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Uveitis & Ocular Inflammation

Uveitis and Ocular Inflammation

What is Uveitis?

Uveitis is inflammation affecting one or both eyes. Patients with ocular inflammation may have components of orbital inflammation (inflammation of the tissues around the eye), scleritis (inflammation of wall of the eye), or episcleritis (the vascular tissues over the eye wall). Ocular inflammation can be due to systemic inflammatory diseases or infection, and so blood tests and imaging are often indicated in an evaluation. Despite extensive testing, many cases of uveitis remain undifferentiated and sometimes repeated tests and examination are necessary for evaluation and management.

What testing is usually needed to determine the cause of uveitis?

Below is a summary of several blood tests commonly ordered in an evaluation of uveitis to help you understand what is being tested:

Complete blood count (CBC). This test provides information about the different types of red cells, white cells, and platelets in the body.

Complete metabolic panel (CMP). This test provides information about electrolytes in your body as well as kidney and liver function.

Treponemal tests for syphilis (Syphilis IGG, VDRL, RPR, FTA-ABS, MHA-TP). Syphilis infection is very rare, but it can cause forms of uveitis. Because it is a serious condition, many patients with uveitis are evaluated for this, even if suspicion of infection is not high.

Tuberculosis tests (TSPOT, Quantiferon gold, PPD skin test). Tuberculosis is leading cause of uveitis worldwide. It is also a test that is necessary to perform before patients can be started on certain medication therapies.

Anti-neutrophil cytoplasmic antibodies (ANCA). This is a test for certain types of vasculitis.

Angiotensin converting enzyme (ACE) and lysozyme. These are tests for a systemic inflammatory condition called sarcoidosis.

Urinalysis (UA). This is a test of components of your urine for signs of infection or inflammation.

Toxoplasma, Bartonella, and Toxocara serologies. These are tests can demonstrate if you have current or previous exposure to organisms called Toxoplasma, Bartonella, and Toxocara, which can cause eye inflammation.

HIV testing. Because having a weak immune system can predispose patients to eye inflammation, HIV testing is sometimes indicated.

Anterior chamber or vitreous paracentesis. This a test where fluid is taken out of the eye with a small needle and sent to a lab for testing.

Antinuclear antibody testing (ANA). This is a test that could indicate risk of a condition called lupus.

HLA typing. These are usually tests for certain genetic types (especially HLA B27 and HLA A29), which may be associated with certain forms of uveitis.

What types of imaging may necessary to evaluate and manage uveitis?

Optical coherence tomography (OCT): This is a special type of picture of the eye that can provide information about layers of the retina, including whether or not swelling (edema) or atrophy is present.

Fluorescein angiography. This is a test in which a yellow dye is administered into a peripheral (usually arm) vein. As the dye enters the bloodstream it travels to the eyes, where it can be photographed by cameras with a special filter. This test provides information about blood flow in the eye. The dye exists the body in the urine, sweat, and tears and can make these fluids appear yellow. Very rarely, patients can have a reaction to the dye causing nausea and other problems.

Indocyanine green angiography. This is similar to fluorescein angiography, but a different dye is used. This dye contains iodine and cannot be given to patients with an iodine allergy.

Visual field testing. This is a test done to evaluate how well patients see things centrally and/or peripherally (or in their "side vision"). It is also a test commonly done to evaluate if high eye pressure, which can be associated with uveitis, has damaged the eye.

Chest x-ray. This is usually arranged to evaluate for an changes in the lungs consistent with certain causes of uveitis, especially sarcoidosis, tumors, and tuberculosis.

Magnetic Resonance Imaging (MRI). This is specialized imaging of the head, chest, or other parts of the body to provide a detailed view of the anatomy. 

What treatment options are available for uveitis?

Depending on the cause of uveitis and the severity of disease, different treatment options may be offered. The treatments range for steroid eyedrops, to injections of medication in and around the eye, to systemic medication. Your physician will discuss options for your unique circumstances.

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