Consider These Best Practices in Patients with Uveitis
Your approach to patients who present with uveitis will have important treatment and prognostic implications for patients, offered Purnima S. Patel, MD, associate professor of ophthalmology, Emory University School of Medicine in Atlanta, during the American Academy of Ophthalmology’s 2018 annual meeting in Chicago.
“Think about infectious causes when you have a patient present with uveitis, because
oftentimes the treatment we most commonly use for uveitis patients requires steroids or some form of immunosuppression, explained Dr. Patel. “If you don’t treat the underlying infectious etiology, then many of these conditions can get worse.”
Be sure to conduct a thorough history and clinical exam. Ask whether the patient recently traveled internationally. “The history and exam–not the laboratory testing– are the most important part of a uveitis workup,” noted Dr. Patel. Consider the following during the examination:
- Unilateral vs bilateral
- Acute, chronic, or recurrent
- Granulomatous vs non-granulomatous
- What structures are involved
- Associated symptoms
- Response to previous treatment
Order lab tests in all cases suspicious for infectious etiologies and intermediate and posterior uveitis:
- Syphilis. “The CDC recently changed the recommendation on how syphilis testing should be done,” explained Dr. Patel. “It now recommends a reverse sequence algorithm, an automated test that produces results more quickly.
- Tuberculosis. Order for patients from endemic areas or exposed to risk factors. Use the QuantiFERON-TB Gold Tb test instead of the purified protein derivative skin test.
- Viral. “Anytime you are considering a viral etiology, an aqueous or vitreous TAP for PCR can be very helpful in determining whether the virus is present and, if so, delineating which virus the patient has,” noted Dr. Patel.
- Bacterial or fungal. “Here, too, you want to get an aqueous or vitreous TAP. Sometimes you may want to consider blood cultures if there is an endogenous source that you are concerned about.”
Patel P. Infectious uveitis and retinitis. Talk presented at: AAO 2018 annual meeting; October, 26-30, 2018; Chicago.