eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Uveitis, Anterior, Granulomatous: Differential Diagnoses & Workup

Author: Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Instructor, Department of Ophthalmology, Oregon Health and Sciences University
Contributor Information and Disclosures

Updated: Sep 5, 2007

Differential Diagnoses

Acute Retinal Necrosis
Retinoblastoma
Foreign Body, Intraocular
Sarcoidosis
Herpes Zoster
Toxoplasmosis
Juvenile Xanthogranuloma
Tuberculosis
Leukemias

Other Problems to Be Considered

Masquerade syndromes
Intraocular lymphoma
Chronic retinal detachment

Workup

Laboratory Studies

  • Findings from the physical examination, a comprehensive review of the patient's medical history, and the review of systems should guide the laboratory evaluation. The workup should be tailored accordingly.
  • All patients who present with a granulomatous iritis should receive a diagnostic evaluation, even if it is their first episode of uveitis.
  • Laboratory tests that may be requested are outlined below. At the least, chest radiography and fluorescent treponemal antibody absorption (FTA-ABS) should be ordered.
    • Chest radiograph for sarcoidosis and TB
    • FTA-ABS test for syphilis
    • Purified protein derivative (PPD) test for TB
    • CBC with differential
    • Angiotensin-converting enzyme (ACE) test for sarcoidosis
    • Gallium scan for sarcoidosis.
    • Anergy evaluation for sarcoidosis
    • Lyme serology
    • Toxoplasmosis enzyme-linked immunosorbent assay (ELISA)

Imaging Studies

  • MRI of the head may help in suspected cases of intraocular (CNS) lymphoma.
  • In patients in whom sarcoidosis is suspected and in whom chest radiographs are negative for disease, consider chest CT to look for hilar adenopathy. Up to 10% of patients with sarcoidosis who have negative chest radiographs may exhibit hilar pathology on chest CT.

Procedures

  • Biopsy of any conjunctival nodules or the lacrimal gland may help in diagnosing sarcoidosis.
  • Vitreous biopsy may be indicated if the diagnosis of intraocular (CNS) lymphoma is seriously considered or if a diagnostic dilemma exists in which a specific tissue diagnosis may alter or direct therapy.
  • Lumbar puncture may be required to help rule out intraocular (CNS) lymphoma.
  • If the patient presents with a secluded pupil from extensive posterior synechiae, iris bombe with angle-closure glaucoma may be present. Perform iridotomy as soon as possible.

More on Uveitis, Anterior, Granulomatous

Overview: Uveitis, Anterior, Granulomatous
Differential Diagnoses & Workup: Uveitis, Anterior, Granulomatous
Treatment & Medication: Uveitis, Anterior, Granulomatous
Follow-up: Uveitis, Anterior, Granulomatous
Multimedia: Uveitis, Anterior, Granulomatous
References
[ CLOSE WINDOW ]

References

  1. Lobo A, Barton K, Minassian D, du Bois RM, Lightman S. Visual loss in sarcoid-related uveitis. Clin Experiment Ophthalmol. Aug 2003;31(4):310-6. [Medline].

  2. McCannel CA, Holland GN, Helm CJ, Cornell PJ, Winston JV, Rimmer TG. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol. Jan 1996;121(1):35-46. [Medline].

  3. Nussenblatt RB, Whitcup SM. Uveitis: Fundamentals and Clinical Practice. 3rd ed. Mosby-Year Book; 2003.

  4. Pepose JS, Holland GN, Wilhelmus KR. Ocular Infection and Immunity. Mosby-Year Book; 1996.

  5. Rao NA, Cousins S, Forster D. Intraocular Inflammation and Uveitis: Basic and Clinical Science Course. 1999.

  6. Rosenbaum JT, George RK. Uveitis. In: Current Ocular Therapy 5. 2000:519-21.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

iritis, iridocyclitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Instructor, Department of Ophthalmology, Oregon Health and Sciences University
Roger K George, MD is a member of the following medical societies: American Uveitis Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew A Dahl, MD, Residency Director, Ophthalmology, Kingston Hospital, Department of Ophthalmology, Assistant Professor of Surgery (Ophthalmology), Mid Hudson Family Practice Institute
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Director of Uveitis and Ocular Inflammatory Diseases Service, Associate Professor, Department of Ophthalmology, University of Tennessee College of Medicine
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.