Uveitis: diagnostic work-up. A literature review and recommendations from an expert committee

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Pascal Sève, Patrice Cacoub, Bahram Bodaghi, Salim Trad, Jérémie Sellam, David Bellocq, Philip Bielefeld, Damien Sène, Gilles Kaplanski, Dominique Monnet, Antoine Brézin, Michel Weber, David Saadoun, Christophe Chiquet, Laurent Kodjikian
PurposeDiagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis.MethodsRecommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only.ResultsDiagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients >40 years-old). Other investigations prescribed in the absence of orientation are usually unhelpful.ConclusionsA strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.



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