Fuchs Heterochromic Iridocyclitis (Fuchs Heterochromic Uveitis) Workup

Updated: May 09, 2017
  • Author: Neerav Neel Lamba, MD, MBA; Chief Editor: Hampton Roy, Sr, MD  more...
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Workup

Laboratory Studies

No laboratory studies are useful to the clinician in making the specific diagnosis of Fuchs heterochromic iridocyclitis (FHI). The diagnosis is based on both the clinical history and the physical examination. When the presentation is not typical of FHI, selected laboratory evaluation may be useful to rule out other forms of uveitis that share some clinical characteristics.

Angiotensin-converting enzyme (ACE) may be useful to the clinician in diagnosing sarcoid uveitis.

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Purified protein derivative (PPD) is beneficial to the clinician in diagnosing tuberculosis.

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Imaging Studies

Imaging studies are not useful in the evaluation of Fuchs heterochromic uveitis (FHU). However, chest radiography may be beneficial in helping to diagnose sarcoid uveitis.

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Other Tests

Fluorescein angiography and optical coherence tomography are used in patients with cystoid macular edema.

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Procedures

Previously, anterior chamber paracentesis was considered a diagnostic test for FHI. This procedure is no longer indicated for this purpose.

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Histologic Findings

Pathological studies show a combination of inflammatory, degenerative, and atrophic changes. The iris and the ciliary body have a low-grade chronic inflammatory cell infiltration of lymphocytes and plasma cells. Although lymphocytes are the predominant infiltrating cells, plasma cells, eosinophils, mast cells, and Russell bodies have all been described. Russell bodies may correlate clinically with the appearance of minute, globular iris crystals that are typical of FUS. The iris and the ciliary body are atrophic with fibrosis and obliteration of the vascular endothelium with a reduced number of melanocytes. Degenerative changes have been observed in the inner wall of the Schlemm canal and in nerve fibers. Electron microscopy of iridectomy specimens from FHI has shown abnormal melanocytes with loss of dendritic processes and damaged myelinated nerve fibers. [3, 32]

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