Uveitis: DDx & Diagnostic Testing Flashcards
- What would be considered an Acute disease? (onset)
2. Chronic onset?
- Sudden onset. Lasts up to 6 weeks
2. Insidious Onset. Usually Lasts MORE than 6 weeks
Causes of Acute Uveitis
- Most Cases of ANTERIOR UVEITIS? (4) (FAIR)
- a. Fuchs Heterchromic Iridocyclitis (FHI)
b. Ankylosing Spondylitis (AS)
c. Idiopathic
d. Reiter Syndrome
Causes of Acute Uveitis
- What other causes are there? (5) (TAP VW)
- Trauma
- Acute Retinal Necrosis (ARN)
- Postsurgical Bacterial Infection
- Vogt-Koyanagi-Harada Syndrome (VKH)
- White-dot Syndromes: Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) & Multiple Evanescent White-dot Syndrome (MEWDS)
Granulomatous Uveitis
- What are ten causes of Granulomatous Uveitis? (SLITSS)
- a. Sarcoidosis
b. Lens-induced Uveitis
c. Intraocular Foreign Body
d. Tuberculosis
e. Sympathetic Ophthalmia
f. Syphilis
g. MS, Lyme Disease, Granulomatosis w/Polyangiitis (Wegener Granulomatosis), and VKH Syndrome
Causes of Unilateral Uveitis? (6) (ABS PIP)
- Acute Retinal Necrosis (ARN)
- Behcet Disease
- Sarcoidosis (may be bilateral)
- Parasitic Disease (Toxoplasmosis is typically Bilateral)
- Intraocular Foreign Body (IOFB)
- Postsurgical Uveitis
Causes of Anterior Uveitis (13)
- Ankylosing Spondylitits
- Behcet Disease
- FHI
- Glaucomatocyclitic Crisis
- HLA-B27 Associated Disease
- Idiopathic
- Inflammatory Bowel Disease
- JIA
- Masquerade Syndromes
- Psoriatic Arthritis
- Reiter Syndrome
- Sarcoidosis
- Syphilis
Causes of Intermediate Uveitis
- What is the WORSE PROGNOSIS?
- What other 4 did she have listed?
- PARS PLANITIS: Idiopathic; Worse Prognosis
- a. IBD
b. Lyme Disease
c. MS
d. Sarcoidosis
Causes of Panuveitis
- What 5? (BIVSS)
- Behcet Disease
- Infectious Endophthalmitis
- VKH Syndrome
- Sarcoidosis
- Syphilis
Demographic Considerations
- Female? (2)
- Male? (2)
- American Black? (1)
- Native American? (1)
- Midwestern American (1)?
- Japanese (3)?
- Mediterranean Ancestry? (1)
- Central American? (2)
- South American? (2)
- West African? (1)
- IV Drug Use? (2)
- Chronic Anterior Uveitis, JIA
- AS, Sympathetic Ophthalmia
- Sarcoidosis
- VKH Syndrome
- Presumed Ocular Histoplasmosis (POHS)
- Behcet Disease, HTLV-1, VKH Syndrome
- Behcet Disease
- Cysticercosis, Onchocerciasis
- Cysticercosis, Toxoplasmosis
- Onchocerciasis
- AIDS, Fungal Endophthalmitis
- What is Sensitivity?
2. What is Specificity?
- Ability of test to correctly identify affected individuals. (Persons test positive = TRUE POSITIVE) (Test negative = FALSE NEGATIVES)
- Persons testing positive = False positive; (ability of test to correctly identify non-affected individuals)
ACE (Angiotensin-Converting Enzyme)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test
- 73% Sensitive; 83% Specific when alone. (increases almost to 100% w/whole Body Gallium Scanning)
- Blood sample ran thru Chemical process to ISOLATE ACE, then MEASURED by PHOTOMETRY
- Sarcoidosis: (Uveitis suspected to have sarcoidosis (elevated levels of ACE)
(Intermediate Uveitis)
ANA (Antinuclear Antibody)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test (Titer: 1:160)
- In Lupus: Sensitivity more than 95%; Specificity: 90%
- Blood Test –> ELISA or Indirect Immunofluorescence
- Lupus, RA, Sjogrens, Scleroderma, JIA
cANCA (Anti-Neutrophil Cytoplasmic Antibody)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood test then Autofluorescence
- More than 90% sensitivity. Variable Specificity depending on disease stage
- Blood test w/Titers for Antibodies PR3. then Staining for Pattern. cANCA (for Wegeners) will have staining throughout the Cytoplasm
- Wegener’s Granulomatosis (Granulomatosis w/Polyangitis)
* SCLERITIS
Test ordered for Necrotizing Scleritis, Peripheral Ulcerative Keratitis, Retinal Vasculitis.
Antiphospholipid Ab (Lupus Anticoagulant; Anticardiolipin Ab)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test: AI, Hypercoagulable State caused by ANTIPHOSPHOLIPID ANTIBODIES. (Blood clots (thrombosis) occurs in Arteries, Veins, CNS disease, and spontaneous abortions in patient)
- 67% Sensitivity; 91% Specificity
- In lab. Use Liquid Phase Coagulation Assays (Lupus Anticoagulant) and Solid Phase ELISA assays (Anti-cardiolipin Antibodies)
- SLE and Antiphospholipid Antibody Syndrome presented w/sudden onset of Pain, redness, photophobia, decreased vision.
* Exam: Will see HYPOPYON UVEITIS and Vaso-occlusive Retinopathy.
* Bilateral Iritis, Vitreitis, Retinal Vasculitis involving both veins and Arteries can lead to CRV occlusion
* Know: SLE, Antiphospholipid Antibody Syndrome
Antitoxoplasma Ab
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood (usually ELISA)
- 88% Sensitivity; 96% Specificity
- ELISA test: Measures IgG and IgM Antibodies
- Toxoplasmosis which is a CAUSE of POSTERIOR UVEITIS!
B-Scan Ultrasonography
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Imaging
- None
- Anesthetize the eye. Gel put on the EYELID and a PROBE is placed on the EYELID to take SCANS. Patient may have to look in different directions depending on view needed. 15 minute test.
- Get Views of POSTERIOR EYE that can be DIRECTLY Blocked due to Uveitis.
Detects RETINAL DETACHMENTS, INFLAMMATION, VITREAL DEGENERATIONS, ETC.
Bx (Biopsy)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Remove portion of Lesion and Test it. (Aq. Humor, Choroid, Conj, Lacrimal Gland, Retina, Skin, Vitreous Humor)
- ??
- Biopsy Lung: DEFINITIVE Dx: We See Noncaseating Granulomatous, Non-infectious Inflammatory Process on Biopsy
- Sarcoidosis; Can test Anterior Chamber for Herpesvirus.
CMV
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood
- N/A
- Blood test. Looks at IgG and IgM Levels. + IgG = PREVIOUS EXPOSURE. + IgM = Active Infection
- POSTERIOR UVEITIS (PIZZA and SAUCE): Test for CMV
Calcium
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Urine or Blood
- Sensitivity: 70-80%
Specificity: 55-65% - 24 hr Urine Collection. Urinary Analysis to test levels (or blood drawn for Serum Level Testing)
- SARCOIDOSIS (sarcoid granules secrete Vit D and this leads to Increased Absorption of Calcium in the GI Tract; Causes Increased Calcium in Urine (and Blood)
CBC w/Diff (Complete Blood Cell count w/platelet Differential)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test
- ??
- Draw blood. Prepare sample to look at under a microscope. Count the different blood cells and Amt of each.
- Retinal Vasculitis w/Systemic Disease
Know: Anemia, Cancers (Leukemia, Lymphoma)
CD4+ T-cells
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood
- ??
- *Small retinal blot hemorrhages on retina usually associated w/decreasing CD4+ counts
- Low CD4+ Count predisposes pt to opportunistic infections (CMV)…basically, this should be done on Pts w/HIV (AIDs will have a major Diminished inflammatory response, especially when CD4+ counts are SEVERELY DIMINISHED)
High CD4+ Count in TUBERCULOID LESIONS
CMP (Complete Metabolic Panel)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test
- Measures Health of Liver and Kidney
Coccidiodomycosis (IgG, IgM)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood test
- ?
- Blood test for IgM and IgG Antibodies. IgG = CHRONIC INFECTION; IgM = ACTIVE/ACUTE Infection
- Fungal Infection Test (Starts in lungs and can spread to eyes)
CRP (C-reactive Protein)
- Type of Test
- Sensitivity/Specificity
- How is the Test Performed?
- Relationship to Uveitis?
- Blood Test
- Test to tell us if there is INFLAMMATION in the BODY! (Acute phase reactants)