[Intermediate uveitis]], pars planitis | |||
|- | |||
| Mutton Fat keratic precipitates || [[Granulomatous]] etiology (e.g., Sarcoid uveitis, Tuberculous uveitis) | |||
|- | |||
| [[Optic disc]] edema || Posterior uveitis, panuveitis | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Ears | |||
| [[Tinnitus]] || [[Multiple sclerosis]], [[sarcoidosis]] | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Neck | |||
| Neck stiffness || [[Ankylosing spondylitis]], [[multiple sclerosis]], [[seronegative spondyloarthropathies]] | |||
|- | |||
! rowspan="2" style="border: 1; background: none;"| Lungs | |||
| [[Cough]] || [[Tuberculosis]], [[Sarcoidosis]] | |||
|- | |||
| [[Hemoptysis]] || [[Tuberculosis]], [[Sarcoidosis]] | |||
|- | |||
! rowspan="2" style="border: 1; background: none;"| Heart | |||
| [[Arrhythmia]] || [[Behcet's disease]], [[Sarcoidosis]], [[Tuberculosis]] | |||
|- | |||
| [[Murmur]] || [[Behcet's disease]], [[Sarcoidosis]], [[Anemia]] | |||
|- | |||
! rowspan="3" style="border: 1; background: none;"| Abdomen | |||
| Abdominal Tenderness || [[Inflammatory bowel disease]], [[Behcet's disease]] | |||
|- | |||
| Palpable abdominal mass || [[Inflammatory bowel disease]], [[Behcet's disease]] | |||
|- | |||
| [[Hematochezia]] on [[rectal exam]] || [[Inflammatory bowel disease]] | |||
|- | |||
! rowspan="2" style="border: 1; background: none;"| Back | |||
| Tenderness over lumbosacaral spine || [[Ankylosing spondylitis]] | |||
|- | |||
| Decreased range of motion of spine|| [[Ankylosing spondylitis]] | |||
|- | |||
! rowspan="3" style="border: 1; background: none;"| Genitourinary | |||
| [[Genital ulcer|Genital ulceration]]|| [[Behcet's disease]] | |||
|- | |||
| [[Genital warts]] || [[Syphilitis uveitis]] | |||
|- | |||
| Genital vesicular lesions || [[Herpitic uveitis]] | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Extremities | |||
| [[Arthritis|Joint stiffness and swelling]] || [[Seronegative spondyloarthropathies]], [[HLA-B27]] related uveitis, [[Reiter's syndrome]] | |||
|- | |||
! rowspan="3" style="border: 1; background: none;"| Neurological | |||
| [[Parasthesia]] || [[Syphilis]], [[multiple sclerosis]] | |||
|- | |||
| Gait abnormalities/[[Ataxia]] || [[Syphilis]], [[multiple sclerosis]] | |||
|- | |||
| [[Cranial nerve]] abnormalities || [[Sarcoidosis]], [[multiple sclerosis]] | |||
|- | |||
|} | |||
== References == | == References == | ||
{{ | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | |||
[[Category:Ophthalmology]] | |||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] |
Latest revision as of 00:37, 30 July 2020
Uveitis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
A complete medical history and comprehensive eye examination must be performed by an optometrist or ophthalmologist to properly diagnosis uveitis. Eye examination of patients with uveitis is usually remarkable for eye redness and increased or decreased intraocular pressure. Depending on the affected anatomy of the uvea, "snowbanking" or optic disc edema may be seen on dilated fundus exam, and mutton fat keratic precipitates on slit lamp test may also be appreciated.[1][2] A complete physical examination can provide insight into the cause, and associated underlying conditions.
Physical examination
A complete medical history and comprehensive eye examination must be performed by an optometrist or ophthalmologist to properly diagnosis uveitis. A thorough physical examination can provide insight into the cause, and associated underlying conditions. The following findings may be found on physical examination:[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]
References
- ↑ Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
- ↑ Wyngaarden, James B.; Smith Jr., Lloyd H. (1988), Cecil Textbook Of Medicine, Philadelphia, PA: W.B. Saunders Company, pp. 2293–2294, ISBN 0-7216-1850-2
- ↑ Sieper J, van der Heijde D, Landewé R, Brandt J, Burgos-Vagas R, Collantes-Estevez E; et al. (2009). "New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)". Ann Rheum Dis. 68 (6): 784–8. doi:10.1136/ard.2008.101501. PMID 19147614.
- ↑ Weisman MH (2012). "Inflammatory back pain: the United States perspective". Rheum Dis Clin North Am. 38 (3): 501–12. doi:10.1016/j.rdc.2012.09.002. PMC 3501982. PMID 23083751.
- ↑ National Heart, Lung, and Blood Institute - National Institiute of Health (2013)www.nhlbi.nih.gov/health/health-topics/sarc/signs
- ↑ Wallace CA (2006). "Current management of juvenile idiopathic arthritis". Best Pract Res Clin Rheumatol. 20 (2): 279–300. doi:10.1016/j.berh.2005.11.008. PMID 16546057.
- ↑ Sullivan KE (2007). "Inflammation in juvenile idiopathic arthritis". Rheum Dis Clin North Am. 33 (3): 365–88. doi:10.1016/j.rdc.2007.07.004. PMID 17936170.
- ↑ Baldwin DS, Levine BB, McCluskey RT, Gallo GR (1968). "Renal failure and interstitial nephritis due to penicillin and methicillin". N Engl J Med. 279 (23): 1245–52. doi:10.1056/NEJM196812052792302. PMID 4176988.
- ↑ Koike K, Lida S, Usui M, Matsumoto Y, Fukami K, Ueda S; et al. (2007). "Adult-onset acute tubulointerstitial nephritis and uveitis with Fanconi syndrome. Case report and review of the literature". Clin Nephrol. 67 (4): 255–9. PMID 17474563.
- ↑ Igarashi T, Kawato H, Kamoshita S, Nosaka K, Seiya K, Hayakawa H (1992). "Acute tubulointerstitial nephritis with uveitis syndrome presenting as multiple tubular dysfunction including Fanconi's syndrome". Pediatr Nephrol. 6 (6): 547–9. PMID 1482643.
- ↑ Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK (1979). "Clinical features and natural history of Crohn's disease". Gastroenterology. 77 (4 Pt 2): 898–906. PMID 381094.
- ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
- ↑ Farmer RG, Hawk WA, Turnbull RB (1975). "Clinical patterns in Crohn's disease: a statistical study of 615 cases". Gastroenterology. 68 (4 Pt 1): 627–35. PMID 1123132.
- ↑ Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B; et al. (2003). "Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece". Clin Exp Rheumatol. 21 (4 Suppl 30): S19–26. PMID 14727454.
- ↑ Riethmüller G, Rieber EP, Kiefersauer S, Prinz J, van der Lubbe P, Meiser B; et al. (1992). "From antilymphocyte serum to therapeutic monoclonal antibodies: first experiences with a chimeric CD4 antibody in the treatment of autoimmune disease". Immunol Rev. 129: 81–104. PMID 1464423.
- ↑ Treudler R, Orfanos CE, Zouboulis CC (1999). "Twenty-eight cases of juvenile-onset Adamantiades-Behçet disease in Germany". Dermatology. 199 (1): 15–9. doi:18197 Check
|doi=
value (help). PMID 10449951. - ↑ Karincaoglu Y, Borlu M, Toker SC, Akman A, Onder M, Gunasti S; et al. (2008). "Demographic and clinical properties of juvenile-onset Behçet's disease: A controlled multicenter study". J Am Acad Dermatol. 58 (4): 579–84. doi:10.1016/j.jaad.2007.10.452. PMID 18045733.
- ↑ American Academy of Ophthalmology EyeWiki TB Uveitis (2015)http://eyewiki.aao.org/Tuberculosis_Uveitis
- ↑ American Academy of Ophthalmology EyeWiki Syphilitic Uveitis (2015)http://eyewiki.aao.org/Syphilitic_Uveitis
- ↑ Jacobson MA, Zegans M, Pavan PR, O'Donnell JJ, Sattler F, Rao N; et al. (1997). "Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy". Lancet. 349 (9063): 1443–5. doi:10.1016/S0140-6736(96)11431-8. PMID 9164318.
- ↑ Hodge WG, Boivin JF, Shapiro SH, Lalonde RG, Shah KC, Murphy BD; et al. (2004). "Clinical risk factors for cytomegalovirus retinitis in patients with AIDS". Ophthalmology. 111 (7): 1326–33. doi:10.1016/j.ophtha.2004.03.001. PMID 15234132.