eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Uveitis, Anterior, Nongranulomatous: 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

Behcet Disease
Ocular Manifestations of HIV
Foreign Body, Intraocular
Ocular Rosacea
Herpes Simplex
Psoriasis
Herpes Zoster
Reactive Arthritis
HLA-B27 Syndromes
Red Eye Evaluation
Inflammatory Bowel Disease
Retinoblastoma
Juvenile Xanthogranuloma
Sarcoidosis
Leukemias
Uveitis, Fuchs Heterochromic
Lyme Disease

Other Problems to Be Considered

Masquerade syndromes 
Pigment dispersion syndrome
Retinal detachment

Workup

Laboratory Studies

  • A comprehensive review of the patient's past medical history and a review of systems should guide the laboratory evaluation, and the workup should be tailored accordingly.
    • If a patient presents with a first episode of nongranulomatous iritis and if the medical history and the review of systems are unremarkable, laboratory studies are not indicated.
    • Iritis that is recurrent, unusual in severity, unresponsive to medical therapy, unusually persistent, or bilateral should be thoroughly evaluated.
  • The following list of possible laboratory studies may be requested. At minimum, chest radiography (see Imaging Studies) and a rapid plasma reagin (RPR) test with a fluorescent treponemal antibody absorption (FTA-ABS) test should be ordered.
    • The RPR test and the FTA-ABS test, or serologic tests for syphilis, should be ordered for each patient who undergoes a laboratory evaluation for uveitis.
    • The erythrocyte sedimentation rate (ESR), serum lysozyme level, and angiotensin-converting enzyme (ACE) test may help in evaluating the patient for sarcoidosis.
    • HLA-B27 typing may be useful.
    • Rheumatoid factor (RF) and antinuclear antibody (ANA) may be indicated if juvenile idiopathic arthritis is suspected.
    • Lyme serologic testing should be ordered if Lyme disease is suspected.
    • Serum creatinine and urinary beta-2 microglobulin levels should be obtained if TINU is suspected.

Imaging Studies

  • Chest radiography helps to rule out sarcoidosis and tuberculosis.
  • ChestCT is more sensitive for sarcoidosis than plain radiography and should be ordered if the radiographs are negative and if sarcoidosis is highly suspected as the etiology of the ocular inflammation.
  • Sacroiliac radiographs may be ordered if ankylosing spondylitis is suspected.

Procedures

  • If a patient presents with a secluded pupil from extensive posterior synechiae, iris bombe with angle-closure glaucoma may be present. In this case, an iridotomy may be necessary.

More on Uveitis, Anterior, Nongranulomatous

Overview: Uveitis, Anterior, Nongranulomatous
Differential Diagnoses & Workup: Uveitis, Anterior, Nongranulomatous
Treatment & Medication: Uveitis, Anterior, Nongranulomatous
Follow-up: Uveitis, Anterior, Nongranulomatous
Multimedia: Uveitis, Anterior, Nongranulomatous
References
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References

  1. Kump LI, Cervantes-Castaneda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. Jul 2005;112(7):1287-92. [Medline].

  2. Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. May 2007;114(5):995-9. [Medline].

  3. 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].

  4. Menezo V, Lightman S. The development of complications in patients with chronic anterior uveitis. Am J Ophthalmol. Jun 2005;139(6):988-92. [Medline].

  5. Nussenblatt RB, Whitcup SM. Uveitis: Fundamentals and Clinical Practice. 3rd ed. 2003.

  6. Pepose JS, Holland GN, Wilhelmus KR. Ocular Infection and Immunity. 1996.

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

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Further Reading

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Keywords

iritis, iridocyclitis, iris, ciliary body, iritis flare, cell and flare, anterior uveitis

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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.

 
 
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