Thorough dilated eye exam, imaging helpful for successful uveitis diagnosis
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KOLOA, Hawaii — Incomplete posterior segment exams, underuse of imaging and failure to reexamine a diagnosis are all common pitfalls when diagnosing uveitis, according to a speaker here.
“A thorough dilated eye exam is crucial for making a correct diagnosis in uveitis,” Lucia Sobrin, MD, MPH, said at Hawaiian Eye 2023. “It is particularly important for ruling out infections.”
Every patient with uveitis should undergo dilation and a good peripheral examination, she said. And, when a patient does not respond to treatment as expected, then dilated examinations should continue and the patient should be reexamined carefully.
Further, checking for infection at the patient’s initial workup is helpful, with physicians keeping syphilis in mind during this process and interpreting results within the appropriate clinical context.
“If a patient is not responding as expected, really take a step back and reevaluate for a possible infection or malignancy,” she said.
Sobrin said that imaging should be used liberally, with ultra-widefield imaging helping to capture pathology through media opacity and OCT offering diagnostic clues when examined carefully.
“Don't let your eye just be drawn to the obvious. Really look through all the scans on the video — there are clues there that may help you find the diagnosis,” she said.
For posterior uveitis, “You don’t know the full story until you get [fluorescein angiography] and [indocyanine green angiography],” she said.
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Sobrin L. Common pitfalls in uveitis diagnosis and how to avoid them. Presented at: Hawaiian Eye 2023; Jan. 14-20, 2023; Koloa, Hawaii.
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