• Don’t Miss These Uveitis Diagnoses

    Is it acute retinal necrosis, toxoplasmosis, or syphilis? During Saturday’s Retina Subspecialty Day, Steven Yeh, MD, provided an overview of multiple uveitis syndromes that can have immediate vision-threatening implications.

    Acute retinal necrosis. Defined as a granulomatous panuveitis with diffuse retinitis, this condition often leads to retinal detachment. Hallmark presentations include anterior uveitis or iritis with ocular hypertension, and transillumination defects may also be present. Corticosteroid therapy in the absence of antiviral medication is contraindicated in this disease. Small studies have suggested that patients can gain significant improvement in vision with intravitreal foscarnet.

    Toxoplasmosis. A common condition, toxoplasmosis often presents as a chorioretinal scar with foci of adjacent retinitis. Other clinical features include retinal whitening, with or without pigmented scarring. Dr. Yeh suggested extreme caution with possible infectious uveitis, and he advised avoiding corticosteroids when toxoplasmosis is a consideration.

    Syphilis. Rates of syphilis have been growing in the last decade, presenting a significant public health issue. Dr. Yeh emphasized that all patients who test positive for syphilis should also be checked for HIV because of the high rates of co-infection. Fortunately, syphilis can typically be resolved with penicillin.

    Cytomegalovirus (CMV) retinitis. Patients who are immunosuppressed and/or HIV positive carry a high risk of CMV infection. Physicians may observe smoldering, subtle retinitis, with inflammation in the peripheral or posterior segment. The antiviral agents ganciclovir and valganciclovir have shown to be effective in treating CMV.

    Vitreoretinal lymphoma. Patients with a history of CNS or systemic lymphoma should be suspected of having vitreoretinal lymphoma as well, and they may present with insidious, nonspecific symptoms such as floaters and decreased vision. This condition warrants advanced diagnostics and consideration of tertiary referral.

    Key considerations. Dr. Yeh strongly urged physicians to consider infectious etiologies (viral, parasitic, spirochetal) prior to corticosteroid administration. Global connectedness also mandates awareness of emerging infectious diseases such as Zika and Ebola, and of their ophthalmic complications, he concluded.—Keng Jin Lee

    Financial disclosures. Clearside: C; Santen, Inc.: C.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.