Distinguishing infectious iris nodules in uveitis aids in proper treatment

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PORTLAND, Ore. — Clinical history and examination are helpful in diagnosing metastatic infection in patients with iris nodules associated with infectious uveitis, a recent study reports. Distinguishing infectious cases from cases that require immunosuppressive therapy is important, the study authors note, because inappropriate immunosuppressive treatment can result in a poor outcome in infectious cases. Researchers here at the Casey Eye Institute retrospectively reviewed a clinical database of 1353 consecutive patients to identify cases of infectious uveitis with iris nodules. A Medline search was additionally performed to identify additional cases. In all, 28 cases were identified, including three from the researchers’ own practice. Infectious uveitis associated with iris nodules was characterized by some or all of the following: a creamy, soft appearance to the nodule; unilateral disease; persistence or growth of the nodules despite corticosteroid therapy; a marked inflammatory response in the anterior chamber or vitreous humor or both; and a history suggesting a potential source of septic emboli. Diseases most commonly associated with iris nodules include sarcoidosis, Vogt-Koyanagi-Harada syndrome, multiple sclerosis, Fuchs’ heterochromic iridocyclitis and metastatic infection, the authors said. They noted that many of these diseases can be appropriately treated with immunosuppressive medications. However, antimicrobial therapy is required to treat infectious uveitis, and immunosuppressive therapy may result in a poor visual outcome in these cases. The report is published in the September issue of the British Journal of Ophthalmology.