Nongranulomatous Iritis (Anterior Uveitis) Workup

Updated: Aug 04, 2017
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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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 may not be indicated. Some uveitis specialists recommend specific antitreponemal serologies on all patients with uveitis.

Iritis that is recurrent, unusual in severity, unresponsive to medical therapy, unusually persistent, or bilateral should be thoroughly evaluated.

The following list of laboratory studies may be requested. At minimum, chest radiography (see Imaging Studies) and a rapid plasma reagin (RPR) test with a specific treponemal serology, such as the 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. However, these are not very sensitive or specific.

HLA-B27 typing: 1% of people who are HLA-B27–positive develop acute anterior uveitis. About 55% of cases of acute anterior uveitis are associated with an HLA-B27–positive serotype, rising to about 70% in patients with recurrent episodes of acute iritis. [1]

Antinuclear antibody (ANA) and, possibly, rheumatoid factor (RF) may be indicated if juvenile idiopathic arthritis is suspected.

Lyme serologic testing should be ordered if Lyme disease is suspected (although if no history otherwise consistent with Lyme disease or exposure, the predictive positivity of a positive test is very low).

Serum creatinine and urinalysis, including urinary beta-2 microglobulin levels, should be obtained if tubulointerstitial nephritis and uveitis are suspected.

A paracentesis for polymerase chain reaction (PCR) or culture may be considered if there is a question of viral anterior uveitis or other infectious uveitis.

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Imaging Studies

Chest radiography helps to rule out sarcoidosis and tuberculosis. However, it is not very sensitive or specific.

High-resolution chest CT scanning 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, lumbar, or thoracolumbar spine radiographs may be ordered if ankylosing spondylitis is suspected.

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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.

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