Uveitis history and symptoms
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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
Obtaining a complete history is an important aspect of making a diagnosis of uveitis. It provides insight into cause, precipitating factors, and associated underlying conditions. Uveitis can present unilaterally or bilaterally. Symptoms may develop acutely or insidiously, and may vary depending on the underlying etiology of the uveitis. Acute uveitis attacks are more commonly symptomatic and affect the anterior chamber. Symptoms of anterior uveitis include eye pain, eye redness, and photophobia. Intermediate, posterior, and panuveitis commonly present with floaters, blurry vision, and impaired vision. Chronic uveitis usually has an indolent courses and may not present with eye pain or redness.[1]
History
Obtaining a complete history is an important aspect of making a diagnosis of uveitis. It provides insight into cause, precipitating factors, and associated underlying conditions. The presence of intermittent or persistent symptoms of uveitis unilaterally or bilaterally, in addition to any of the following, is suggestive of the following most common etiologies:
- Ankylosing spondylitis:[2][3]
- Back pain that improves with exercise and worsens with rest
- Morning stiffness
- Lumbar pain at night
- Pain is chronic
- Buttock pain
- Sarcoid uveitis:[4]
- Fever
- Anorexia
- Cough
- Shortness of breath
- Chest pain
- Bone and joint pain
- Skin lesions
- Renal abnormality or history of hypercalcemia
- History of abnormal EKG
- History of infertility in males
- Juvenile idiopathic arthritis:[5][6]
- Joint pain and swelling in a child for at least 6 weeks
- Morning stiffness
- Pain improvement with exercise
- TINU syndrome:[7][8][9]
- Fever
- Malaise
- Flank pain
- Rash
- Polyuria or oliguria
- Gross hematuria
- Inflammatory bowel disease:[10][11][12]
- Hematochezia
- History of anemia
- Weight loss
- Abdominal pain
- Fever
- Arthalgia
- Behcet's disease:[13][14][15][16]
- Patient of Mediterranean or Middle Eastern descent
- Oral aphthous ulcers
- Painful genital ulcers
- Skin lesions
- History of vascular abnormalities
- Fever and malaise
- Headaches
- CMV retinitis:[17][18]
- History of AIDS
- Recent anti-retroviral therapy (ART)
- Photopsia
- Toxoplasmosis:[19][20][21][22]
- History of AIDS or immunosuppression
- Fever
- Cough
- Children born in endemic regions
- Tuberculosis[23]
- Fever
- Night sweats
- Weight loss
- History of chronic pulmonary infection
- Travel to endemic regions or exposure to TB
- History of AIDS or immunosuppression
- Syphilis[24]
- History of unprotected sex
- History of recent sexually transmitted infections
- History of HIV infection
- History of Substance abuse
- Isolated uveal diseases or idiopathic (e.g., birdshot chorioretinopathy, Fuch's heterochromic uveitis ,acute posterior multifocal placoid pigment epitheliopathy, multifocal choroiditis and panuveitis, Vogt-Koyanagi-Harada syndrome, etc.)
- Isolated symptoms of uveitis with unremarkable systemic manifestations (see below)
Symptoms
Uveitis can present unilaterally or bilaterally. Symptoms may develop acutely or insidiously, and may vary depending on the underlying etiology of the uveitis. Acute uveitis attacks are more commonly symptomatic and affect the anterior chamber. Chronic, indolent courses may not present with pain or eye redness.
Common symptoms of uveitis, according to anatomic location, include:[25][26]
- Anterior uveitis
- Photophobia
- Eye pain
- Eye redness
- Intermediate and Posterior Uveitis
- Floaters
- Blurry vision
- Scotomata
- Panuveitis
References
- ↑ Guly CM, Forrester JV (2010). "Investigation and management of uveitis". BMJ. 341: c4976. doi:10.1136/bmj.c4976. PMID 20943722.
- ↑ 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.
- ↑ 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.
- ↑ Park YH, Nam HW (2013). "Clinical features and treatment of ocular toxoplasmosis". Korean J Parasitol. 51 (4): 393–9. doi:10.3347/kjp.2013.51.4.393. PMC 3770869. PMID 24039281.
- ↑ Dodds EM (2006). "Toxoplasmosis". Curr Opin Ophthalmol. 17 (6): 557–61. doi:10.1097/ICU.0b013e32801094ca. PMID 17065925.
- ↑ Moshfeghi DM, Dodds EM, Couto CA, Santos CI, Nicholson DH, Lowder CY; et al. (2004). "Diagnostic approaches to severe, atypical toxoplasmosis mimicking acute retinal necrosis". Ophthalmology. 111 (4): 716–25. doi:10.1016/j.ophtha.2003.07.004. PMID 15051204.
- ↑ Rabaud C, May T, Lucet JC, Leport C, Ambroise-Thomas P, Canton P (1996). "Pulmonary toxoplasmosis in patients infected with human immunodeficiency virus: a French National Survey". Clin Infect Dis. 23 (6): 1249–54. PMID 8953067.
- ↑ 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
- ↑ 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