Uveitis differential diagnosis
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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
Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.[1][2][3][4]
Differential Diagnosis
Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.[1][2][3][4]
Differentiating Uveitis from Other Diseases
Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance.[5][6][7]
- Corneal ulceration
- Conjunctivitis
- Closed angle glaucoma
- Corneal abrasion
- Ulcerative keratitis
- Herpes keratitis
- Intraocular foreign body
- Episcleritis or scleritis
- Endophthalmitis
- Radiation-induced keratitis
Masquerade syndromes
Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:[4]
- Anterior segment
- Posterior segment
Differential Diagnosis of Uveitis Subtypes by Clinical Features
As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype. Etiologies of acute anterior unilateral infectious uveitis must be differentiated from other subtypes that cause conjuctival injection, eye pain, and photophobia, such as acute anterior bilateral non-infectious uveitis or chronic anterior uveitis. Diversely, posterior infectious uveitis must be differentiated from other subtypes that cause visual changes, such as intermediate non-infectious uveitis and infectious panuveitis.
Anterior Uveitis
Anterior uveitis can be differentiated according to the following presentation:[1][2][3]
- Acute (>3 months of active symptoms)[8]
- Unilateral
- Infectious: Cytomegalovirus, Herpes simplex, Varicella zoster, Syphilis
- Non-infectious: seronegative spondyloarthropathy, relapsing polychondritis, systemic lupus erythematosus (SLE), Kawasaki disease
- Bilateral
- Infectious: Tuberculosis, Syphilils
- Non-infectious: tubulointerstitial nephritis with uveitis (TINU syndrome)
- Unilateral
- Chronic (>3 months of active symptoms)[8]
- Infectious: Tuberculosis
- Non-infectious: juvenile idiopathic arthritis, Sjorgen's Syndrome, sarcoidosis
Intermediate Uveitis
Intermediate may present with unilateral or bilateral involvement. It can be differentiated according to the following etiologies:[1][2][3]
- Infectious: Lyme disease, Whipple's disease
- Non-infectious: multiple sclerosis, sarcoidosis, tubulointerstitial nephritis with uveitis (TINU syndrome), lymphoma
Posterior Uveitis
Posterior uveitis may present with unilateral or bilateral involvement. It can be differentiated according to the following most common etiologies:[1][2][3]
- Infectious: Toxoplasmosis, Cytomegalovirus, Tuberculosis, Syphilis, Toxocariasis, Herpes simplex, Varicella zoster, cat scratch disease
- Non-infectious:Vogt-Koyanagi-Harada syndrome, systemic lupus erythematosus, [with polyangitis], Behcet's disease, birdshot chorioretinopathy, lymphoma
Panuveitis
Panuveitis may present with unilateral or bilateral involvement. It can be differentiated according to the following most common etiologies:[1][2][3]
- Infectious: Tuberculosis, Syphilis
- Non-infectious: juvenile idiopathic arthritis, Behcet's disease, sarcoidosis, Vogt-Koyanagi-Harada syndrome, Sjorgen's Syndrome
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Prior-Español Á, Martínez-Morillo M, Holgado-Pérez S, Juega FJ (2016). "Differential diagnosis of acute bilateral uveitis in the rheumatologist's office". Reumatol Clin. 12 (3): 174–175. doi:10.1016/j.reuma.2015.05.012. PMID 26187650.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Guly CM, Forrester JV (2010). "Investigation and management of uveitis". BMJ. 341: c4976. doi:10.1136/bmj.c4976. PMID 20943722.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Category:Uveitis
- ↑ 4.0 4.1 4.2 Rothova A, Ooijman F, Kerkhoff F, Van Der Lelij A, Lokhorst HM (2001). "Uveitis masquerade syndromes". Ophthalmology. 108 (2): 386–99. PMID 11158819.
- ↑ Dart JK (1986). "Eye disease at a community health centre". Br Med J (Clin Res Ed). 293 (6560): 1477–80. PMC 1342247. PMID 3099921.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ University of Michigan Eyes Have it (2009)http://kellogg.umich.edu/theeyeshaveit/red-eye/
- ↑ 8.0 8.1 McCluskey PJ, Towler HM, Lightman S (2000). "Management of chronic uveitis". BMJ. 320 (7234): 555–8. PMC 1117601. PMID 10688564.