Antonio Chirumbolo, OD, talks with Dr. Dan Epshtein of Mt. Sinai hospital in New York about diagnosing, treating, and managing uveitis in patients.
Uveitis causes intraocular inflammation, and while a majority presents in the anterior segment of the eye, patients can have inflammation in the posterior or periphery as well. In fact, for some patients, anterior uveitis might be a sign that an infection further back in the eye has moved forward.
Dr. Epshtein says it’s important to dilate every single uveitis patient, even though this can be difficult as many of these patients are extremely sensitive to light. You should then look for synechiae and keratic precipitates.
Remember to check pressure, as uveitis patients will have low pressure, and ocular hypertension can interfere with your diagnosis. For example, if a patient has unilateral uveitis with high pressure and iris atrophy, the condition is likely herpetic. Finally, remember to always transilluminate your patients.
Some of the most common etiologies for uveitis, especially for the posterior segment, can range from conditions like vasculitis to infectious diseases like toxoplasmosis chorioretinitis. Therefore it’s important to do a thorough examination and review all of the patient’s systems. Since there are no standard labs for uveitis, doctors must rely on the standard examination, patient history, and a review of systems. Sometimes finding the cause takes a little detective work, as when Dr. Epshtein deduced a likelihood of tuberculosis from a patient’s travel history.
When examining his patients, Dr. Epshtein uses a Clarus 500 ultrawide field camera, as it captures images without much color distortion. Since uveitis patients are often photophobic, looking at a photograph can make things easier on the doctor and the patient. Taking photographs at follow up visits is also important for tracking the success of the treatment. It’s also important to be able to recognize what cells in flare look like. Looking at a patient’s eyes after surgery is a good way to recognize this, as post-surgical uveitis presents a baseline that you can apply to more variable forms of uveitis afterwards.
From start to finish, Dr. Epshtein’s protocol for examining uveitis patients is as follows. First, see the cells in flare. Second, check pressure, and check the iris for transillumination defects. Third, dilate the patient, and while dilating, ask the patient about their general health and ocular history.
Watch out for things like recent cataract surgeries, or a history of STDs, respiratory or stomach issues, joint or back pain, rashes, oral ulcers, and neurological issues. It’s important to remember that while you’re an eyecare specialist, as a doctor you have to look at the patient’s whole body to make a proper diagnosis.