Differential Diagnosis of Uveitis
The differential diagnosis of uveitis includes infectious agents (viruses, bacteria, fungi, protozoa, and helminths), noninfectious entities of presumed immunologic origin, and unknown/idiopathic causes (called undifferentiated uveitis). In addition, masquerade syndromes such as intraocular lymphoma, retinoblastoma, leukemia, choroidal metastases, and malignant melanoma can be mistaken for uveitis. Other masquerade syndromes include juvenile xanthogranuloma, pigment dispersion syndrome, retinal detachment, vitreous hemorrhage, retinitis pigmentosa, and ocular ischemic syndrome. One should consider each of these entities in the differential diagnosis of uveitis.
A careful history and accurate description of biomicroscopic and fundus findings are extremely helpful in narrowing the differential diagnosis, as certain presentations are characteristic for specific diseases; however, many patients do not present with classic signs and symptoms, or their clinical appearance may evolve with time and treatment. The clinician should consider the differential diagnosis and how well the individual patient’s uveitis fits with the various known entities. This system first classifies the type of uveitis based on anatomical criteria and associated factors (eg, acute versus chronic, unilateral versus bilateral, adult versus child) and then matches the pattern of uveitis with a list of potential entities that share similar characteristics. See Table 5-4 for a simplified version of one such system for narrowing the differential diagnosis. Activity 5-1 provides a decision-tree algorithm for the evaluation of a uveitis patient.
Flow chart for clinical diagnosis and treatment of uveitis: simplified interactive tool.
Activity developed by Thellea K. Leveque, MD, MPH.
Access the activity at www.aao.org/bcscactivity_section09.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.